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Knapik DM, Kamitani A, Smith MV, Motley J, Haas AK, Matava MJ, Wright RW, Brophy RH. Relationship between Kinesiophobia and Dynamic Postural Stability after Anterior Cruciate Ligament Reconstruction: A Prospective Cohort Study. J Knee Surg 2024; 37:796-803. [PMID: 38677296 DOI: 10.1055/a-2315-8034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2024]
Abstract
Anterior cruciate ligament (ACL) injuries in young, active patients generally require ACL reconstruction (ACLR) to restore mechanical and postural stability. The fear of movement or reinjury (kinesiophobia) has become increasingly recognized in the post-ACLR population; however, the association between restoration of postural stability and kinesiophobia remains largely unknown. The purpose of this study was to investigate changes in mean Tampa Scale of Kinesiophobia-11 (TSK-11), dynamic motion analysis (DMA) scores, and time on the testing platform, as well as any correlation between TSK-11 and mean overall and individual translational and rotational DMA scores during the first 12 months following ACLR. Cohort study. Patients undergoing ACLR were prospectively enrolled and dynamic postural stability and kinesiophobia based on the TSK-11 were collected within 2 days prior to surgery and at 6 and 12 months following ACLR. Dynamic postural stability was quantified by calculating a DMA score, with score calculated in three translational (anterior/posterior [AP], up/down [UD], medial/lateral [ML]) and three rotational (left/right [LR], flexion/extension, and internal/external rotation) independent planes of motions. Correlations between DMA and TSK-11 scores at each time point were analyzed. A total of 25 patients meeting inclusion criteria were analyzed. Mean overall DMA and TSK-11 scores increased with each successive testing interval. At 6-month follow-up, a weakly positive association between TSK-11 and DMA scores was appreciated based on overall DMA, AP, UD, ML, and LR. At 12 months, a moderately positive correlation was appreciated between TSK-11 and the translational, but not rotational, planes of motion. Following ACLR, lower level of kinesiophobia were found to be moderately associated with improved dynamic stability, especially in the translation planes of motion.
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Affiliation(s)
- Derrick M Knapik
- Division of Sports Medicine, Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
- Washington University in St. Louis, School of Medicine, St. Louis, Missouri
| | - Aguri Kamitani
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Matthew V Smith
- Division of Sports Medicine, Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
- Washington University in St. Louis, School of Medicine, St. Louis, Missouri
| | - John Motley
- STAR Sports Therapy and Rehabilitation, Chesterfield, Missouri
| | - Amanda K Haas
- Washington University in St. Louis, School of Medicine, St. Louis, Missouri
| | - Matthew J Matava
- Division of Sports Medicine, Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
- Washington University in St. Louis, School of Medicine, St. Louis, Missouri
| | - Rick W Wright
- Department of Orthopaedic Surgery, Vanderbilt University, Nashville, Tennessee
| | - Robert H Brophy
- Division of Sports Medicine, Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
- Washington University in St. Louis, School of Medicine, St. Louis, Missouri
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Pirayeh N, Shahoori F, Goharpey S, Mostafaee N. Responsiveness of a Persian version of the international knee documentation committee and the anterior cruciate ligament-quality of life questionnaires in athletes with anterior cruciate ligament reconstruction following physiotherapy intervention. Physiother Theory Pract 2024:1-9. [PMID: 39099189 DOI: 10.1080/09593985.2024.2388111] [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: 04/08/2024] [Revised: 07/22/2024] [Accepted: 07/22/2024] [Indexed: 08/06/2024]
Abstract
INTRODUCTION The International Knee Documentation Committee (IKDC) and Anterior Cruciate Ligament - Quality of Life Questionnaire (ACL-QOL) are frequently used patient-reported instruments designed for individuals with anterior cruciate ligament reconstruction (ACL-R). PURPOSE To evaluate responsiveness and determine minimal important change (MIC) for the Persian-version of IKDC and ACL-QOL in athletes with ACL-R following physiotherapy intervention. METHOD One hundred athletes with ACL-R, undergoing 16-week physiotherapy completed IKDC and ACL-QOL at weeks 4 and 20 post ACL-R. Participants also rated their overall changes on a 7-point global rating of change at follow-up. Responsiveness was evaluated using the receiver operating characteristics (ROC) curve and correlation analysis. In addition, the minimal important change (MIC) was determined on the ROC curve. RESULTS Acceptable responsiveness was reached by the IKDC and most of the subscales of ACL-QOL (area under the ROC curve (AUC) of 0.72-0.79). Also, the subscale of Lifestyle issues of ACL-QOL (AUC of 0.81 (95% CI = 0.72-0.89) and the overall of ACL-QOL (AUC of 0.87 (95% CI = 0.80-0.93) showed the good level of responsiveness. The MIC scores of IKDC and the Overall ACL-QOL were determined 25 and 26 points, respectively. CONCLUSION The IKDC and ACL-QOL questionnaires have adequate responsiveness and are able to measure the change in athletes with ACL-R following a 16-week physiotherapy intervention.
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Affiliation(s)
- Nahid Pirayeh
- Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Physiotherapy, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Fatemeh Shahoori
- Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Shahin Goharpey
- Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Physiotherapy, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Neda Mostafaee
- Department of Physiotherapy, School of Paramedical and Rehabilitation Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Elabd OM, Alghadir AH, Ibrahim AR, Hasan S, Rizvi MR, Sharma A, Iqbal A, Elabd AM. Functional outcomes of accelerated rehabilitation protocol for anterior cruciate ligament reconstruction in amateur athletes: a randomized clinical trial. J Rehabil Med 2024; 56:jrm12296. [PMID: 38385715 PMCID: PMC10910537 DOI: 10.2340/jrm.v56.12296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 01/11/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Anterior cruciate ligament (ACL) rupture is the most common knee injury among athletes, and can result in long-term complications and career-ending conditions for sportspeople. There is no consensus in the literature on the effectiveness of rehabilitation after ACL reconstruction, or the best protocol to follow for functional outcome improvement. OBJECTIVE To determine the impact of an accelerated rehabilitation protocol on knee functional outcomes in amateur athletes with anterior cruciate ligament reconstruction (ACLR). DESIGN Two-arm, parallel-group randomized comparative design. PATIENTS A total of 100 amateur male athletes (mean age 22.01 ± 1.79 years) with ACLR were randomly divided into experimental and control groups (n = 50/group). METHODS An accelerated rehabilitation protocol and a conventional rehabilitation protocol were used for the experimental group. In contrast, only the conventional rehabilitation protocol was used for the control group. The rehabilitation was delivered in 5 weekly sessions for 22 weeks. The primary outcome measure, knee pain, was measured using a visual analogue scale (VAS). Extensive test batteries, for hop tests, Knee Injury and Osteoarthritis Outcome Score (KOOS), and knee effusion, were measured, aiming to add more objective criteria to determine functional performance. RESULTS Both groups (n = 50/group) were well-matched (p = 0.816), with insignificant differences in their demographic characteristics (p > 0.05). A multivariate analysis of variance (MANOVA) test showed no significant difference between the 2 groups (p = 0.781) at baseline. A 2-way MANOVA (2 × 2 MANOVA) of within- and between-group variations indicated overall significant treatment, time, and treatment × time interaction effects (p < 0.001) in favour of the accelerated rehabilitation group. CONCLUSION The accelerated rehabilitation protocol was more effective in improving functional outcomes than a conventional rehabilitation protocol in amateur athletes with ACLR.
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Affiliation(s)
- Omar M Elabd
- Department of Orthopedics and its Surgeries, Faculty of Physical Therapy, Delta University for Science and Technology, Gamasa, Egypt
| | - Ahmad H Alghadir
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
| | - Abeer R Ibrahim
- Basic Science Department, Faculty of Physical Therapy, Cairo University, Egypt; Department of Physiotherapy, College of Applied Medical Sciences, Umm Al-Qura University, Saudi Arabia
| | - Shahnaz Hasan
- Department of Physiotherapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al-Majmaah, Saudi Arabia
| | - Moattar R Rizvi
- Department of Physiotherapy, School of Allied Health Sciences, Manav Rachna International Institute and Studies (MRIIRS), Faridabad, India
| | - Ankita Sharma
- Department of Physiotherapy, School of Allied Health Sciences, Manav Rachna International Institute and Studies (MRIIRS), Faridabad, India
| | - Amir Iqbal
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia.
| | - Aliaa M Elabd
- Basic Science Department, Faculty of Physical Therapy, Benha University, Egypt
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Strong A, Markström JL, Schelin L, Häger CK. Asymmetric loading strategies during squats following anterior cruciate ligament reconstruction: A longitudinal investigation with curve analyses throughout and after rehabilitation. Scand J Med Sci Sports 2024; 34:e14524. [PMID: 37853508 DOI: 10.1111/sms.14524] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 09/29/2023] [Accepted: 10/08/2023] [Indexed: 10/20/2023]
Abstract
Investigations of kinetic asymmetries during bilateral squats following anterior cruciate ligament reconstruction (ACLR) are limited to mainly cross-sectional studies and discrete value data extracted at specific knee angles. We assessed loading asymmetries during squats longitudinally throughout rehabilitation using curve analysis and compared patient-reported outcome measures (PROMs) between those with and without asymmetry. Bodyweight squats were performed by 24 individuals (13 females) post-ACLR on three occasions: (1) Early 2.9 (1.1) months; (2) Mid 8.8 (3.1) months; (3) at Return to Sport (RTS) 13.1 (3.6) months; and 29 asymptomatic controls (22 females) once. Time-normalized between-leg asymmetry curves of sagittal plane hip, knee, and ankle moments and vertical ground reaction forces were compared using functional data analysis methods. Individual asymmetrical loading for ACLR was classified when exceeding the 95% confidence interval of controls during ≥50% of the squat. At Early, ACLR had greater asymmetry than controls for knee (15%-100% eccentric phase; 0%-100% concentric) and ankle flexion moments (56%-65% concentric). At Mid, ACLR had greater asymmetry for knee (41%-72% eccentric) and ankle flexion moments (56%-69% concentric). No between-group differences were found at RTS. From Early to RTS, ACLR reduced asymmetry for hip (21%-46% eccentric), knee (27%-58% concentric), and ankle flexion moments (21%-57% eccentric). At Early, 11/24 underloaded their ACLR knee and 1 overloaded compared with controls. At RTS, 4 underloaded and 6 overloaded. No differences in PROMs were found based on loading asymmetry. Beyond the early phase of rehabilitation from ACLR, individual-level analyses are required to reveal differing loading strategies during bilateral squats.
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Affiliation(s)
- Andrew Strong
- Unit of Physiotherapy, Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Jonas L Markström
- Unit of Physiotherapy, Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
- Department of Statistics, Umeå School of Business, Economics and Statistics, Umeå University, Umeå, Sweden
| | - Lina Schelin
- Department of Statistics, Umeå School of Business, Economics and Statistics, Umeå University, Umeå, Sweden
| | - Charlotte K Häger
- Unit of Physiotherapy, Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
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Elabd OM, Elabd AM. Functional outcomes of a criterion-based rehabilitation protocol for anterior cruciate ligament reconstruction in amateur athletes: A randomised clinical trial. J Bodyw Mov Ther 2023; 35:7-13. [PMID: 37330806 DOI: 10.1016/j.jbmt.2023.04.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/24/2023] [Accepted: 04/11/2023] [Indexed: 06/19/2023]
Abstract
INTRODUCTION Although current rehabilitation protocols following anterior cruciate ligament reconstruction (ACLR) are based on the graft remodeling process, there is uncertainty about its time schedule. Moreover, there are individual differences in neuromotor learning and flexibility after ACLR. The current study was conducted to investigate the functional outcomes of the criterion-based rehabilitation protocol in amateur athletes following ACLR. METHODS Fifty amateur male athletes who had ACLR were assigned randomly into two equal groups. The experimental group received a criterion-based rehabilitation protocol. The control group received a conventional physical therapy program. Both groups had five treatment sessions per week for six months. The primary outcome was pain intensity measured by VAS. Secondary outcomes included functional assessments measured by the limb symmetry index (LSI) of the hop test battery, knee effusion, and the Knee injury and Osteoarthritis Outcome Score (KOOS). RESULTS Mixed-design-MANOVA indicated significant treatment, time, and treatment × time interaction. The interaction was significant for all outcome measures in favor of subjects who received a criterion-based rehabilitation protocol. Within-group analysis revealed a significant reduction in pain in both groups and improvements in all variables related to the KOOS or LSI of the hop test battery. Knee effusion was significantly reduced post-treatment in patients who received a criterion-based protocol when compared to their controls. CONCLUSIONS Although application of a criterion-based rehabilitation protocol for 6 months after ACLR is more effective than a conventional program, its duration should be expanded beyond this period to allow patients to reach their return to play goals.
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Affiliation(s)
- Omar M Elabd
- Department of Orthopedics and Its Surgeries, Faculty of Physical Therapy, Delta University for Science and Technology, Gamasa, Egypt
| | - Aliaa M Elabd
- Basic Science Department, Faculty of Physical Therapy, Benha University, Egypt; Basic Science Department, Faculty of Physical Therapy, Pharos University in Alexandria, Egypt.
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Abed V, Dupati A, Hawk GS, Johnson D, Conley C, Stone AV. Return to Play and Performance After Anterior Cruciate Ligament Reconstruction in the National Women's Soccer League. Orthop J Sports Med 2023; 11:23259671231164944. [PMID: 37162761 PMCID: PMC10164258 DOI: 10.1177/23259671231164944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 01/27/2023] [Indexed: 05/11/2023] Open
Abstract
Background The anterior cruciate ligament (ACL) is commonly injured in elite-level female athletes, which usually requires ACL reconstruction (ACLR). Purpose To analyze return to play (RTP) and changes in performance of players in the National Women's Soccer League (NWSL) after ACLR. Study Design Descriptive epidemiology study. Methods NWSL players who sustained an ACL tear and underwent surgery between the 2013 and 2020 seasons were identified by multiple online resources. Players were classified as forwards, defenders, midfielders, and goalkeepers. RTP was assessed according to games played, games started, percentage of minutes played, plus/minus net per 90 minutes (a measure of a player's contribution to their team's performance while on the field), goals scored, and assists. A subanalysis was performed based on the median age at the time of the injury (≤24 vs ≥25 years). Nonparametric testing methods were used throughout the analysis. Results A total of 30 NWSL athletes were included. Midfielders had the highest percentage of injuries (n = 11; 36.7%), followed by forwards (n = 10; 33.3%). Overall, 27 players returned to the NWSL at a median of 12.1 months (IQR, 10.9-14.3 months), constituting a 90.0% RTP rate. There was a significant decrease in the percentage of minutes played from 1 year before the injury to 1 year after the injury (median, 87.9% [IQR, 80.7%-90.6%] vs 25.1% [IQR, 16.3%-57.2%], respectively; P = .031). Forwards and midfielders had a significant decrease in the number of assists from 1 year before the injury to 1 year after the injury (median, 3.0 [IQR, 1.0-3.0] vs 0.0 [IQR, 0.0-1.0], respectively; P = .037) as well as the number of goals scored when averaging across 2 seasons before the injury to 2 seasons after the injury (median, 3.0 [IQR, 1.5-5.5] vs 1.0 [IQR, 0.5-3.5], respectively; P = .031). On subanalysis, older players started in significantly more games (median, 12.0 [IQR, 3.8-18.5] vs 3.0 [IQR, 0.5-6.0], respectively; P = .048) and had a higher percentage of minutes played (median, 63.0% [IQR, 18.8%-77.3%] vs 14.9% [IQR, 2.0%-21.2%], respectively; P = .046) at 1 year after the injury versus younger players. Conclusion There was a 90.0% RTP rate after ACLR in the NWSL. Players who returned to the NWSL had a lower percentage of minutes played in their first year after RTP, with older players starting in more games and having a greater percentage of minutes played. Compared with preinjury performance, forwards and midfielders had a significant decrease in the number of assists at 1 year after the injury as well as the number of goals scored at 2 years after the injury.
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Affiliation(s)
- Varag Abed
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Ajith Dupati
- School of Medicine, Wayne State University, Detroit, Michigan, USA
| | - Gregory S. Hawk
- Department of Statistics, University of Kentucky, Lexington, Kentucky, USA
| | - Darren Johnson
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Caitlin Conley
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Austin V. Stone
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky, USA
- Austin V. Stone, MD, PhD, Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, 2195 Harrodsburg Road, Lexington, KY 40504, USA ()
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Güzel N, Genç AS, Yılmaz AK, Kehribar L. The Relationship between Lower Extremity Functional Performance and Balance after Anterior Cruciate Ligament Reconstruction: Results of Patients Treated with the Modified All-Inside Technique. J Pers Med 2023; 13:466. [PMID: 36983648 PMCID: PMC10052949 DOI: 10.3390/jpm13030466] [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: 02/06/2023] [Revised: 02/27/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Anterior cruciate ligament (ACL) ruptures are common injuries, and ACL reconstruction (ACLR) is among the most common surgical procedures in sports surgery. Our research aims to compare the 6-month post-operative results of the modified all-inside (MAI) ACLR technique, single leg hop tests (SLHT), and Y balance tests applied in different directions on the operated and non-operated sides. MATERIALS AND METHODS A retrospective cohort of 22 male recreational athletes who underwent MAI ACLR techniques performed by the same surgeon were evaluated. The functional knee strengths of the participants on the operated and non-operated sides were evaluated with five different tests of SLHTs: single hop for distance (SH), triple hop for distance (TH), crossover triple hop for distance (CH), medial side triple hop for distance (MSTH), and medial rotation (90°) with hop for distance (MRH). Their dynamic balance was evaluated with the Y balance Test. RESULTS Compared to pre-operative levels, there was a significant improvement in the mean Lysholm, Tegner, and IKDC scores during the post-operative period (p < 0.05). There was a difference between SH, THD, CHD, MSTH, and MRH on the operated and non-operative sides (p < 0.05). There was no difference between Y balance scores on the operated and non-operative sides, and there were no differences between LSI scores resulting from SLHTs (p > 0.05). There were no significant relationships between YBT (composite scores) and SH, TH, CH, MSTH, and MRH distances in the healthy leg (p > 0.05), but a significant correlation with only CH in the ACL leg (p < 0.05). CONCLUSIONS Our research shows that sixth-month post-operative SLHT findings were lower on the ACL side compared to the healthy side in patients tested with the MAI ACLR technique. However, when these scores are evaluated in terms of balance, it can be seen that both sides reveal similar findings. The similarity of LSIs in SLHTs applied in different directions, and balance scores of ACL and healthy sides revealed that the MAI technique is also an ACLR technique that can be used in athletes from a functional point of view.
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Affiliation(s)
- Nizamettin Güzel
- Department of Orthopedics and Traumatology, Samsun Training and Research Hospital, 55090 Samsun, Türkiye
| | - Ahmet Serhat Genç
- Department of Orthopedics and Traumatology, Samsun Training and Research Hospital, 55090 Samsun, Türkiye
| | - Ali Kerim Yılmaz
- Departments of Recreation, Faculty of Yaşar Doğu Sport Sciences, Ondokuz Mayıs University, 55100 Samsun, Türkiye
| | - Lokman Kehribar
- Department of Orthopedics and Traumatology, Samsun University, 55090 Samsun, Türkiye
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Rutkowska-Kogut K, Truszczyńska-Baszak A, Wrzesień Z. Physiotherapy After Anterior Cruciate Ligament Reconstruction a Literature Review. REHABILITACJA MEDYCZNA 2023. [DOI: 10.5604/01.3001.0016.2374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Introduction: The anterior cruciate ligament (ACL) is the main stabiliser that inhibits excessive anterior translation of the tibia and prevents excessive rotational movements of the knee joint. ACL injuries occur at a frequency of 30 to 78 per 100,000 people a year, leading to instability and impaired function of the knee joint. Continuous development of knowledge on the anatomy and functions of the anterior cruciate ligament, along with the improvement of surgical and physiotherapeutic techniques, allowed for the development of satisfactory modern methods for treating ACL lesions.Objective: The aim of the study is to review literature on modern methods of physiotherapy after the reconstruction of the anterior cruciate ligament.Material and methods: Pubmed, Google Scholar and ScienceDirect scientific databases were searched using a combination of keywords: anterior cruciate ligament, ACL, reconstruction, physiotherapy, protocol. The inclusion criteria were: publication date from the last 10 years and a detailed description of the physiotherapy protocol included.Results: Six publications meeting the inclusion criteria were included in the analysis. Selected physiotherapy protocols consisted of 3 to 5 phases. Phase 1 was focused on reducing pain and swelling in all cases. The purpose of the following phases was to increase the range of motion and to strengthen muscle strength as well as neuromuscular coordination. The final stage consisted of dynamic exercises allowing to prepare for a chosen sports activity.Conclusion: Contemporary protocols for physiotherapy after ACL reconstruction are based on early recovery of range of motion in the knee joint, early increase in load on the operated limb as well as shortening (or excluding) the period of immobilisation and the use of orthoses.
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Affiliation(s)
| | | | - Zuzanna Wrzesień
- Józef Piłsudski University of Physical Education in Warsaw, Poland
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Perez-Mozas M, Payo-Ollero J, Montiel V, Valenti-Nin JR, Valenti-Azcarate A. Meniscal Suture Influence on Driving Ability 6 Weeks after Anterior Cruciate Ligament Reconstruction with Hamstring Autograft. J Knee Surg 2023; 36:79-86. [PMID: 33932951 DOI: 10.1055/s-0041-1729553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The purpose of this study was to determine if driving ability 6 weeks after anterior cruciate ligament (ACL) reconstruction is affected by the addition of a meniscal suture. It was also hypothesized that no differences in the driving performance would be found between right or left knee surgery subgroups. A total of 82 people participated in this prospective cohort study: 36 healthy controls, 26 patients undergoing isolated ACL (iACL) reconstruction with hamstring autograft, and 20 patients undergoing ACL and meniscal suture (ACL-MS) reconstruction. ACL-MS group followed a weight-bearing and movement restriction protocol during the first 2 postoperative weeks, whereas patients undergoing iACL could start range-of-motion exercises and full weight-bearing ambulation on the first postoperative day. A driving simulator that reproduced real-life driving conditions was used to evaluate driving ability. The software analyzed multiple driving and braking variables. Driving performance in the sixth postoperative week was compared with that of a healthy control group. Subgroup analysis considering additional procedures (iACL, ACL-MS) and the side of the operated knee (right, left) was also performed. No statistically significant differences were found in the demographic characteristics nor in the driving performance (collisions, p = 0.897; sidewalk invasions, p = 0.749; pedestrian impact, p = 0.983) between iACL, ACL-MS, and control groups. No statistically significant differences were found in right-left subgroup analysis. The results of the present study show that patients in their sixth postoperative week after right or left ACL reconstruction showed similar driving performance as compared with a healthy control group, regardless of associating or not a meniscal suture, suggesting it is safe to resume driving 6 weeks after the mentioned surgeries.
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Affiliation(s)
- Maria Perez-Mozas
- Department of Orthopaedic Surgery and Traumatology, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - Jesus Payo-Ollero
- Department of Orthopaedic Surgery and Traumatology, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - Veronica Montiel
- Department of Orthopaedic Surgery and Traumatology, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - Juan Ramon Valenti-Nin
- Department of Orthopaedic Surgery and Traumatology, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - Andres Valenti-Azcarate
- Department of Orthopaedic Surgery and Traumatology, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
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Riffitts M, Cook H, McClincy M, Bell K. Evaluation of a Smart Knee Brace for Range of Motion and Velocity Monitoring during Rehabilitation Exercises and an Exergame. SENSORS (BASEL, SWITZERLAND) 2022; 22:9965. [PMID: 36560329 PMCID: PMC9781044 DOI: 10.3390/s22249965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/06/2022] [Accepted: 12/14/2022] [Indexed: 06/17/2023]
Abstract
Anterior cruciate ligament (ACL) injuries often require a lengthy duration of rehabilitation for patients to return to their prior level of function. Adherence to rehabilitation during this prolonged period can be subpar due to the treatment duration and poor adherence to home exercises. This work evaluates whether a smart instrumented knee brace system is capable of monitoring knee range of motion and velocity during a series of common knee rehabilitation exercises and an exergame. A total of 15 healthy participants completed a series of common knee rehabilitation exercises and played an exergame while wearing a smart instrumented knee brace. The range of motion (ROM) and velocity of the knee recorded by the knee brace was compared to a reference optoelectronic system. The results show good agreement between the knee brace system and the reference system for all exercises performed. Participants were able to quickly learn how to play the exergame and scored well within the game. The system investigated in this study has the potential to allow rehabilitation to occur outside of the clinic with the use of remote monitoring, and improve adherence and outcomes through the use of an exergame.
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Affiliation(s)
- Michelle Riffitts
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15206, USA
| | - Harold Cook
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15206, USA
| | - Michael McClincy
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA 15206, USA
| | - Kevin Bell
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15206, USA
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Lee D, Lencer AJ, Gibbs BS, Paul RW, Tjoumakaris FP. Disruptions in standard care: anterior cruciate ligament reconstruction outcomes during the SARS-COV2 pandemic. PHYSICIAN SPORTSMED 2022; 50:515-521. [PMID: 34424824 DOI: 10.1080/00913847.2021.1971494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The SARS-COV2 pandemic led to massive disruptions of care for orthopedic patients. Although many elective procedures were put on hold, a cohort of patients who underwent surgery prior to the outbreak of the pandemic were rendered unable to participate in standard post-operative care. The purpose of this study was to determine the methods of post-operative care in arthroscopic anterior cruciate ligament reconstruction patients who received care during an early height of the pandemic to those who received standard of care in the prior year. We aimed to correlate those results with 1-year clinical outcomes in the form of subjective surveys. METHODS Retrospective chart review was used to identify patients who underwent primary anterior cruciate ligament reconstruction in February and March of 2020 (case) and 2019 (control) at a single institution. Workman's compensation patients were excluded. Identified patients were asked to report post-operative care received, satisfaction with care, and complete the IKDC and Lysholm outcome measures. Surveys were conducted minimum 1-year post-operative. RESULTS 236 patients were identified, including 103 in 2020 and 133 in 2019. Follow-up data was collected for 73 patients (70.9%) in 2020 and 97 patients (72.9%) in 2019. Fifty-one COVID cohort patients (69.9%) had at least one clinical visit conducted via telehealth, compared to zero in the control. There were no differences in IKDC (82.8 ± 13.2 vs 85.0 ± 12.0, P = 0.29) and Lysholm (89.2 ± 11.3 vs 89.6 ± 10.8, P = 0.82) between groups. There were no differences in patient satisfaction with the care received (82.9 ± 22.4 vs 81.9 ± 21.8, P = 0.79). CONCLUSION Despite disruptions in care, anterior cruciate ligament reconstruction patients have excellent 1-year outcomes during the pandemic. Telehealth follow-up appointments may be appropriate for anterior cruciate ligament reconstruction patients beyond the pandemic and do not seem to adversely affect short-term patient reported outcome measures.
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Affiliation(s)
- Donghoon Lee
- Department of Sports Medicine, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Adam J Lencer
- Department of Sports Medicine, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Brian S Gibbs
- Department of Sports Medicine, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Ryan W Paul
- Department of Sports Medicine, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Fotios P Tjoumakaris
- Department of Sports Medicine, Rothman Orthopaedic Institute, Philadelphia, PA, USA
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Molina I, Muñoz A, Linde X. Treatment of ACL injury in a professional soccer player during COVID-19 lockdown. APUNTS SPORTS MEDICINE 2022. [PMCID: PMC9293858 DOI: 10.1016/j.apunsm.2022.100392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Anterior Cruciate Ligament (ACL) injuries stand out as the most severe in sports such as soccer. This study presents the rehabilitation process of a professional soccer player who suffered a total ACL tear. It details the treatment performed after the surgical intervention and all the adaptations that had to be applied in the rehabilitation process due to the lockdown period established at the beginning of the COVID-19 pandemic. During the period comprised between weeks 9 and 21 post-surgery, the rehabilitation treatment was carried out virtually, adapting the actions, work environment and equipment used. Despite the limitations it entailed, the virtual format and the adaptations in the treatment allowed the rehabilitation process to continue, fulfilling all the pre-established objectives and deadlines with a consequent satisfactory and safe return to competitive sport. After carrying out a bibliographic research, no clinical cases have been found regarding the adaptation of the rehabilitation process of an ACL reconstruction in a professional soccer player during the COVID-19 lockdown.
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Van Cant J, Pairot de Fontenay B, Douaihy C, Rambaud A. Characteristics of return to running programs following an anterior cruciate ligament reconstruction: A scoping review of 64 studies with clinical perspectives. Phys Ther Sport 2022; 57:61-70. [PMID: 35921783 DOI: 10.1016/j.ptsp.2022.07.006] [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: 04/03/2022] [Accepted: 07/12/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To (1) describe return to running (RTR) programs used during rehabilitation after anterior cruciate ligament reconstruction (ACLR); and (2) provide clinical guidelines for RTR program after ACLR. DESIGN Scoping review. LITERATURE SEARCH We searched the MEDLINE (Pubmed), EMBASE, Web of Science and PEDro databases. STUDY SELECTION CRITERIA We included randomized controlled trial (RCT), cases series, meta-analyses, both scoping and systematic reviews including a rehabilitation program after ACLR with a specific RTR program. A "Running program checklist" (RPC) was elaborated based on the Template for Intervention Description and Replication (TIDieR), and on the Consensus on Exercise Reporting Template (CERT) checklist. DATA SYNTHESIS The percentage and number of studies specifying each of the running program checklist items in their RTR program were reported. Number of items reported in each study and specific analysis item-by-item were also proposed. RESULTS The "When (2)" item was the most frequently found (92.19%) and, conversely, the "Who (1)" item appeared only in four studies (6.2%). One-third of the studies presented only one item of the RPC, and 48 of the 64 articles discussed less than three items. Two studies described in detail their RTR program by reporting 8 and 9 items out of the 10, respectively. No study presented 10 of the PRC items. CONCLUSION There is a serious lack of information concerning RTR program following ACLR in the literature and further studies are needed to establish a program based on the best evidence.
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Affiliation(s)
- Joachim Van Cant
- Faculty of Motors Sciences, Université Libre de Bruxelles, Brussels, Belgium; SFMKS Lab, Pierrefitte-sur-Seine, France; The Running Clinic, Lac Beauport, Canada.
| | - Benoît Pairot de Fontenay
- SFMKS Lab, Pierrefitte-sur-Seine, France; Inter-university Laboratory of Human Movement Science (LIBM EA 7424), Univ Lyon - UJM, Saint Etienne, France; The Running Clinic, Lac Beauport, Canada
| | - Charbel Douaihy
- Faculty of Motors Sciences, Université Catholique de Louvain, Brussels, Belgium
| | - Alexandre Rambaud
- SFMKS Lab, Pierrefitte-sur-Seine, France; Univ Lyon, UJM-Saint-Etienne, Inter-university Laboratory of Human Movement Biology, EA 7424, F-42023, Saint-Etienne, France; Department of Clinical and Exercise Physiology, Sports Medicine Unity, University Hospital of Saint-Etienne, Faculty of Medicine, Saint-Etienne, France
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Abstract
PURPOSE OF REVIEW The purpose of this review is to discuss treatment options, rehabilitation protocols, return-to-play criteria, and expected outcomes after non-operative and operative treatment of anterior cruciate ligament (ACL) tears among an athletic population. RECENT FINDINGS Non-operative treatment may be a viable option for some athletes with an ACL tears but can be difficult to predict "copers," and those that resume to sports return at lower performance level and/or less intense activities. Most studies assessing function after ACL reconstruction demonstrate favorable outcomes using patient-reported outcome studies. However, return-to-play and graft re-rupture rates vary substantially based on patient characteristics and level and type of athletic activity. Grafts used to reconstruct ACL produce similar objective outcomes and favorable patient-reported outcomes but have variable re-rupture rates depending on study and differ largely on morbidity associated with graft harvest. Various treatment methods including non-operative and operative techniques have been demonstrated to be efficacious in returning athletes to athletic activity depending on patient age and level of activity. Adherence to fundamental rehabilitation principles and accepted return-to-play guidelines can optimize outcomes and limit re-injury to the injured or contralateral limb.
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15
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So BC, Kwok MM, Fung VC, Kwok AH, Lau CW, Tse AL, Wong MS, Mercer JA. A Study Comparing Gait and Lower Limb Muscle Activity During Aquatic Treadmill Running with Different Water Depth and Land Treadmill Running. J Hum Kinet 2022; 82:39-50. [PMID: 36196338 PMCID: PMC9465725 DOI: 10.2478/hukin-2022-0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Aquatic treadmill running is a partial weight-bearing exercise for rehabilitation. The purpose of this study was to investigate the surface electromyography activities of the rectus femoris, tibialis anterior, biceps femoris and medial head of gastrocnemius, and gait kinematics during aquatic treadmill running in water levels at waist, mid-thigh and mid-shin and on land. Seventeen healthy subjects (9 males and 8 females) were recruited by convenience sampling. Participants performed 2-min aquatic treadmill running at a specific speed for each water depth. The test speed was selected based upon the speed that elicited 110 steps per min. The surface electromyography data of lower limb muscles and the joint angles at three different water depths and on land were collected to evaluate the muscle activity and gait kinematics using a waterproofed surface electromyography system and inertial measurement unit for each muscle. Results showed that rectus femoris electromyography was different between depths during the swing and stance phases. Likewise, biceps femoris and tibialis anterior electromyography were different between depths for the swing phase. However, it was not the case for gastrocnemius electromyography. Peak flexion angles in both left and right hips were different between depths. A significant increase in a stance/swing ratio was observed with rising water depths. Water depth influenced muscle activity as well as kinematics. Aquatic treadmill running in the mid-thigh level should be further evaluated for its effectiveness, training value and applicability.
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Affiliation(s)
- Billy C.L. So
- Gait and Motion Analysis Laboratory, Department of Rehabilitation Scicences, The Hong Kong Polytechnic UniversityHung Hom, Hong Kong
| | - Manny M.Y. Kwok
- Gait and Motion Analysis Laboratory, Department of Rehabilitation Scicences, The Hong Kong Polytechnic UniversityHung Hom, Hong Kong
| | - Veron C.Y. Fung
- Gait and Motion Analysis Laboratory, Department of Rehabilitation Scicences, The Hong Kong Polytechnic UniversityHung Hom, Hong Kong
| | - Ally H.Y. Kwok
- Gait and Motion Analysis Laboratory, Department of Rehabilitation Scicences, The Hong Kong Polytechnic UniversityHung Hom, Hong Kong
| | - Crystal W.C. Lau
- Gait and Motion Analysis Laboratory, Department of Rehabilitation Scicences, The Hong Kong Polytechnic UniversityHung Hom, Hong Kong
| | - Alison L.Y. Tse
- Gait and Motion Analysis Laboratory, Department of Rehabilitation Scicences, The Hong Kong Polytechnic UniversityHung Hom, Hong Kong
| | - Mini S.Y. Wong
- Gait and Motion Analysis Laboratory, Department of Rehabilitation Scicences, The Hong Kong Polytechnic UniversityHung Hom, Hong Kong
| | - John A. Mercer
- Department of Kinesiology and Nutrition Sciences, Univesity of Nevada, Las Vegas, USA
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Memmel C, Krutsch W, Szymski D, Pfeifer C, Henssler L, Frankewycz B, Angele P, Alt V, Koch M. Current Standards of Early Rehabilitation after Anterior Cruciate Ligament Reconstruction in German Speaking Countries-Differentiation Based on Tendon Graft and Concomitant Injuries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074060. [PMID: 35409745 PMCID: PMC8997891 DOI: 10.3390/ijerph19074060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 03/22/2022] [Accepted: 03/25/2022] [Indexed: 02/01/2023]
Abstract
Background: Although anterior cruciate ligament reconstruction (ACLR) is a well-established procedure and is standardly performed by orthopedic surgeons all over the world, there does not seem to be a standard protocol for early rehabilitation. The purpose of this study was to give answers to the following questions: (i) Does (a) the use of a specific tendon graft, and (b) potentially additional therapy of concomitant pathologies influence surgeons’ choice of a distinct postoperative rehabilitation protocol after ACLR? (ii) To what extent do these rehabilitation recommendations differ? Methods: Retrospective analysis of currently used early rehabilitation protocols after ACLR in German-speaking countries (GER, AUT and SUI) was conducted. Rehabilitation criteria included weight bearing, range of motion (ROM), the utilization of braces, continuous passive/active motion therapy (CPM/CAM), rehabilitation training and sport-specific training. Tendon grafts were differentiated as hamstring (HAM) and bone−patellar tendon−bone grafts (BTB). Concomitant pathologies included meniscus injuries (+M) and unhappy triad injuries (+UTI). Results: Most of the surveyed protocols were differentiated according to the used tendon graft or additional therapy of concomitant injuries (ACLR-differentiated, n = 147 vs. ACLR without graft differentiation, n = 58). When comparing ACLR-HAM and ACLR-BTB, significant differences were found regarding weight bearing (p = 0.01), ROM (p = 0.05) and the utilization of braces (p = 0.03). Regarding ACLR+M, an overall significant decelerated rehabilitation could be detected. After ACLR+UTI-therapy, a significant delayed start to full weight bearing (p = 0.002) and ROM (p < 0.001) was found. Conclusions: Most orthopedic surgeons from German-speaking countries differentiate early rehabilitation after ACLR according to the tendon graft used and therapy of concomitant pathologies. No consensus about early rehabilitation after ACLR is available. However, tendencies for an accelerated rehabilitation after ACLR-BTB and a more restrained rehabilitation of multiple injured knees were detected.
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Affiliation(s)
- Clemens Memmel
- Department of Paediatric Surgery and Orthopaedics, Clinic St. Hedwig, Barmherzige Brueder Regensburg, KUNO Paediatric University Medical Centre and FIFA Medical Centre of Excellence, University Medical Centre Regensburg, 93053 Regensburg, Germany
- Correspondence:
| | - Werner Krutsch
- Department of Trauma Surgery and FIFA Medical Centre of Excellence, University Medical Centre Regensburg, 93053 Regensburg, Germany; (W.K.); (D.S.); (C.P.); (L.H.); (B.F.); (P.A.); (V.A.); (M.K.)
- SportDocs Franken, 90455 Nuremberg, Germany
| | - Dominik Szymski
- Department of Trauma Surgery and FIFA Medical Centre of Excellence, University Medical Centre Regensburg, 93053 Regensburg, Germany; (W.K.); (D.S.); (C.P.); (L.H.); (B.F.); (P.A.); (V.A.); (M.K.)
| | - Christian Pfeifer
- Department of Trauma Surgery and FIFA Medical Centre of Excellence, University Medical Centre Regensburg, 93053 Regensburg, Germany; (W.K.); (D.S.); (C.P.); (L.H.); (B.F.); (P.A.); (V.A.); (M.K.)
- Department of Trauma Surgery, InnKlinikum Altoetting, 84503 Altoetting, Germany
| | - Leopold Henssler
- Department of Trauma Surgery and FIFA Medical Centre of Excellence, University Medical Centre Regensburg, 93053 Regensburg, Germany; (W.K.); (D.S.); (C.P.); (L.H.); (B.F.); (P.A.); (V.A.); (M.K.)
| | - Borys Frankewycz
- Department of Trauma Surgery and FIFA Medical Centre of Excellence, University Medical Centre Regensburg, 93053 Regensburg, Germany; (W.K.); (D.S.); (C.P.); (L.H.); (B.F.); (P.A.); (V.A.); (M.K.)
| | - Peter Angele
- Department of Trauma Surgery and FIFA Medical Centre of Excellence, University Medical Centre Regensburg, 93053 Regensburg, Germany; (W.K.); (D.S.); (C.P.); (L.H.); (B.F.); (P.A.); (V.A.); (M.K.)
| | - Volker Alt
- Department of Trauma Surgery and FIFA Medical Centre of Excellence, University Medical Centre Regensburg, 93053 Regensburg, Germany; (W.K.); (D.S.); (C.P.); (L.H.); (B.F.); (P.A.); (V.A.); (M.K.)
| | - Matthias Koch
- Department of Trauma Surgery and FIFA Medical Centre of Excellence, University Medical Centre Regensburg, 93053 Regensburg, Germany; (W.K.); (D.S.); (C.P.); (L.H.); (B.F.); (P.A.); (V.A.); (M.K.)
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland, Bruderholz, 4101 Basel, Switzerland
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Fort-Vanmeerhaeghe A, Arboix-Alió J, Montalvo AM. Return-to-sport following anterior cruciate ligament reconstruction in team sport athletes. Part II: Progressive framework. APUNTS SPORTS MEDICINE 2022. [DOI: 10.1016/j.apunsm.2021.100361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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18
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Germano Maciel D, Santos Cerqueira M, Gabbett TJ, Elsangedy HM, de Brito Vieira WH. Should We Trust Perceived Effort for Loading Control and Resistance Exercise Prescription After ACL Reconstruction? Sports Health 2021; 14:764-769. [PMID: 34486455 DOI: 10.1177/19417381211041289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
CONTEXT The rating of perceived effort (RPE) is a common method used in clinical practice for monitoring, loading control, and resistance training prescription during rehabilitation after rupture and anterior cruciate ligament reconstruction (ACLR). It is suggested that the RPE results from the integration of the afferent feedback and corollary discharge in the motor and somatosensory cortex, and from the activation of brain areas related to emotions, affect, memory, and pain (eg, posterior cingulate cortex, precuneus, and prefrontal cortex). Recent studies have shown that rupture and ACLR induce neural adaptations in the brain commonly associated with the RPE. Therefore, we hypothesize that RPE could be affected because of neural adaptations induced by rupture and ACLR. STUDY DESIGN Clinical review. LEVEL OF EVIDENCE Level 5. RESULTS RPE could be directly altered by changes in the activation of motor cortex, posterior cingulate cortex, and prefrontal cortex. These neural adaptations may be induced by indirect mechanisms, such as the afferent feedback deficit, pain, and fear of movement (kinesiophobia) that patients may feel after rupture and ACLR. CONCLUSION Using only RPE for monitoring, loading control, and resistance training prescription in patients who had undergone ACLR could lead to under- or overdosing resistance exercise, and therefore, impair the rehabilitation process. STRENGTH-OF-RECOMMENDATION TAXONOMY 3C.
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Affiliation(s)
- Daniel Germano Maciel
- Department of Physical Therapy, Laboratory of Neuromuscular Performance, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Mikhail Santos Cerqueira
- Department of Physical Therapy, Laboratory of Neuromuscular Performance, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Tim J Gabbett
- Gabbett Performance Solutions, Brisbane, Queensland, Australia.,University of Southern Queensland, Institute for Resilient Regions, Ipswich, Queensland, Australia
| | - Hassan Mohamed Elsangedy
- Department of Physical Education, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Wouber Hérickson de Brito Vieira
- Department of Physical Therapy, Laboratory of Neuromuscular Performance, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
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Yao S, Fu BSC, Yung PSH. Graft healing after anterior cruciate ligament reconstruction (ACLR). ASIA-PACIFIC JOURNAL OF SPORT MEDICINE ARTHROSCOPY REHABILITATION AND TECHNOLOGY 2021; 25:8-15. [PMID: 34094881 PMCID: PMC8134949 DOI: 10.1016/j.asmart.2021.03.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/05/2021] [Accepted: 03/21/2021] [Indexed: 01/11/2023]
Abstract
Anterior cruciate ligament reconstruction (ACLR) is a commonly performed procedure in Orthopaedic sports medicine. With advances in surgical techniques providing better positioning and fixation of the graft, subsequent graft failure to certain extent should be accounted by poor graft healing. Although different biological modulations for enhancement of graft healing have been tried in different clinical and animal studies, complete graft incorporation into bone tunnels and the “ligamentization” of the intra-articular part have not been fully achieved yet. Based on the understanding of graft healing process and its failure mechanism, the purpose of this review is to combine both the known basic science & clinical evidence, to provide a much clearer picture of the obstacle encountered in graft healing, so as to facilitate researchers on subsequent work on the enhancement of ACL graft healing.
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Affiliation(s)
- Shiyi Yao
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong
| | - Bruma Sai-Chuen Fu
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong
| | - Patrick Shu-Hang Yung
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong
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20
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Roe C, Jacobs C, Hoch J, Johnson DL, Noehren B. Test Batteries After Primary Anterior Cruciate Ligament Reconstruction: A Systematic Review. Sports Health 2021; 14:205-215. [PMID: 33896240 DOI: 10.1177/19417381211009473] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
CONTEXT There is a lack of consensus regarding test batteries for return to sport (RTS) after anterior cruciate ligament reconstruction (ACLR). OBJECTIVE To report the RTS test batteries for individuals after ACLR and to examine alignment with the American Academy of Orthopaedic Surgeons (AAOS) Appropriate Use Criteria (AUC). Finally, to examine how published RTS batteries prior to the AAOS AUC (2010-2015) compared with those after publication of the AUC (2016-2020). DATA SOURCE A systematic search of PubMed (2010-2020). STUDY SELECTION Studies were included if they were published from 2010 to 2020, patients underwent primary ACLR and were tested between 6 months and 2 years postoperatively and included a minimum of 2 assessments. Studies were excluded if patients were tested outside the designated time; had undergone a revision, contralateral, or multiligament injury; included healthy participants; were level 5 evidence or the study was a systematic review. A total of 1012 articles were reviewed and 63 met the criteria. STUDY DESIGN Systematic review. LEVEL OF EVIDENCE Level 4. DATA EXTRACTION Information regarding the RTS batteries and patient demographics were extracted from the included articles. RESULTS A total of 63 studies met the inclusion and exclusion criteria (22 from 2010-2015 and 41 from 2016-2020). The most common RTS batteries included the hop test, quadriceps strength test, and patient-reported outcome measures. No study met all 7 AUC; the most common criteria met were functional skills (98.4%), followed by confidence (22.2%), then range of motion and knee stability (20.6%). CONCLUSION The test batteries in the current literature show high variability and a lack of essential components necessary for RTS. No study met the AUC guidelines, suggesting a disconnect between recommended guidelines and clinical practice. Test battery research has expanded over the past decade; however, standardized, clinically applicable batteries that encompass all criteria are needed.
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Affiliation(s)
- Chelsey Roe
- Department of Physical Therapy, University of Kentucky, Lexington, Kentucky
| | - Cale Jacobs
- Department of Orthopedic Surgery & Sports Medicine, University of Kentucky, Lexington, Kentucky
| | - Johanna Hoch
- Department of Athletic Training and Clinical Nutrition, University of Kentucky, Lexington, Kentucky
| | - Darren L Johnson
- Department of Orthopedic Surgery & Sports Medicine, University of Kentucky, Lexington, Kentucky
| | - Brian Noehren
- Department of Physical Therapy, University of Kentucky, Lexington, Kentucky
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Zerega R, Killelea C, Losciale J, Faherty M, Sell T. Examination of the Feasibility of a 2-Dimensional Portable Assessment of Knee Joint Stability: A Pilot Study. J Appl Biomech 2020; 36:381-389. [PMID: 32919379 DOI: 10.1123/jab.2020-0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 06/12/2020] [Accepted: 06/17/2020] [Indexed: 11/18/2022]
Abstract
Rupture of the anterior cruciate ligament (ACL) remains extremely common, with over 250,000 injuries annually. Currently, clinical tests have poor utility to accurately screen for ACL injury risk in athletes. In this study, the position of a knee marker was tracked in 2-dimensional planes to predict biomechanical variables associated with ACL injury risk. Three-dimensional kinematics and ground reaction forces were collected during bilateral, single-leg stop-jump tasks for 44 healthy male military personnel. Knee marker position data were extracted to construct 2-dimensional 95% prediction ellipses in each anatomical plane. Knee marker variables included: ellipse areas, major/minor axes lengths, orientation of ellipse axes, absolute ranges of knee position, and medial knee collapse. These variables were then used as predictor variables in stepwise multiple linear regression analyses for 7 biomechanical variables associated with ACL injury risk. Knee flexion excursion, normalized peak vertical ground reaction forces, and knee flexion angle at initial contact were the response variables that generated the highest adjusted R2 values: .71, .37, and .31, respectively. The results of this study provide initial support for the hypothesis that tracking a single marker during 2-dimensional analysis can accurately reflect the information gathered from 3-dimensional motion analysis during a task assessing knee joint stability.
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Raisbeck LD, Diekfuss JA, Rhea CK. Does an External Focus Improve Single-Leg Jump Distance for Individuals With Chronic Ankle Instability? ACTA ACUST UNITED AC 2020. [DOI: 10.3928/19425864-20191106-01] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Giordano K, Chaput M, Anz A, Braziel J, Andrews J, Oliver GD. Knee Kinetics in Baseball Hitting and Return to Play after ACL Reconstruction. Int J Sports Med 2020; 42:847-852. [PMID: 32947638 DOI: 10.1055/a-1236-4102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The purpose of this study was to describe the knee kinetics of baseball hitting, develop a tool to predict knee kinetics from easily obtainable measures, and to compare knee kinetics to other exercises along the rehabilitation continuum to determine a timeline for when hitting may resume after ACL reconstruction. Nineteen high school baseball athletes (16.3±0.8 yrs, 180.6±5.7 cm, 78.4±10.8 kg) participated. Participants took ten swings off a tee. Kinetic data were recorded using an electromagnetic tracking system. Data from swings with the top three exit velocities were averaged for analysis. Linear regressions were used to determine if predictors of height, mass, age and exit velocity could predict the following torques: bilateral knee net, extension, internal and external rotation, valgus and varus torque; and anterior force. Backwards regression models revealed independent variables could significantly predict front knee net, internal and external rotation, extension, and varus torque, and anterior force; and back knee net and valgus torque. Based on the kinetics of baseball hitting compared to those of rehabilitation exercises, if the involved knee is the front, we suggest tee hitting may be initiated at 13 weeks after ACL reconstruction. If the involved knee is the back, we suggest tee hitting may initiated at 17 weeks after ACL reconstruction.
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Affiliation(s)
- Kevin Giordano
- School of Kinesiology, Auburn University, Auburn, United States
| | - Meredith Chaput
- School of Applied Health Sciences and Wellness, Ohio University, Athens, United States
| | - Adam Anz
- Andrews Research and Education Foundation, Gulf Breeze, United States
| | - Jeremy Braziel
- The Shoulder Center of Arkansas, Fayetteville, United States
| | - James Andrews
- Andrews Research and Education Foundation, Gulf Breeze, United States
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Does an Accelerated Program Give Equivalent Results in Both Elite Athletes and Nonathletes? J Sport Rehabil 2020; 29:572-577. [PMID: 31094619 DOI: 10.1123/jsr.2018-0346] [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: 09/18/2018] [Revised: 03/12/2019] [Accepted: 03/24/2019] [Indexed: 11/18/2022]
Abstract
CONTEXT Although many researchers have investigated the functional outcomes of different accelerated rehabilitation programs after anterior cruciate ligament reconstruction (ACLR), the functional results of the same accelerated rehabilitation program following ACLR applied for both elite athletes and nonathletes have not yet been investigated. OBJECTIVE To examine the effects of the same accelerated anterior cruciate ligament rehabilitation program on pain and functionality of elite athletes and nonathletes. DESIGN Prospective preintervention-postintervention design. SETTING Physiotherapy department. PARTICIPANTS Fifteen elite athletes and 15 nonathletes who underwent unilateral ACLR with autologous hamstring tendon graft. INTERVENTION All participants received the same protocol for 6 weeks (5 sessions in a week). MAIN OUTCOME MEASURES Primary measurements were pain intensity, which was measured by visual analog scale, range of motion measurement using universal goniometer, and functionality, which was detected by Lysholm score. Secondary measurements were short form-36 and Beck Depression Inventory. RESULTS Higher Lysholm (P = .001) and Beck Depression Inventory (P = .03) scores were observed in the elite athlete group, and higher pain (P = .001) was observed in the nonathlete group at baseline assessments. Significant improvement detected for pain (P < .05), knee flexion range (P < .05), Lysholm score (P < .05), and Beck Depression Inventory (P < .05) compared with preintervention for both groups. Finally, after comparing the mean change values, the nonathlete group displayed greater decrease in pain level (P = .01) and participants in the elite athlete group further showed a greater decrease in depression level (P = .001). CONCLUSIONS This study found that the same accelerated rehabilitation protocol provides significant improvements for pain, functionality, and depression in both elite athletes and nonathletes after ACLR. Clinicians should consider our results when applying an anterior cruciate ligament rehabilitation program for nonathlete groups.
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Lesevic M, Kew ME, Bodkin SG, Diduch DR, Brockmeier SF, Miller MD, Gwathmey FW, Werner BC, Hart JM. The Affect of Patient Sex and Graft Type on Postoperative Functional Outcomes After Primary ACL Reconstruction. Orthop J Sports Med 2020; 8:2325967120926052. [PMID: 32637429 PMCID: PMC7313335 DOI: 10.1177/2325967120926052] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 01/29/2020] [Indexed: 01/12/2023] Open
Abstract
Background: Graft choice in anterior cruciate ligament reconstruction (ACLR) and postoperative rehabilitation may affect strength recovery differently in men than women and therefore affect a timely and successful return to sport. Purpose: To compare knee extensor and flexor strength between men and women who underwent isolated ACLR with either patellar tendon or hamstring tendon (HST) autografts. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 166 patients (87 women, 79 men) with primary unilateral and uncomplicated ACLRs were recruited for participation. A total of 100 patients had bone–patellar tendon–bone (BPTB) autografts and 66 had HST autografts. At 6 months postoperatively, all patients completed the Tegner activity scale and International Knee Documentation Committee Subjective Knee Evaluation as well as underwent bilateral isokinetic (90 deg/s) tests of the knee extensor and flexor groups. Outcomes were recorded in a single session as part of a return-to-sport test battery. Surgical notes were obtained to determine the type of autograft and nerve block used at the time of ACLR. Results: There was a significant sex × graft type interaction for mass-normalized knee flexor torque (P = .017). Female patients with an HST graft had a significantly lower knee flexor torque compared with female patients with a BPTB graft (0.592 ± 0.49 N·m/kg vs 0.910 ± 0.24 N·m/kg; Cohen d [95% CI] = 0.91 [0.45, 1.36]). They also had a significantly lower knee flexor torque when compared with male patients with an HST graft (0.592 ± 0.49 N·m/kg vs 0.937 ± 0.35 N·m/kg; Cohen d [95% CI]= 0.88 [0.45, 1.31]). There were significant main effects for graft type with knee flexion (P = .001) and extension (P = .008) symmetry. Patients with a BPTB graft demonstrated lower knee extensor symmetry (65.7% ± 17.0%) and greater knee flexor symmetry (98.7% ± 18.0%) compared with patients with an HST graft (extension: 77.1% ± 32%, Cohen d [95% CI] = 0.47 [0.16, 0.79]; flexion: 82.9% ± 33.3%, Cohen d [95% CI] = 0.63 [0.31, 0.95]). We also observed a significant main effect for sex (P = .028) and graft type (P = .048) for mass-normalized knee extensor strength. Female participants and patients of either sex with BPTB grafts had lower knee extensor strength compared with male participants and patients with HST grafts, respectively. Conclusion: At approximately 6 months after ACLR, female patients reconstructed with HST autografts demonstrated weaker HST strength compared with female patients with a BPTB autograft. There were no differences in HST strength between graft types in male patients. Female patients appear to be recovering HST strength differently than male patients when using an HST autograft. These findings may have implications in surgical planning, postoperative rehabilitation, and return-to-sport decision making.
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Affiliation(s)
- Milos Lesevic
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Michelle E Kew
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Stephan G Bodkin
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia, USA
| | - David R Diduch
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Stephen F Brockmeier
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Mark D Miller
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - F Winston Gwathmey
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Brian C Werner
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Joseph M Hart
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA.,Department of Kinesiology, University of Virginia, Charlottesville, Virginia, USA
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Aquino CF, Ocarino JM, Cardoso VA, Resende RA, Souza TR, Rabelo LM, Fonseca ST. Current clinical practice and return-to-sport criteria after anterior cruciate ligament reconstruction: a survey of Brazilian physical therapists. Braz J Phys Ther 2020; 25:242-250. [PMID: 32561136 DOI: 10.1016/j.bjpt.2020.05.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 05/15/2020] [Accepted: 05/28/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Adherence to the use of recommended measures/criteria for return to sport clearance after anterior cruciate ligament reconstruction is crucial for successful rehabilitation. OBJECTIVES The purpose of this study was to describe the current clinical practice of Brazilian physical therapists that treat patients after anterior cruciate ligament reconstruction, including the measures/criteria used to support the decision-making process regarding return to sport. The secondary aim was to investigate factors associated with the use of the most recommended measures/criteria for return to sport. METHODS An electronic survey questionnaire was sent to Brazilian physical therapists. The survey consisted of questions about demographics and professional and clinical practice data related to anterior cruciate ligament reconstruction postoperative rehabilitation and return to sport criteria. Descriptive statistics and chi-square tests were used for analyses. RESULTS A sample of 439 professionals participated in the survey. Only 6.4% of the physical therapists use the most recommended measures/criteria for return to sport after anterior cruciate ligament reconstruction. Professional certification in Sports Physical Therapy was the only factor associated with the use of these recommended measures/criteria (p=0.02). The measures most used for return to sport clearance were related to physical factors (65.3% to 75.1%), such as range of motion and muscle strength. A small number of professionals use questionnaires to assess functional (16.6%) and psychological (19.1%) aspects of their patients to support the decision-making process. CONCLUSION In their clinical practice, most Brazilian physical therapists do not use the recommended measures/criteria for return to sport after anterior cruciate ligament reconstruction.
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Affiliation(s)
- Cecilia Ferreira Aquino
- Department of Physical Therapy, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil; Department of Physical Therapy, Universidade José do Rosário Vellano, Divinópolis, MG, Brazil; Universidade do Estado de Minas Gerais, Divinópolis, MG, Brazil
| | - Juliana Melo Ocarino
- Department of Physical Therapy, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Vanessa Aparecida Cardoso
- Department of Physical Therapy, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Renan Alves Resende
- Department of Physical Therapy, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Thales Rezende Souza
- Department of Physical Therapy, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Laís Menezes Rabelo
- Department of Physical Therapy, Universidade José do Rosário Vellano, Divinópolis, MG, Brazil
| | - Sérgio Teixeira Fonseca
- Department of Physical Therapy, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.
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Lin PE, Sigward SM. Influence of Hamstrings on Knee Moments During Loading Response of Gait in Individuals Following ACL Reconstruction. J Orthop Res 2020; 38:378-386. [PMID: 31502699 DOI: 10.1002/jor.24465] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 08/23/2019] [Indexed: 02/04/2023]
Abstract
Biomechanical studies consistently report smaller knee extensor moments in the surgical limb during loading response (LR) of gait following ACL reconstruction (ACLr). However, this reduction in knee loading is quantified by net joint moments (NJM). As a result, in the presence of greater hamstring activity, the true contribution from the knee extensors may not be reduced. The purpose of this study is to compare hamstring activity and strength and knee joint moments between individuals post-ACLr and controls. Eighteen individuals 3 months post-ACLr and matched controls walked and net knee extensor moment peak and impulse and hamstring activity were identified during LR, as well as maximal hamstring strength. A hybrid musculoskeletal model estimated knee flexor moments from joint kinematics and hamstring electromyography. Flexor moments (SIMM) were scaled based on strength. Knee extensor moments were estimated from the sum of the net knee moment and estimated knee flexor moment; estimated extensor moment peaks and impulse were calculated during LR. Repeated measures analysis of variance compared groups and limbs. Smaller net knee extensor moment and greater hamstring activity, as well as deficits in maximal hamstring strength, were observed in the surgical limb (all p < 0.05). When accounting for the torque-producing capabilities of the knee flexors, estimated knee extensor moment peak and impulse were smaller in the surgical limb. These findings suggest that net knee moments accurately reflect smaller knee extensor loading post-ACLr. Statement of Clinical Significance: Rehabilitation programs should target increasing knee extensor loading to restore gait mechanics during early rehabilitation. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:378-386, 2020.
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Affiliation(s)
- Paige E Lin
- Human Performance Laboratory, Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 Alcazar St, CHP 155, Los Angeles, California, 90089-9006
| | - Susan M Sigward
- Human Performance Laboratory, Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 Alcazar St, CHP 155, Los Angeles, California, 90089-9006
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Baez SE, Hoch JM, Cramer RJ. Social Cognitive Theory and the Fear-Avoidance Model: An Explanation of Poor Health Outcomes After ACL Reconstruction. ACTA ACUST UNITED AC 2019. [DOI: 10.3928/19425864-20181002-02] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Kaplan Y, Witvrouw E. When Is It Safe to Return to Sport After ACL Reconstruction? Reviewing the Criteria. Sports Health 2019; 11:301-305. [PMID: 31136725 DOI: 10.1177/1941738119846502] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
CONTEXT There is an ever-increasing trend toward sports, fitness, and recreation activities, so the incidence of anterior cruciate ligament sports injuries has increased. Perhaps the greatest challenge for sports clinicians is to return the injured athlete back to his/her original sport at an even greater level of functional ability than preinjury. For this, rigorous and well-researched criteria are needed. EVIDENCE ACQUISITION Using medical subject headings and free-text words, an electronic search was conducted up to October 2018. Subject-specific search was based on the terms return to play and return to sport in combination with guidelines, criteria, and anterior cruciate ligament reconstruction. STUDY DESIGN Descriptive review. LEVEL OF EVIDENCE Level 2. RESULTS Five principal criteria were found, including psychological factors, performance/functional tests, strength tests, time, and modifiable and nonmodifiable risk factors. CONCLUSION The psychological readiness of the player is a major factor in successful safe return to sport (SRTS) decision making. Although strength, performance, and functional tests presently form the mainstay of SRTS criteria, there exists very little scientific evidence for their validity. More protection should be provided to athletes with known risk factors. Movement quality is important, if not more important than the quantifiable measures. As a result of the significantly high rerupture rate in young individuals, delayed SRTS should be considered preferably beyond 9 months postsurgery.
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Affiliation(s)
- Yonatan Kaplan
- Jerusalem Sports Medicine Institute, Lerner Sports Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Erik Witvrouw
- Department of Rehabilitation Sciences & Physiotherapy at the Ghent University, Ghent, Belgium
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Head PL, Kasser R, Appling S, Cappaert T, Singhal K, Zucker-Levin A. Anterior cruciate ligament reconstruction and dynamic stability at time of release for return to sport. Phys Ther Sport 2019; 38:80-86. [PMID: 31071659 DOI: 10.1016/j.ptsp.2019.04.016] [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: 02/06/2019] [Revised: 04/23/2019] [Accepted: 04/23/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Examine dynamic stability using Dynamic Postural Stability Index (DPSI) in athletes following anterior cruciate ligament reconstruction (ACLR) at time of release for return-to-sport (RTS), compared to matched controls. DESIGN Cross-sectional case-control study. SETTING Sports medicine clinic. SUBJECTS Fifteen ACLR athletes who had completed post-operative rehabilitation and were within 6 weeks following release to RTS were age-, gender-, and activity-matched to 15 healthy controls. MAIN OUTCOME MEASURES Ground reaction forces (GRFs) were collected using a portable force plate during stabilization from three different single-leg landing tasks. A composite DPSI was calculated using GRFs. RESULTS Compared to matched controls, ACLR athletes within 6 weeks of release for RTS did not significantly differ in dynamic postural stability and there were no significant differences between the involved and uninvolved limbs in the ACLR group. CONCLUSION Current findings indicate that dynamic postural stability, as measured using the DPSI, is not significantly different in ACLR subjects at time of release for RTS compared to matched controls. In addition, the DPSI was not significantly different between the involved and uninvolved limbs in the ACLR subjects. The results suggest that the post-ACLR rehabilitation program utilized may have adequately restored postural stability in this particular sample.
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Affiliation(s)
- Penny L Head
- University of Tennessee Health Science Center, 930 Madison Avenue, Suite 604, Memphis, TN, 38163, USA.
| | - Richard Kasser
- University of Tennessee Health Science Center, 930 Madison Avenue, Suite 604, Memphis, TN, 38163, USA
| | - Susan Appling
- Ohio State University, 516 Atwell Hall, 453 W, 10th Avenue, Columbus, OH, 43210, USA
| | - Thomas Cappaert
- Rocky Mountain University of Health Professions, 122 East 1700 South, Bldg. 3, Provo, UT 84606, USA
| | - Kunal Singhal
- University of Tennessee Health Science Center, 930 Madison Avenue, Suite 604, Memphis, TN, 38163, USA
| | - Audrey Zucker-Levin
- University of Saskatchewan, 104 Clinic Place, Health Sciences E-Wing, Saskatoon, SK, S7N 2Z4, Canada
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Relationship Between Physical Therapy Characteristics, Surgical Procedure, and Clinical Outcomes in Patients After ACL Reconstruction. J Sport Rehabil 2019; 28:171-179. [DOI: 10.1123/jsr.2017-0176] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Context: Postoperative rehabilitation is critical to optimize outcomes after anterior cruciate ligament reconstruction (ACLR). However, the relationship between physical therapy (PT) and clinical outcomes is unclear. Objective: To describe PT characteristics following ACLR and to assess the relationships between PT characteristics, surgical procedure, and clinical outcomes. Design: Cross-sectional. Setting: Laboratory. Patients (or Other Participants): A total of 60 patients (31 females/29 males, age = 22.4 [9.2] y, height = 171.7 [9.9] cm, and mass = 70.2 [14.7] kg) with a history of primary unilateral ACLR (53.6% patellar tendon and 46.4% hamstring) participated. Intervention(s): Patients completed a performance assessment and rated subjective knee function prior to physician clearance (mean = 6.3 [1.3] mo postoperatively) and were contacted within 6 months of clearance to complete a PT questionnaire. Main Outcome Measures: PT questionnaire item response, knee extension maximum voluntary isometric contraction (MVIC) torque, peak isokinetic knee extension torque, single leg hop distance, and International Knee Documentation Committee were measured. Correlations assessed relationships between PT quantity and clinical outcomes. Independent t tests compared PT quantity and clinical outcomes based on return-to-sport status, readiness to return to sport, and surgical procedure. Results: Patients completed regular PT (2 d/wk, 25 wk, 58 visits) and were most likely to conclude when discharged by the therapist (68.3%). More than half (56.7%) returned to sport, yet most (73.3%) felt unready at discharge. Isokinetic torque was correlated with days of PT/week (r = .29, P = .03). Isokinetic torque and hop symmetry were reduced in patients who returned to sport (P < .05). Patients who felt ready to return completed fewer weeks of PT (P < .05). Patients with a patellar tendon graft completed more days of PT/week and total visits, but demonstrated lower MVIC torque, MVIC symmetry, and isokinetic symmetry (P < .05). Conclusions: Many patients felt unready to return to sport at PT discharge. PT frequency was associated with isokinetic torque, yet this relationship was small. Outcomes were reduced in patients who returned to sport, suggesting premature resumption of preinjury activity.
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Hewett TE, Webster KE, Hurd WJ. Systematic Selection of Key Logistic Regression Variables for Risk Prediction Analyses: A Five-Factor Maximum Model. Clin J Sport Med 2019; 29:78-85. [PMID: 28817414 PMCID: PMC5815966 DOI: 10.1097/jsm.0000000000000486] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
GENERAL AND CRITICAL REVIEW FORMAT The evolution of clinical practice and medical technology has yielded an increasing number of clinical measures and tests to assess a patient's progression and return to sport readiness after injury. The plethora of available tests may be burdensome to clinicians in the absence of evidence that demonstrates the utility of a given measurement. OBJECTIVE Thus, there is a critical need to identify a discrete number of metrics to capture during clinical assessment to effectively and concisely guide patient care. DATA SOURCES The data sources included Pubmed and PMC Pubmed Central articles on the topic. Therefore, we present a systematic approach to injury risk analyses and how this concept may be used in algorithms for risk analyses for primary anterior cruciate ligament (ACL) injury in healthy athletes and patients after ACL reconstruction. MAIN RESULTS In this article, we present the five-factor maximum model, which states that in any predictive model, a maximum of 5 variables will contribute in a meaningful manner to any risk factor analysis. CONCLUSIONS We demonstrate how this model already exists for prevention of primary ACL injury, how this model may guide development of the second ACL injury risk analysis, and how the five-factor maximum model may be applied across the injury spectrum for development of the injury risk analysis.
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Affiliation(s)
- Timothy E. Hewett
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
- Department of Sports Medicine, Sports Health and Performance Institute, The Ohio State University, Columbus, Ohio
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota
| | - Kate E. Webster
- School of Allied Health, La Trobe University, Melbourne, Australia
| | - Wendy J. Hurd
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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Labanca L, Rocchi JE, Laudani L, Guitaldi R, Virgulti A, Mariani PP, Macaluso A. Neuromuscular Electrical Stimulation Superimposed on Movement Early after ACL Surgery. Med Sci Sports Exerc 2018; 50:407-416. [PMID: 29059108 DOI: 10.1249/mss.0000000000001462] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE Quadriceps weakness and asymmetrical loading of lower limbs are two major issues after anterior cruciate ligament reconstruction (ACLR). The aim of this study was to evaluate the effectiveness of a 6-wk training protocol involving neuromuscular electrical stimulations (NMES) of the quadriceps muscle superimposed on repeated sit-to-stand-to-sit exercises (STSTS), as an additional treatment to standard rehabilitation, from the 15th to the 60th day after ACLR. METHODS Sixty-three ACLR patients were randomly allocated to one of the three treatment groups: NMES superimposed on STSTS (NMES + STSTS), STSTS only, or no additional treatment (NAT) to standard rehabilitation. Maximal isometric strength of the knee extensor and flexor muscles was measured 60 and 180 d after surgery. Asymmetry in lower extremity loading was measured during a sit-to-stand movement at 15, 30, 60, and 180 d after surgery and during a countermovement jump 180 d after surgery by means of two adjacent force platforms placed under each foot. RESULTS The NMES + STSTS participants showed higher muscle strength of the knee extensors, which was accompanied by lower perception of pain and higher symmetry in lower extremity loading compared with STSTS-only and NAT participants after both 60 and 180 d from surgery. Participants in the STSTS-only treatment group showed higher symmetry in lower extremity loading compared with those in the NAT group 60 d after surgery. CONCLUSIONS These results suggest that an early intervention based on NMES superimposed to repeated STSTS exercises is effective for recovering quadriceps strength and symmetry in lower extremity loading by the time of return to sport.
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Affiliation(s)
- Luciana Labanca
- Department of Movement, Human and Health Sciences, University of Rome Foro Italico, Rome, ITALY
| | - Jacopo Emanuele Rocchi
- Department of Movement, Human and Health Sciences, University of Rome Foro Italico, Rome, ITALY.,Department of Movement, Human and Health Sciences, University of Rome Foro Italico, Rome, ITALY
| | - Luca Laudani
- Department of Movement, Human and Health Sciences, University of Rome Foro Italico, Rome, ITALY
| | - Rita Guitaldi
- Department of Movement, Human and Health Sciences, University of Rome Foro Italico, Rome, ITALY
| | - Alessandro Virgulti
- Department of Movement, Human and Health Sciences, University of Rome Foro Italico, Rome, ITALY
| | - Pier Paolo Mariani
- Department of Movement, Human and Health Sciences, University of Rome Foro Italico, Rome, ITALY.,Department of Movement, Human and Health Sciences, University of Rome Foro Italico, Rome, ITALY
| | - Andrea Macaluso
- Department of Movement, Human and Health Sciences, University of Rome Foro Italico, Rome, ITALY.,Department of Movement, Human and Health Sciences, University of Rome Foro Italico, Rome, ITALY
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Frontal plane movement of the pelvis and thorax during dynamic activities in individuals with and without anterior cruciate ligament injury. Knee 2018; 25:997-1008. [PMID: 30172444 PMCID: PMC6291429 DOI: 10.1016/j.knee.2018.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 05/29/2018] [Accepted: 06/04/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND For elite athletes with anterior cruciate ligament (ACL) reconstruction, reducing pelvis and trunk obliquities is a common goal of rehabilitation. It is not known if this is also a suitable goal for the general population. This study aimed to quantify pelvis and thorax obliquities during dynamic activities in individuals from the general population with and without history of ACL injury. METHODS Retrospective analysis of cross-sectional data from 30 participants with ACL reconstruction, 28 participants with ACL deficiency (ACLD), and 32 controls who performed overground walking and jogging, single-leg squat, and single-leg hop for distance. Pelvis and thorax obliquities were quantified in each activity and compared across groups using one-way ANOVA. Coordination was quantified using cross covariance. RESULTS In the stance phase of walking and jogging, pelvis and thorax obliquities were within ±10° of neutral and there was a negative correlation between the two segments at close to zero phase lag. In single-leg squat and hop, range of obliquities varied across individuals and there was no consistent pattern of coordination. Eight ACLD participants felt unable to perform the single-leg hop. In the remaining participants, range of pelvis (p = 0.04) and thorax (p = 0.02) obliquities was smaller in ACLD than controls. CONCLUSIONS In challenging single-leg activities, minimal frontal plane motion was not the typical movement pattern observed in the general population. Coordination between the pelvis and thorax was inconsistent within and across individuals. Care should be taken when considering minimising pelvis and thorax obliquities in patients with ACL injury.
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Mostafaee N, Negahban H, Shaterzadeh Yazdi MJ, Goharpey S, Mehravar M, Pirayeh N. Responsiveness of a Persian version of Knee Injury and Osteoarthritis Outcome Score and Tegner activity scale in athletes with anterior cruciate ligament reconstruction following physiotherapy treatment. Physiother Theory Pract 2018; 36:1019-1026. [PMID: 30468412 DOI: 10.1080/09593985.2018.1548672] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE To evaluate the responsiveness and determine the minimal clinically important changes (MCICs), anchored by the patient response to a 7-point global rating scale, for Knee Injury and Osteoarthritis Outcome Score (KOOS), and Tegner activity scale in athletes undergoing physiotherapy treatment after anterior cruciate ligament reconstruction (ACL-R). Methods: Fifty-four patients undergoing physiotherapy completed the Persian versions of KOOS and Tegner scales at weeks 6 and 10 post ACL-R. The 7-point global rating of change was also completed at week 10. Responsiveness was calculated via receiver operating characteristic curve and correlation analysis. Results: Acceptable responsiveness was reached by the KOOS sports and recreation subscale (Sport/Rec) (area under the curve (AUC) = 0.72; Gamma = 0.37) and Tegner scale (AUC = 0.75; Gamma = 0.59). The MCIC scores of KOOS subscales and Tegner scale were reported. Conclusion: Our findings demonstrated that the KOOS Sport/Rec subscale and Tegner scale have adequate responsiveness between weeks 6 and 10 of physiotherapy. Therefore, these scales should be used to evaluate the effects of physiotherapy treatment and the changes in activity levels in this population. The MCIC scores of the KOOS and Tegner scale can be used to detect changes significant to the patient while avoiding limitations of other methods.
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Affiliation(s)
- Neda Mostafaee
- Department of Physical Therapy, School of Paramedical Sciences, Mashhad University of Medical Sciences , Mashhad, Iran
| | - Hossein Negahban
- Department of Physical Therapy, School of Paramedical Sciences, Mashhad University of Medical Sciences , Mashhad, Iran.,Orthopedic Research Center, Mashhad University of Medical Sciences , Mashhad, Iran
| | | | - Shahin Goharpey
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences , Ahvaz, Iran
| | - Mohammad Mehravar
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences , Ahvaz, Iran
| | - Nahid Pirayeh
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences , Ahvaz, Iran
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Psychological and Functional Readiness for Sport Following Advanced Group Training in Patients With Anterior Cruciate Ligament Reconstruction. J Orthop Sports Phys Ther 2018; 48:864-872. [PMID: 29895233 DOI: 10.2519/jospt.2018.8041] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Decreased psychological readiness for sport may contribute to poor return-to-sport rates after anterior cruciate ligament reconstruction (ACLR). Though advanced rehabilitation is used to improve functional readiness for sport after ACLR, the effect of advanced rehabilitation on psychological readiness is unknown. OBJECTIVE To examine changes in psychological and functional measures and readiness for sport based on these measures in patients with ACLR following advanced group training. METHODS In this retrospective cohort study, patients with primary ACLR enrolled in a 5-week group training program after completing traditional physical therapy. Data collection pretraining and posttraining included demographic information, the Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) scale, and single-leg hop testing (single, triple, crossover triple, and timed hops). Readiness for sport was based on criteria for the ACL-RSI scale score (low threshold, 56 points or greater; high threshold, 75 points or greater) and hop tests (90% or greater limb symmetry). RESULTS Fifty-eight patients (21 male) participated. Mean ACL-RSI scale scores, mean hop test limb symmetry, and the proportion of patients meeting ACL-RSI and hop test readiness-for-sport criteria significantly improved from pretraining to posttraining. Posttraining ACL-RSI scale scores were correlated with single hop (r = 0.269) and triple hop (r = 0.275) limb symmetry, yet changes in the measures were not significantly correlated. After training, only 53.4% (lower ACL-RSI threshold) or 37.9% (higher ACL-RSI threshold) of the sample met both psychological and functional readiness criteria. CONCLUSION Advanced group training following ACLR improved psychological and functional outcomes; however, further, individualized intervention may be needed to address residual deficiencies in some patients. LEVEL OF EVIDENCE Therapy, level 2b. J Orthop Sports Phys Ther 2018;48(11):864-872. Epub 12 Jun 2018. doi:10.2519/jospt.2018.8041.
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Garrison JC, Hannon J, Goto S, Giesler L, Bush C, Bothwell JM. Participants at three months post-operative anterior cruciate ligament reconstruction (ACL-R) demonstrate differences in lower extremity energy absorption contribution and quadriceps strength compared to healthy controls. Knee 2018; 25:782-789. [PMID: 30001937 DOI: 10.1016/j.knee.2018.06.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 06/19/2018] [Accepted: 06/23/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND The purpose of this study was to compare hip and knee energy absorption contribution (EAC) during a double limb squat (DLS) and quadriceps strength in patients three months post-operative ACL-R versus matched healthy controls. METHODS Twenty-four ACL-R participants (Age = 15.5 ± 1.3 yrs; Ht = 1.66 ± .07 m; Mass = 66.3 ± 15.5 kg) were compared to 24 age, sex, limb, and activity-matched healthy controls (Age = 15.5 ± 1.2 yrs; Ht = 1.65 ± .08 m; Mass = 59.0 ± 9.8 kg). Lower extremity biomechanical data was collected at three months post-operative ACL-R during five consecutive DLS. EAC was calculated during DLS descent. Isokinetic quadriceps strength was collected at 60°/s. Normalized quadriceps peak torque (QUADS) was averaged across five trials. Independent t-tests examined differences in group hip and knee EAC during each task. Separate Pearson product-moment correlations examined the relationship between QUADS and hip and knee EAC during the DLS. RESULTS ACL-R demonstrated greater injured limb hip EAC (46.4 ± 16.0) than Healthy (31.7 ± 11.0) during a DLS (p = 0.001). ACL-R demonstrated less injured limb knee EAC (42.7 ± 14.6) than Healthy (60.6 ± 8.9) during DLS (p < 0.001). No differences were seen between uninjured limb hip (ACL-R = 0.0 ± 14.2; Healthy = 33.4 ± 9.1, p = 0.629) or knee (ACL-R = 56.9 ± 15.6; Healthy = 59.1 ± 9.8, p = 0.561) EAC and matched limbs. ACL-R injured limb QUADS was decreased compared to Healthy (ACL-R = 1.1 ± 0.5; Healthy = 2.0 ± 0.5, p < 0.001). No differences were seen in QUADS on the uninjured and matched limbs (ACL-R = 2.0 ± 0.6; Healthy = 1.9 ± 0.5, p = 0.894). There was a weak, negative correlation between injured limb QUADS and hip EAC (r = -0.471, p = 0.001) and moderate, positive correlation between injured limb QUADS and knee EAC (r = 0.615, p < 0.001). CONCLUSIONS ACL-R participants demonstrate different eccentric loading strategies during a DLS at three months postoperative compared to matched healthy controls.
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Affiliation(s)
- J Craig Garrison
- Texas Health Sports Medicine, 800 5th Ave. Suite 150, Fort Worth, TX 76104, United States of America.
| | - Joseph Hannon
- Texas Health Sports Medicine Southwest, 6301 Harris Pkwy. Suite 150, Fort Worth, TX 76132, United States of America
| | - Shiho Goto
- Texas Health Sports Medicine Southwest, 6301 Harris Pkwy. Suite 150, Fort Worth, TX 76132, United States of America
| | - Laura Giesler
- Texas Health Sports Medicine, 800 5th Ave. Suite 150, Fort Worth, TX 76104, United States of America
| | - Curtis Bush
- Orthopedic Specialty Associates, 800 5th Ave, Suite 500, Fort Worth, TX 76104, United States of America
| | - James M Bothwell
- Fort Worth Orthopedics, 6301 Harris Pkwy. Suite 200, Fort Worth, TX 76132, United States of America
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Compensatory Strategies That Reduce Knee Extensor Demand During a Bilateral Squat Change From 3 to 5 Months Following Anterior Cruciate Ligament Reconstruction. J Orthop Sports Phys Ther 2018; 48:713-718. [PMID: 29895231 DOI: 10.2519/jospt.2018.7977] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background Decreased extensor moments in the surgical knee during bilateral squats can persist beyond 1 year following anterior cruciate ligament reconstruction (ACLR). This is accomplished using interlimb and intralimb compensations. Objectives This study sought to assess loading during squatting longitudinally, 3 and 5 months post ACLR, and to determine the extent to which interlimb and intralimb compensations contribute to reduced knee extensor moments. Methods In this controlled, longitudinal laboratory study, 11 individuals (4 male) underwent 3-D motion analysis of a squat at 3 and 5 months post ACLR. A repeated-measures multivariate analysis of variance (limb by time) assessed differences in peak knee and hip flexion angles, knee extensor moment, vertical ground reaction force, and hip-to-knee extensor moment ratio. Stepwise linear regression analysis was used to determine the contribution of interlimb (between-limb vertical ground reaction force ratio) and intralimb (within-surgical-limb hip-to-knee moment ratio) compensations to the between-limb knee extensor moment ratio. Results A significant effect of limb was observed for knee flexion angle, knee extensor moment, vertical ground reaction force, and hip-to-knee extensor moment ratio, while a significant effect of time was observed for knee extensor moment and hip-to-knee extensor moment ratio. At 3 months, the vertical ground reaction force ratio and hip-to-knee extensor moment ratio predicted the knee extensor moment ratio (R2 = 0.854, P<.001). At 5 months, the hip-to-knee extensor moment ratio predicted the knee extensor moment ratio (R2 = 0.584, P = .006). Conclusion Individuals used interlimb and intralimb compensations to reduce the knee extensor moment of the surgical limb at 3 months post ACLR. Similar reductions in the knee extensor moment at 5 months were accomplished with only intralimb compensations. J Orthop Sports Phys Ther 2018;48(9):713-718. Epub 12 Jun 2018. https://doi.org/10.2519/jospt.2018.7977.
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Pérez J, Novoa GA, Pierobon A, Soliño S, Calvo Delfino M, Sajfar ME, Carmody C, Vuoto T, Dorado JH, Salzberg S. Postoperative rehabilitation of simultaneous rupture of anterior cruciate ligament and patellar ligament: A case report. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2018; 23:e1735. [PMID: 30058203 DOI: 10.1002/pri.1735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 06/15/2018] [Indexed: 01/05/2023]
Abstract
INTRODUCTION The simultaneous rupture of anterior cruciate ligament (ACL) and patellar ligament (PL) is an infrequent condition. Each isolated injury has surgical techniques and rehabilitation protocols that differ widely among each other. Nonetheless, there is no established physical rehabilitation approach when both injuries are associated. OBJECTIVE The aim of this report is to describe the rehabilitation and the outcomes obtained in the postoperative period of simultaneous rupture of ACL and PL and the follow-up period. CASE REPORT A 21-year-old male patient suffered the rupture of ACL and PL after landing from a jump while playing soccer. The knee was immediately immobilized, and 10 weeks later, he was operated in a one-stage surgery. He initiated his rehabilitation 3 weeks after the surgical resolution. A three-times a week rehabilitation was implemented to restore range of motion and improve functional status. An extensive evaluation was carried out monthly using dynamic neuromuscular tests and self-reported questionnaires. RESULTS At the end of the rehabilitation, he presented a complete extension and 130° of knee flexion in passive open kinetic chain. The Single Leg Squat and Landing Error Scoring System showed a good performance, while the Star Excursion Balance Test and the single hops assessments were symmetrical. The International Knee Documentation Committee and Lower Extremity Functional Scale questionnaires yielded values of 90.8% and 77 points, respectively. CONCLUSION An approach based on mobility exercises and strengthening of the lower limbs and the core muscles, considering the biological healing times of each particular structure, made it possible to obtain satisfactory results in mobility, functional tests, self-reported questionnaires, and patient's satisfaction.
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Affiliation(s)
- Joaquín Pérez
- Physical Therapy Unit, Carlos G. Durand Hospital, Autonomous City of Buenos Aires, Argentina
| | - Gabriel Adrián Novoa
- Physical Therapy Unit, Carlos G. Durand Hospital, Autonomous City of Buenos Aires, Argentina
| | - Andrés Pierobon
- Physical Therapy Unit, Carlos G. Durand Hospital, Autonomous City of Buenos Aires, Argentina
| | - Santiago Soliño
- Physical Therapy Unit, Carlos G. Durand Hospital, Autonomous City of Buenos Aires, Argentina
| | - Melina Calvo Delfino
- Physical Therapy Unit, Carlos G. Durand Hospital, Autonomous City of Buenos Aires, Argentina
| | - Malka Eugenia Sajfar
- Physical Therapy Unit, Carlos G. Durand Hospital, Autonomous City of Buenos Aires, Argentina
| | - Candela Carmody
- Physical Therapy Unit, Carlos G. Durand Hospital, Autonomous City of Buenos Aires, Argentina
| | - Tomas Vuoto
- Physical Therapy Unit, Carlos G. Durand Hospital, Autonomous City of Buenos Aires, Argentina
| | - Javier Hernán Dorado
- Physical Therapy Unit, Carlos G. Durand Hospital, Autonomous City of Buenos Aires, Argentina
| | - Sandra Salzberg
- Physical Therapy Unit, Carlos G. Durand Hospital, Autonomous City of Buenos Aires, Argentina
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Gokeler A, Seil R, Kerkhoffs G, Verhagen E. A novel approach to enhance ACL injury prevention programs. J Exp Orthop 2018; 5:22. [PMID: 29916182 PMCID: PMC6005994 DOI: 10.1186/s40634-018-0137-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 06/06/2018] [Indexed: 12/22/2022] Open
Abstract
Efficacy studies have demonstrated decreased anterior cruciate ligament (ACL) injury rates for athletes participating in injury prevention programs. Typically, ACL injury prevention programs entail a combination of plyometrics, strength training, agility and balance exercises. Unfortunately, improvements of movement patterns are not sustained over time. The reason may be related to the type of instructions given during training. Encouraging athletes to consciously control knee movements during exercises may not be optimal for the acquisition of complex motor skills as needed in complex sports environments. In the motor learning domain, these types of instructions are defined as an internal attentional focus. An internal focus, on one's own movements results in a more conscious type of control that may hamper motor learning. It has been established in numerous studies that an external focus of attention facilitates motor learning more effectively due to the utilization of automatic motor control. Subsequently, the athlete has more recourses available to anticipate on situations on the field and take appropriate feed forward directed actions. The purpose of this manuscript was to present methods to optimize motor skill acquisition of athletes and elaborate on athletes' behavior.
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Affiliation(s)
- Alli Gokeler
- Luxembourg Institute of Research for Orthopedics, Medicine and Science in Sports, 76 rue d'Eich, L-1460, Luxembourg, Luxembourg. .,Department of Applied Neuroscience in Sports and Exercise, Institute of Sports Medicine, University of Paderborn, Paderborn, Germany. .,University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, Netherlands.
| | - Romain Seil
- Luxembourg Institute of Research for Orthopedics, Medicine and Science in Sports, 76 rue d'Eich, L-1460, Luxembourg, Luxembourg
| | - Gino Kerkhoffs
- Academic Center for Evidence based Sports Medicine (ACES), Academic Medical Center, Amsterdam, Netherlands.,Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam, Netherlands.,Amsterdam Collaboration for Health & Safety in Sports (ACHSS), IOC Research Center, Academic Medical Center/VU Medical Center, Amsterdam, Netherlands
| | - Evert Verhagen
- Amsterdam Collaboration for Health & Safety in Sports (ACHSS), IOC Research Center, Academic Medical Center/VU Medical Center, Amsterdam, Netherlands.,Department of Public and Occupational Health, Amsterdam Movement Sciences, VU University Medical Center, Amsterdam, Netherlands.,Division of Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town, Cape Town, South Africa
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Jalali M, Farahmand F, Esfandiarpour F, Golestanha SA, Akbar M, Eskandari A, Mousavi SE. The effect of functional bracing on the arthrokinematics of anterior cruciate ligament injured knees during lunge exercise. Gait Posture 2018; 63:52-57. [PMID: 29709723 DOI: 10.1016/j.gaitpost.2018.04.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 04/05/2018] [Accepted: 04/18/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Functional knee braces are extensively used for partially and completely torn anterior cruciate ligament (ACL) patients and those who have undergone ACL graft reconstruction, in order to support the healing ACL, improve the joint's functional stability, and restore the normal joint kinematics. RESEARCH QUESTION Does wearing braces alter the arthrokinematics of the ACL deficient knees during lung exercise? METHODS For ten male unilateral ACL deficient subjects, 3D knee models were reconstructed from CT images, acquired in rest position. Sagittal plane fluoroscopy was then performed throughout a complete cycle of lunge in braced and non-braced conditions. The 3D kinematics of the knees were obtained using a 2D-3D registration method in which six anatomical bony landmarks on the fluoroscopic images were matched with those on the 3D models. RESULTS No significant difference was found between the tibial anterior-posterior translations and abduction-adduction motions of the braced and non-braced knees. A significant decrease, however, was observed after bracing in the tibial internal rotation at 45° flexion during eccentric (non-braced: 5.9° (±6.7°) vs. braced: 2.4° (±7.0°); p = 0.045), and at 30° flexion during concentric (non-braced: 2.3° (±6.9°) vs. braced: -1.6° (±8.1°); p = 0.001) phases of the lunge cycle. SIGNIFICANCE The immediate effect of knee bracing is limited to controlling the tibial rotation of the ACL deficient individuals during the lunge exercise. Hence, care should be taken in prescribing the lunge exercise for rehabilitation of ACL injured patients with high anterior-posterior knee instability, even when wearing knee braces.
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Affiliation(s)
- Maryam Jalali
- Orthotics & Prosthetics Department, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.
| | - Farzam Farahmand
- Mechanical Engineering Department, Sharif University of Technology, Tehran, Iran.
| | - Fateme Esfandiarpour
- Musculoskeletal Rehabilitation Research Centre, Ahvaz Jundishapour University of Medical Sciences, Ahvaz, Iran; Department of Family Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
| | - Seyed Ali Golestanha
- Department of Radiology, Mostafa Khomeini Hospital, Shahed University, Tehran, Iran.
| | - Mohammad Akbar
- Mechanical Engineering Department, Sharif University of Technology, Tehran, Iran.
| | - Amirhosein Eskandari
- Mechanical Engineering Department, Sharif University of Technology, Tehran, Iran.
| | - Seyed Ebrahim Mousavi
- Orthotics & Prosthetics Department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
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Rambaud AJM, Ardern CL, Thoreux P, Regnaux JP, Edouard P. Criteria for return to running after anterior cruciate ligament reconstruction: a scoping review. Br J Sports Med 2018; 52:1437-1444. [DOI: 10.1136/bjsports-2017-098602] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2018] [Indexed: 12/22/2022]
Abstract
ObjectiveTo describe the criteria used to guide clinical decision-making regarding when a patient is ready to return to running (RTR) after ACL reconstruction.DesignScoping review.Data sourcesThe MEDLINE (PubMed), EMBASE, Web of Science, PEDro, SPORTDiscus and Cochrane Library electronic databases. We also screened the reference lists of included studies and conducted forward citation tracking.Eligibility criteria for selecting studiesReported at least one criterion for permitting adult patients with primary ACL reconstruction to commence running postoperatively.Results201 studies fulfilled the inclusion criteria and reported 205 time-based criteria for RTR. The median time from when RTR was permitted was 12 postoperative weeks (IQR=3.3, range 5–39 weeks). Fewer than one in five studies used additional clinical, strength or performance-based criteria for decision-making regarding RTR. Aside from time, the most frequently reported criteria for RTR were: full knee range of motion or >95% of the non-injured knee plus no pain or pain <2 on visual analogue scale; isometric extensor limb symmetry index (LSI)>70% plus extensor and flexor LSI>70%; and hop test LSI>70%.ConclusionsFewer than one in five studies reported clinical, strength or performance-based criteria for RTR even though best evidence recommends performance-based criteria combined with time-based criteria to commence running activities following ACL reconstruction.
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Gokeler A, Dingenen B, Mouton C, Seil R. Clinical course and recommendations for patients after anterior cruciate ligament injury and subsequent reconstruction: A narrative review. EFORT Open Rev 2017; 2:410-420. [PMID: 29209517 PMCID: PMC5702954 DOI: 10.1302/2058-5241.2.170011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Almost all athletes who have suffered an anterior cruciate ligament (ACL) injury expect a full return to sports at the same pre-injury level after ACL reconstruction (ACLR). Detailed patient information on the reasonable outcomes of the surgery may be essential to improve patient satisfaction. Pre-operative rehabilitation before ACLR should be considered as an addition to the standard of care to maximise functional outcomes after ACLR. We propose an optimised criterion-based rehabilitation programme within a biopsychosocial framework. No benchmark exists for evaluating return-to-sport (RTS) readiness after ACLR. Therefore, the authors propose a multi-factorial RTS test battery. A combination of both physical and psychological elements should be included in the RTS test battery. There is need for shared decision-making regarding RTS.
Cite this article: EFORT Open Rev 2017;2:410-420. DOI: 10.1302/2058-5241.2.170011
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Affiliation(s)
- Alli Gokeler
- University of Groningen, University Medical Center Groningen, Center for Human Movement Science, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands
| | - Bart Dingenen
- Rehabilitation Research Institute, Biomedical Research Institute, Faculty of Medicine and Life Sciences, UHasselt, Diepenbeek, Belgium
| | - Caroline Mouton
- Département de l'Appareil Locomoteur, Centre Hospitalier de Luxembourg - Clinique d'Eich, 76, rue d'Eich, L-1460 Luxembourg, Luxembourg
| | - Romain Seil
- Département de l'Appareil Locomoteur, Centre Hospitalier de Luxembourg - Clinique d'Eich, 76, rue d'Eich, L-1460 Luxembourg, Luxembourg and Sports Medicine Research Laboratory, Luxembourg Institute of Health, 76, rue d'Eich, L-1460 Luxembourg, Luxembourg
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Di Miceli R, Marambio CB, Zati A, Monesi R, Benedetti MG. Do Knee Bracing and Delayed Weight Bearing Affect Mid-Term Functional Outcome after Anterior Cruciate Ligament Reconstruction? JOINTS 2017; 5:202-206. [PMID: 29270556 PMCID: PMC5738480 DOI: 10.1055/s-0037-1606617] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Purpose The aim of this study was to assess the effect of knee bracing and timing of full weight bearing after anterior cruciate ligament reconstruction (ACLR) on functional outcomes at mid-term follow-up. Methods We performed a retrospective study on 41 patients with ACLR. Patients were divided in two groups: ACLR group, who received isolated ACL reconstruction and ACLR-OI group who received ACL reconstruction and adjunctive surgery. Information about age at surgery, bracing, full or progressive weight bearing permission after surgery were collected for the two groups. Subjective IKDC score was obtained at follow-up. Statistical analysis was performed to compare the two groups for IKDC score. Subgroup analysis was performed to assess the effect of postoperative regimen (knee bracing and weight bearing) on functional outcomes. Results The mean age of patients was 30.8 ± 10.6 years. Mean IKDC score was 87.4 ± 13.9. The mean follow-up was 3.5 ± 1.8 years. Twenty-two (53.7%) patients underwent ACLR only, while 19 (46.3%) also received other interventions, such as meniscal repair and/or collateral ligament suture. Analysis of overall data showed no differences between the groups for IKDC score. Patients in the ACLR group exhibited a significantly better IKDC score when no brace and full weight bearing after 4 weeks from surgery was prescribed in comparison with patients who worn a brace and had delayed full weight bearing. No differences were found with respect to the use of brace and postoperative weight bearing regimen in the ACLR-OI group. Conclusion Brace and delayed weight bearing after ACLR have a negative influence on long-term functional outcomes. Further research is required to explore possible differences in the patients operated on ACLR and other intervention with respect to the use of a brace and the timing of full weight bearing to identify optimal recovery strategies. Level of Evidence Level III, retrospective observational study.
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Affiliation(s)
- Riccardo Di Miceli
- SC Medicina Fisica e Riabilitativa, Istituto Ortopedico Rizzoli di Bologna, Bologna, Italy
| | | | - Alessandro Zati
- SC Medicina Fisica e Riabilitativa, Istituto Ortopedico Rizzoli di Bologna, Bologna, Italy
| | - Roberta Monesi
- SC Medicina Fisica e Riabilitativa, Istituto Ortopedico Rizzoli di Bologna, Bologna, Italy
| | - Maria Grazia Benedetti
- SC Medicina Fisica e Riabilitativa, Istituto Ortopedico Rizzoli di Bologna, Bologna, Italy
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Lynch AD, Chmielewski T, Bailey L, Stuart M, Cooper J, Coady C, Sgroi T, Owens J, Schenck R, Whelan D, Musahl V, Irrgang J. Current Concepts and Controversies in Rehabilitation After Surgery for Multiple Ligament Knee Injury. Curr Rev Musculoskelet Med 2017; 10:328-345. [PMID: 28779476 DOI: 10.1007/s12178-017-9425-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW The purpose of this manuscript is twofold: (1) to review the literature related to rehabilitation after surgery for multiple ligament knee injury (MLKI) and after isolated surgery for the posterior cruciate ligament (PCL), posterolateral corner (PLC), and medial side of the knee and (2) to present a hierarchy of anatomic structures needing the most protection to guide rehabilitation. RECENT FINDINGS MLKIs continue to be a rare but devastating injury. Recent evidence indicates that clinicians may be providing too much protection from early weight bearing and range of motion, but an accelerated approach has not been rigorously tested. Consideration of the nature and quality of surgical procedures (repair and reconstruction) can help clinicians determine the structures needing the most protection during the rehabilitation period. The biomechanical literature and prior clinical experience can aid clinicians to better structure rehabilitation after surgery for MLKI and improve clinical outcome for patients.
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Affiliation(s)
- Andrew D Lynch
- University of Pittsburgh, 100 Technology Drive, Pittsburgh, PA, 15219, USA.
| | | | - Lane Bailey
- University of Texas at Houston, Houston, TX, USA
| | | | | | - Cathy Coady
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | | | - Johnny Owens
- San Antonio Military Medical Center, San Antonio, TX, USA
| | | | | | - Volker Musahl
- University of Pittsburgh, 100 Technology Drive, Pittsburgh, PA, 15219, USA
| | - James Irrgang
- University of Pittsburgh, 100 Technology Drive, Pittsburgh, PA, 15219, USA
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Eckenrode BJ, Carey JL, Sennett BJ, Zgonis MH. Prevention and Management of Post-operative Complications Following ACL Reconstruction. Curr Rev Musculoskelet Med 2017; 10:315-321. [PMID: 28710739 DOI: 10.1007/s12178-017-9427-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW The goal of this paper is to review the current management and prevention of post-operative complications after anterior cruciate ligament (ACL) reconstruction. Trends in rehabilitation techniques will be presented, in addition to suggestions for interventions and expected milestones in ACL reconstruction recovery. RECENT FINDINGS ACL reconstruction protocols have evolved to more of a criterion-based progression rather than a tissue-healing time frame. Given the evolution of ACL surgical reconstruction techniques and rehabilitation protocols, the risk of post-operative complications can arise both early and late in the recovery process. This paper will discuss the role of preventative measures as it applies to the post-operative patient with ACL reconstruction. Short-term complications following ACL reconstruction include infection and deficits to knee motion and strength, whereas long-term complications include secondary ACL injury to either the involved or contralateral knee and lack of ability to return to high-level sports following this procedure. Future research should continue to address the multifactorial causes of secondary ACL injury and limited ability of patients to return to high level activities.
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Affiliation(s)
- Brian J Eckenrode
- Arcadia University, 450 S. Easton Road, Glenside, PA, 19038, USA. .,Good Shepherd Penn Partners at Penn Sports Medicine Center, Philadelphia, PA, USA.
| | - James L Carey
- Penn Sports Medicine Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Brian J Sennett
- Penn Sports Medicine Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Miltiadis H Zgonis
- Penn Sports Medicine Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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McGowan J, Reid DA, Caldwell J. Post-operative rehabilitation of anterior cruciate ligament reconstruction in the skeletally immature child: a systematic review of the literature. PHYSICAL THERAPY REVIEWS 2017. [DOI: 10.1080/10833196.2017.1364541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - Duncan A. Reid
- School of Sport and Recreation, Auckland University of Technology , Auckland, New Zealand
| | - Jill Caldwell
- School of Physiotherapy, Auckland University of Technology , Auckland, New Zealand
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Abstract
PURPOSE OF REVIEW Mechanisms leading to anterior cruciate ligament (ACL) injury have been identified, yet re-injury or a secondary injury persists in the athletic population. The purpose of this review is to identify risk factors associated with ACL injury and investigate programs to prevent injury. RECENT FINDINGS Faulty mechanics during dynamic movement that cause excessive valgus force at the knee increases the risk of ACL injury. Faulty mechanics may be a result of lateral displacement of the trunk, unequal limb loading, and lack of control to avoid the valgus knee position. Altered movements that place the ACL at risk are best identified in a fatigued state; however, could be recognized in a standard dynamic assessment. The faulty movement patterns are modifiable and should be addressed in an injury prevention program. Prevention programs include various modes of exercise such as plyometrics, neuromuscular training, and strength training. This review concludes that those programs which utilize neuromuscular training and strength training at a young age show the most promise in reducing ACL injuries. An ongoing thorough dynamic examination is necessary for all athletes while adjusting the intervention program in order to decrease the risk of ACL injury.
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Graziano J, Chiaia T, de Mille P, Nawabi DH, Green DW, Cordasco FA. Return to Sport for Skeletally Immature Athletes After ACL Reconstruction: Preventing a Second Injury Using a Quality of Movement Assessment and Quantitative Measures to Address Modifiable Risk Factors. Orthop J Sports Med 2017; 5:2325967117700599. [PMID: 28451617 PMCID: PMC5400136 DOI: 10.1177/2325967117700599] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Reinjury rates after anterior cruciate ligament reconstruction (ACLR) are highest among young athletes, who consequently suffer from low rates of return to play. Historically, quantitative measures have been used to determine readiness to return to sport; however, they do not assess modifiable risk factors related to the quality of movement. Purpose: To determine the effectiveness of a criteria-based rehabilitation progression and return-to-sport criteria on efficient return to activity and prevention of second injury in young athletes post-ACLR. Study Design: Case series; Level of evidence, 4. Methods: Between December 2010 and 2013, 42 skeletally immature athletes (mean chronologic age, 12 years; range, 10-15 years) who underwent ACLR using ipsilateral hamstring tendon autograft were prospectively evaluated. All athletes progressed through a criteria-based rehabilitation progression; were assessed at specific time frames for strength, biomechanical, and neuromuscular risk factors predictive of injury; and were provided targeted interventions. The final return to sport phase consisted of quantitative testing as well as a quality of movement assessment of several functional movements with progressive difficulty and sports-specific loading. Clearance for unrestricted activity was determined by achieving satisfactory results on both qualitative and quantitative assessments with consideration for the demands of each sport. Results: The mean time for return to unrestricted competitive activity was 12 months. All but 3 (7%) athletes returned to their primary sport. Thirty-five athletes (83%) returned to unrestricted activity. Of the 6 (14%) who sustained a second injury, 3 (50%) were injured in sports they were not cleared for. All ACL reinjuries occurred in a cutting sport. Half of reinjuries occurred within 1 year of surgery, while the remaining occurred between 1 and 2 years. Eighty-three percent of reinjuries involved highly competitive cutting athletes. Conclusion: In our cohort, the combination of qualitative and quantitative data served as a good indicator for reducing risk and determining readiness to return to sport.
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