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Manojlovic M, Ninkovic S, Matic R, Versic S, Modric T, Sekulic D, Drid P. Return to Play and Performance After Anterior Cruciate Ligament Reconstruction in Soccer Players: A Systematic Review of Recent Evidence. Sports Med 2024; 54:2097-2108. [PMID: 38710914 DOI: 10.1007/s40279-024-02035-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND The available literature referring to the return to play (RTP) and performance after anterior cruciate ligament reconstruction (ACLR) has already been comprehensively summarized in team sports such as basketball or American Football. Therefore, in this sense, it is necessary to synthesize evidence relating to the mentioned parameters in soccer players who underwent ACLR. OBJECTIVE The aim of this systematic review was to examine RTP and the performance of soccer players after ACLR. METHODS Three electronic databases, Web of Science, Scopus, and PubMed, have been comprehensively searched to identify relevant articles. The following inclusion criteria were applied: (1) the sample of respondents consisted of soccer players irrespective of their age, sex, or level of competition; (2) athletes experienced anterior cruciate ligament injury and underwent ACLR; (3) outcomes estimated referred to the RTP, RTP at the preinjury level of competition, RTP time, performance, and career duration of soccer players; (4) studies were written in the English language. The methodological quality of the research was evaluated using the Methodological Index for Non-Randomized Studies (MINORS). RESULTS Databases searched yielded a total of 694 studies, of which 17 fulfilled the eligibility criteria and were included in the final analysis. These included 3657 soccer players, 2845 males and 812 females, who underwent ACLR and most commonly competed at the elite, national, amateur, and recreational levels. The results obtained indicated that 72% of soccer players successfully RTP and 53% RTP at the preinjury level of participation after ACLR. In addition, recent evidence provided in this literature review demonstrated that mean RTP time was 264 days or 8.7 months. Moreover, the majority of the studies unambiguously suggested that performance related to statistical aspects noticeably deteriorated compared with both the preinjury period and noninjured athletes. The mean career length of soccer players following ACL surgery was approximately between 4 and 5 years. CONCLUSION Although a high percentage of athletes RTP after a relatively short period of absence from the sports field compared with other sports closely related to soccer, ACLR negatively impacts soccer players' performance and career duration.
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Affiliation(s)
- Marko Manojlovic
- Faculty of Sport and Physical Education, University of Novi Sad, Novi Sad, Serbia.
| | - Srdjan Ninkovic
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Department of Orthopedic Surgery and Traumatology, Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Radenko Matic
- Faculty of Sport and Physical Education, University of Novi Sad, Novi Sad, Serbia
| | - Sime Versic
- Faculty of Kinesiology, University of Split, Split, Croatia
| | - Toni Modric
- Faculty of Kinesiology, University of Split, Split, Croatia
| | - Damir Sekulic
- Faculty of Kinesiology, University of Split, Split, Croatia
| | - Patrik Drid
- Faculty of Sport and Physical Education, University of Novi Sad, Novi Sad, Serbia
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Tan Y, Kaldau NC, Lumban-Gaol I, Budhiparama NC, Peers K. Anterior cruciate ligament injuries in elite badminton athletes: 84% Return to sport, half return to performance. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38984858 DOI: 10.1002/ksa.12347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 06/03/2024] [Accepted: 06/17/2024] [Indexed: 07/11/2024]
Abstract
PURPOSE Badminton requires fast and pivoting movements, putting athletes at risk of sustaining an anterior cruciate ligament (ACL) injury. The primary purpose is to investigate the return to sport (RTS) and the return to performance (RTP) after an ACL injury in elite badminton athletes. The secondary purpose is to describe ACL injury mechanisms in elite badminton players. METHODS Athletes within the top 200 of the Badminton World Federation World Ranking who sustained an ACL injury between January 2001 and December 2021 were retrospectively included. An anonymous online survey was created in eight languages. RTS, RTP and contributing factors were analysed among athletes aiming to RTP. The injury mechanism was analysed in all participants. RESULTS Sixty-six athletes from 32 countries were included. Fifty-seven athletes (86.4%) aimed to RTP. Forty-eight out of 57 (84.2%) did RTS. Twenty-nine (50.9%) managed to successfully RTP. Forty-nine (74.2%) of ACL injuries occurred during a competition, 14 (21.2%) occured during training. Thirty-one (49.2%) occurred in the rear court backhand side and 47 (74.6%) occurred during landing after a jump. CONCLUSION Forty-eight out of 57 (84.2%) athletes managed to RTS. Half of the athletes managed to successfully RTP. Most of the ACL injuries occurred during competition, in the rear court backhand side and during landing after a jump. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Yuhan Tan
- Department of Orthopaedics, Noorderhart Ziekenhuis, Pelt, Belgium
- Department of Orthopaedics, University Hospital Brussels, Brussels, Belgium
- Department of Physical Medicine & Rehabilitation, University Hospitals Leuven, Leuven, Belgium
| | - Niels Christian Kaldau
- Department of Orthopaedic Surgery, Sports Orthopaedic Research Center Copenhagen (SORC-C), Copenhagen University Hospital, Amager-Hvidovre Hospital, Copenhagen, Denmark
| | - Imelda Lumban-Gaol
- Nicolaas Institute of Constructive Orthopaedic Research and Education Foundation for Arthroplasty and Sports Medicine, Department of Orthopaedics, Medistra Hospital, Jakarta, Indonesia
| | - Nicolaas C Budhiparama
- Nicolaas Institute of Constructive Orthopaedic Research and Education Foundation for Arthroplasty and Sports Medicine, Department of Orthopaedics, Medistra Hospital, Jakarta, Indonesia
| | - Koenraad Peers
- Department of Physical Medicine & Rehabilitation, University Hospitals Leuven, Leuven, Belgium
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Bodkin SG. Time to Reflect on Return to Sport Timing Following ACL Reconstruction. Sports Med 2024; 54:1749-1754. [PMID: 38554249 DOI: 10.1007/s40279-024-02017-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2024] [Indexed: 04/01/2024]
Abstract
The time of return to sport following anterior cruciate ligament (ACL) reconstruction is a commonly discussed topic within clinical settings and the sports medicine literature. Emerging science has demonstrated protective effects of delaying the time of sport clearance on athlete reinjury. Though a single time cutoff is unlikely to be applicable for all athletes, large inconsistencies in the time of return to sport clearance are present in both the literature and within prescribed clinical protocols. A multitude of patient factors, such as perceived function, objective function, confidence, post-operative goals, among others, are vital for how athletes are progressed and released for sport participation. This Current Opinion article is constructed to discuss the time to return to sport after ACL reconstruction-factors that may influence timing decisions, how time is assessed within the scientific literature-and to promote discussion on this common topic within the sports medicine and athletic communities. The aim of the article is not to establish defined clinical time cutoffs for this population.
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Affiliation(s)
- Stephan G Bodkin
- Department of Physical Therapy and Athletic Training, University of Utah, 290 S 1850 E, HPER-W 113, Salt Lake City, UT, 84115, USA.
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Tomihara T, Hashimoto Y, Okazaki S, Nishino K, Taniuchi M, Takigami J, Tsumoto S, Katsuda H. Bone-patellar tendon-bone autograft is associated with a higher rate of return to preinjury levels of performance in high-level athletes than anterior cruciate ligament reconstruction using hamstring autograft. Knee Surg Sports Traumatol Arthrosc 2024; 32:1384-1395. [PMID: 38558484 DOI: 10.1002/ksa.12144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/26/2024] [Accepted: 02/29/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE Return to preinjury levels of performance (RTP) is the main goal after anterior cruciate ligament reconstruction (ACL-R) for athletes when ACL graft rupture is a career-threatening event. The purpose of this study was to elucidate the associated factors for RTP and subsequent ACL injury after ACL-R using bone-patellar tendon-bone (BPTB) or hamstring (HT) autograft in high-level athletes with a minimum postoperative follow-up of 24 months. METHODS This retrospective study included 157 patients who had preinjury Tegner activity level of 9 and underwent primary ACL-R using BPTB (average age, 16.9 years; 35 males and 36 females) or HT (average age, 17.2 years; 49 males and 37 females). The mean follow-ups were 33.6 months in BPTB and 44.5 months in HT, respectively. The data were obtained based on routine clinical follow-ups and telephone interviews performed by the surgeon. Multivariate logistic regression analysis was conducted to determine the association of patient variables with RTP and subsequent ACL injury. RESULTS Ninety-nine patients (63.1%) were able to RTP. The rate of RTP in BPTB (74.6%) was significantly higher than that of HT (53.5%) (p < 0.05). The overall average timing of RTP after ACL-R was 10.0 months while that was significantly earlier in BPTB (9.7 months) than in HT (10.5 months) (p < 0.05). Twenty-three (14.6%) and 21 patients (13.4%) had ACL graft ruptures and ACL injuries in the contralateral knees, respectively. Multivariate analyses showed that BPTB (odds ratio [OR], 2.590; 95% confidence interval [CI], 1.300-5.160; p = 0.007) was associated with a higher potential for RTP after ACL-R. The incidence of ACL graft rupture after ACL-R decreased with BPTB (OR, 0.861; 95% CI, 0.770-0.962; p = 0.009). CONCLUSIONS The use of BPTB autograft was associated with a higher rate of RTP and a lower incidence of ACL graft rupture compared to ACL-R using HT autograft. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Tomohiro Tomihara
- Department of Orthopaedic Surgery, Shimada Hospital, Habikino, Japan
| | - Yusuke Hashimoto
- Department of Sport Sciences, Osaka University of Health and Sport Sciences, Sennan-gun, Japan
| | - Shiro Okazaki
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Habikino, Japan
| | - Kazuya Nishino
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Habikino, Japan
| | | | - Junsei Takigami
- Department of Orthopaedic Surgery, Shimada Hospital, Habikino, Japan
| | - Shuko Tsumoto
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Habikino, Japan
| | - Hiroshi Katsuda
- Department of Orthopaedic Surgery, Shimada Hospital, Habikino, Japan
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Figueroa D, Figueroa ML, Figueroa F. Return to sports in female athletes after anterior cruciate ligament reconstruction: A systematic review and metanalysis. J ISAKOS 2024; 9:378-385. [PMID: 38242500 DOI: 10.1016/j.jisako.2024.01.008] [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: 10/31/2023] [Revised: 12/26/2023] [Accepted: 01/14/2024] [Indexed: 01/21/2024]
Abstract
IMPORTANCE Return to sport (RTS) is considered an indicator of successful recovery after anterior cruciate ligament reconstruction (ACLR). In recent years, there has been major interest in documenting RTS following anterior cruciate ligament (ACL) injury. Despite women being at increased risk for ACL injuries and a global increase in women's participation in sports, research has not adequately focused on female athletes. OBJECTIVE The purpose of this study is to conduct a systematic review and meta-analysis evaluating the RTS rate in female athletes after ACLR. We hypothesize that most of the female athletes can RTS. EVIDENCE REVIEW A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Electronic databases (PubMed, Embase, and Epistemonikos) were searched for articles reporting RTS rates and contextual data in female athletes. The following search terms were used: "anterior cruciate ligament reconstruction" OR "ACL reconstruction" AND "female" OR "women" AND "return to sports" OR "return to play" to retrieve all relevant articles published between 2003 and 2023. A quality assessment of the included studies was conducted. FINDINGS Fifteen articles were included, reporting on 1456 female athletes participating in pivoting sports. The included studies comprised 9 cohorts, 1 case-control study, 2 case series, 2 descriptive epidemiology studies, and 1 observational study. Eight out of fifteen studies focused solely on elite-level athletes. The participants had a mean age of 23.13 years. Soccer was the most prevalent sport among the participants, accounting for 49.7% of all athletes included. All 15 studies reported an RTS rate, yielding a meta-proportion of 69% [95% CI, 58-80%] for RTS. Nine articles reported the average time to RTS, which was 10.8 months [95% CI, 8.7-12.8 months]. CONCLUSIONS This systematic review demonstrates that a majority of female athletes (69 %) can RTS participation at an average of 10.8 months, however, the available information is insufficient, and quantitative data and reasons for not returning to play are lacking. Future studies should establish return-to-play criteria in this population and determine reasons for not returning to play. LEVEL OF EVIDENCE III.
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Affiliation(s)
- David Figueroa
- Departamento de Traumatologia, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, 7650568, Chile
| | - María Loreto Figueroa
- Departamento de Traumatologia, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, 7650568, Chile.
| | - Francisco Figueroa
- Departamento de Traumatologia, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, 7650568, Chile; Departamento de Traumatología, Hospital Dr. Sótero del Río, Santiago, 8207257, Chile
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Brinkman JC, Iturregui JM, Moore ML, Haglin J, Thompson A, Makovicka J, Economopoulos KJ. Arthroscopic Posterior Capsular Release Improves Range of Motion and Outcomes for Flexion Contracture After Anterior Cruciate Ligament Reconstruction in Athletes. Arthrosc Sports Med Rehabil 2024; 6:100914. [PMID: 39006795 PMCID: PMC11240015 DOI: 10.1016/j.asmr.2024.100914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 02/12/2024] [Indexed: 07/16/2024] Open
Abstract
Purpose To assess outcomes of arthroscopic posterior capsular release among athletes for loss of terminal extension following anterior cruciate ligament (ACL) reconstruction. Methods A retrospective review of prospectively collected data was performed for patients undergoing arthroscopic posterior capsular release for knee extension loss following ACL reconstruction between January 2014 and December 2019. Procedure indications included extension loss greater than 10° at least 3 months after ACL reconstruction that was refractory to physical therapy. Patients were included if they were involved in either high school or college athletics, had complete outcomes of interest, and had at least 2 years of follow-up. Prospectively collected outcomes included preoperative and postoperative measurement of knee extension, International Knee Documentation Committee score, Lysholm score, return to sport data, and complications. Results Eighteen athletes with minimum 2 years of follow-up who underwent posterior capsular release following ACL reconstruction performed by a single surgeon were included in the analysis. Patients underwent surgery at an average of 16 weeks after ACL reconstruction. Knee extension improved an average of 13.8° at 2 years' follow-up (prerelease mean extension deficit 15.1°, postrelease mean extension deficit 1.3°, P < .005). Improvements in the International Knee Documentation Committee score averaged 21.7 at 6 months and 35.0 at 24 months, both of which were statistically significant (P < .001). Similarly, differences in Lysholm included a significant improvement of 23.0 and 34.2 at 6 months and 2 years, respectively (P < .001). In total, 77.8% returned to sport at an average of 9.8 months from their primary ACL surgery and 6.5 months following posterior capsular release surgery. No infections or neurovascular complications were observed. One patient required secondary release to achieve adequate extension. Conclusions For athletes with persistent knee extension loss after ACL reconstruction, knee extension was significantly improved at 2 years following arthroscopic posterior capsular release. Substantial improvements in patient-reported outcomes also were seen. In addition, subjects demonstrated a high rate of return to sport and return to preinjury performance levels. Level of Evidence Level IV, therapeutic case series.
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Affiliation(s)
- Joseph C Brinkman
- Department of Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona, U.S.A
| | - Jose M Iturregui
- Department of Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona, U.S.A
| | - M Lane Moore
- Mayo Clinic Alix School of Medicine, Scottsdale, Arizona, U.S.A
| | - Jack Haglin
- Department of Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona, U.S.A
| | - Adam Thompson
- University of Vermont School of Medicine, Burlington, Vermont, U.S.A
| | - Justin Makovicka
- Department of Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona, U.S.A
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Murakami R, Fukai A, Yoshitomi H, Honda E, Sanada T, Iwaso H. Quadriceps strength is an early indicator of return to competitive sports 1 year after anterior cruciate ligament reconstruction in adult amateur athletes. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:361-366. [PMID: 34988722 DOI: 10.1007/s00590-021-03195-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 12/29/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Return to sports is one of the important reasons why athletes with an anterior cruciate ligament (ACL) injury undergo surgery. There are few reports on return to sports among adult amateur athletes (individuals older than the college age who participate in competitive sports). This study aimed to investigate the return of adult amateur athletes to competitive sports 1 year after ACL reconstruction and to identify the indicators for return to competitive sports. METHODS Between January 2015 and December 2017, adult amateur athletes who underwent primary ACL reconstruction were retrospectively investigated. The rate of return to competitive sports 1 year after surgery was evaluated. The patients were categorized into two groups: return to sports group (R group) and non-return to sports group (N group). Pre- and postoperative range of motion, pivot-shift test, anteroposterior laxity, quadriceps strength, Lysholm score, and the International Knee Documentation Committee score were compared between the groups. RESULTS This study included 78 patients (48 men, 30 women; age range, 22-53 years). Five months after ACL reconstruction, quadriceps strength was significantly lower in the N group than in the R group, denoting muscle weakness in the N group at that time. No significant differences were found in the other items between the groups preoperatively and 1 year after surgery. CONCLUSION In this study, the rate of return to competitive sports of adult amateur athletes 1 year after ACL reconstruction was 76.9%. Quadriceps strength may be an early indicator of return to competitive sports 1 year after reconstruction.
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Kingery MT, Kouk S, Anil U, McCafferty J, Lemos C, Gelber J, Gonzalez-Lomas G. Performance and return to sport after injury in professional mixed martial arts. PHYSICIAN SPORTSMED 2022; 50:435-439. [PMID: 34236932 DOI: 10.1080/00913847.2021.1953358] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Mixed Martial Arts (MMA) is an increasingly popular combat sport incorporating striking and grappling that results in a high incidence of injuries. OBJECTIVES The purpose of this study was to analyze the impact of injuries on the return to sport and post-injury performance of professional MMA athletes. We hypothesize that increased age is associated with lower probability of return to sport and diminished post-injury performance. METHODS Publicly available data (obtained from ESPN.com/MMA, UFC.com, Rotowire.com/MMA) from professional MMA fighters who resigned from fight cards due to injury from 2012 to 2014 were analyzed. Injury history, match history and outcomes, and duration of time to return to professional fighting were recorded and compared to a cohort consisting of uninjured opponents. RESULTS 454 fighters were included in the analysis. The mean age at the time of injury was 30.0±3.9 years. 94.4% of injured athletes were able to return to professional MMA, and athletes required a mean duration of 6.8±6.7 months between injury and their next professional fight (range 0.3-58 months). There was no significant difference in winning percentage in the post-injury period between the injured group and the uninjured group (p = 0.691). Increased age at the time of injury was associated with the odds of being able to return to professional fighting after injury (OR = 0.822, p = 0.001). CONCLUSION In this analysis of publicly available injury data on MMA fighters, there was a high rate of return to professional sport and no evidence of an associated decline in performance following major injury requiring withdrawal from a fight card. Older age at the time of injury was associated with decreased odds of being able to return to professional fighting. With increasing popularity of combat sports, sport-specific prognostic information will help guide and treat specific injuries associated with MMA participation.
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Affiliation(s)
- Matthew T Kingery
- Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
| | - Shalen Kouk
- Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
| | - Utkarsh Anil
- Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
| | - Joseph McCafferty
- Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
| | - Connor Lemos
- Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
| | - Jonathan Gelber
- Elite Sports Medicine, Connecticut Children's Medical Center Farmington, CT, USA
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Shoe Bending Stiffness Influence on Lower Extremity Energetics in Consecutive Jump Take-Off. Appl Bionics Biomech 2022; 2022:5165781. [PMID: 35677199 PMCID: PMC9168200 DOI: 10.1155/2022/5165781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 05/13/2022] [Indexed: 12/01/2022] Open
Abstract
Objective This study examined the influence of shoe bending stiffness on lower extremity energetics in the take-off phase of consecutive jump. Methods Fifteen basketball and volleyball players wearing control shoes and stiff shoes performed consecutive jumps. Joint angle, angular velocity, moments, power, jump height, take-off velocity, take-off time, and peak vertical ground reaction force data were simultaneously captured by motion capture system and force platform. Paired t-tests were performed on data for the two shoe conditions that fit the normal distribution assumptions, otherwise Wilcoxon signed-rank tests. Results There are significant differences (P < 0.05) in take-off velocity and take-off time between stiff and control shoe conditions; the stiff shoes had faster take-off velocity and shorter take-off time than control shoes. There was no significant difference between two conditions in jump height (P = 0.512) and peak vertical ground reaction force (P = 0.589). The stiff shoes had significantly lower MTP dorsiflexion angle and greater joint work than the control shoes (P < 0.05). The MTP range of motion and maximum angular velocity in stiff shoe condition were significantly lower than those in control shoe condition (P < 0.01). However, there are no significant differences between two conditions in kinetics and kinematics of the ankle, knee, and hip joint. Conclusions The findings suggest that wearing stiff shoes can reduce the effect of participation of the MTP joint at work and optimize the energy structure of lower-limb movement during consecutive jumps.
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Arnold MT, Hart CM, Greig DE, Trikha R, Gelabert HA, Jones KJ. Thoracic Outlet Syndrome in Major League Baseball Pitchers: Return to Sport and Performance Metrics After Rib Resection. Orthop J Sports Med 2022; 10:23259671221079835. [PMID: 35494495 PMCID: PMC9047814 DOI: 10.1177/23259671221079835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 11/30/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Thoracic outlet syndrome (TOS) is a rare injury that affects Major League
Baseball (MLB) pitchers and is often corrected with surgical resection of
the first rib. There are limited return-to-play (RTP) data for this surgery
in MLB pitchers. Hypothesis: It was hypothesized that MLB pitchers who undergo first rib resection for TOS
will show (1) a high rate of RTP, (2) no difference in postoperative career
length compared with controls, (3) no difference in pre- and postoperative
performance, and (4) no difference in postoperative performance compared
with controls. Study Design: Cohort study; Level of evidence, 3. Methods: This retrospective cohort study evaluated MLB pitchers with neurogenic or
vascular TOS who underwent rib resection surgery between January 1, 2001,
and December 31, 2019. Players were identified through public injury reports
from press releases, the MLB website, MLB team injury reports, and blogs. A
demographics- and performance-matched control group was generated for
comparison. Each player in the control group was given an index year that
corresponded to the surgery year of the case group. Performance data
included innings pitched (IP), games played (GP), earned run average (ERA),
complete GP, shutouts, saves, hits, runs, home runs (HR), walks, strikeouts
(K), walks plus hits per IP (WHIP), and earned runs (ER). Results: We identified 26 MLB pitchers who underwent rib resection for neurogenic or
vascular TOS; 21 players (81%) had a successful RTP. Pitchers were 30 ± 3.6
years old at the time of surgery and had played 6.2 ± 3.5 seasons before
undergoing surgery. Average postoperative career length was 3.1 ± 2.0
seasons, with an average time from surgery to RTP being 10 ± 4.7 months.
Pitchers who RTP showed no significant differences in performance metrics
compared with controls. Players pitch 0.94 (P < .05)
more IP/GP in the season directly following RTP compared with the season
before surgical intervention. Conclusion: MLB pitchers undergoing rib resection for TOS demonstrated (1) high RTP rates
following rib resection, (2) no difference in postoperative career length
compared with controls, (3) improvement in postoperative performance, and
(4) no difference in postoperative performance compared with controls.
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Affiliation(s)
- Michael T. Arnold
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Christopher M. Hart
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Danielle E. Greig
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Rishi Trikha
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Hugh A. Gelabert
- Department of Vascular Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Kristofer J. Jones
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Jia SW, Lam WK, Huang Z, Baker JS, Ugbolue UC, Gu Y. Influence of metatarsophalangeal joint stiffness on take-off performances and lower-limb biomechanics in jump manoeuvres. J Sports Sci 2022; 40:638-645. [PMID: 35083953 DOI: 10.1080/02640414.2021.2010412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Forefoot and toes are prominent regions for locomotion and individual metatarsophalangeal joint (MTPJ) stiffness may be linked to jump take-off mechanics and performances. However, little is known about the relationships between MTPJ stiffness and take-off related variables. This study examined the relationship between individual MTPJ stiffness and biomechanical variables under various vertical countermovement jumps (CMJ) conditions. We measured MTPJ stiffness on 21 male university basketball players and then asked them to perform jumps under single, consecutive and running CMJ conditions. Pearson's correlation coefficient was employed to examine the relationships between MTP passive stiffness and each jumping performance, ground reaction force (GRF) and joint kinematic and kinetic variables. The results indicated that MTPJ stiffness significantly correlated with maximum jump height (r = 0.49, moderate), peak take-off velocity (r = 0.47, moderate), peak take-off ankle plantarflexion moment (r = 0.68, strong), peak dorsiflexion moment (r = 0.60, strong) and peak take-off ankle power (r = 0.44, moderate) in consecutive CMJ. Only a moderate correlation between MTPJ stiffness and peak MTPJ extension take-off velocity (r = -0.46, moderate) was determined in a single CMJ. There were no significant correlations found in running CMJ conditions. These findings imply that higher MTPJ stiffness of participants was related to improved jump performances in consecutive jumps.
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Affiliation(s)
- Sheng-Wei Jia
- Guangdong Provincial Engineering Technology Research Center for Sports Assistive Devices, Guangzhou Sport University, Guangzhou, China.,Faculty of Sports Science, Ningbo University, Ningbo, China.,Li Ning Sports Science Research Center, Li Ning (China) Sports Goods Company Limited, Beijing, China
| | - Wing-Kai Lam
- Guangdong Provincial Engineering Technology Research Center for Sports Assistive Devices, Guangzhou Sport University, Guangzhou, China.,Li Ning Sports Science Research Center, Li Ning (China) Sports Goods Company Limited, Beijing, China.,Department of Kinesiology, Shenyang Sport University, Shenyang, China
| | - Zhiguan Huang
- Guangdong Provincial Engineering Technology Research Center for Sports Assistive Devices, Guangzhou Sport University, Guangzhou, China
| | - Julien S Baker
- Faculty of Sports Science, Ningbo University, Ningbo, China.,School of Health and Life Sciences, Institute for Clinical Exercise & Health Science, University of the West of Scotland, Scotland, UK.,Department of Sport, Physical Education and Health, Hong Kong Baptist University, Kowloon Tong, Hong Kong
| | - Ukadike C Ugbolue
- Faculty of Sports Science, Ningbo University, Ningbo, China.,School of Health and Life Sciences, Institute for Clinical Exercise & Health Science, University of the West of Scotland, Scotland, UK
| | - Yaodong Gu
- Faculty of Sports Science, Ningbo University, Ningbo, China
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12
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Hodgens BH, Geller JS, Rizzo MG, Munoz J, Kaplan J, Aiyer A. Performance Outcomes After Surgical Repair of Achilles Tendon Rupture in the Women's National Basketball Association. Orthop J Sports Med 2021; 9:23259671211030473. [PMID: 34527757 PMCID: PMC8436311 DOI: 10.1177/23259671211030473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 03/18/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Achilles tendon ruptures are devastating in elite athletes. There are currently no studies examining the effects of Achilles tendon rupture on performance outcomes in the Women’s National Basketball Association (WNBA). Hypothesis: Athletes in the WNBA who sustained an Achilles tendon rupture and underwent subsequent surgical repair will sustain declines in performance metrics when compared with their preinjury statistics and matched controls. Study Design: Cohort study; Level of evidence, 3. Methods: Seventeen WNBA players who sustained an Achilles tendon rupture from 2000 to 2019 were identified through publicly available injury reports and player profiles. Athlete information collected included age, body mass index, position, and service in the WNBA when the tear occurred. Statistics were collected for 1 season before and 2 seasons after the injury, and the player efficiency rating (PER) was calculated. Players were matched to uninjured controls by service in the WNBA, position, and performance statistics. Results: On average, players were 28 years of age at the time of Achilles tendon rupture, with a service time in the WNBA of 6.5 years. Four players never returned to play in the WNBA, while 7 players failed to play more than 1 season. Players who did return played significantly fewer minutes per game compared with preinjury in both postinjury seasons 1 and 2 (mean difference, –6.11 and –6.54 min/game, respectively; P < .01 for both) and had a significantly decreased PER in postinjury season 2 (mean difference, –2.53; P = .024). After returning to play, the injured players experienced significant decreases when compared with controls in field goals (–0.85 vs +0.20; P = .047), free throws (–1.04 vs +0.12; P < .01), steals (–0.48 vs +0.24; P = .018), and points scored (–2.89 vs +0.58; P = .014). Conclusion: WNBA players experienced significant decreases in performance metrics after Achilles tendon rupture compared with their preinjury levels and compared with uninjured controls. Overall, 23.5% of players failed to return to the WNBA, while 41.2% failed to play for more than 1 season.
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Affiliation(s)
- Blake H Hodgens
- University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Joseph S Geller
- Department of Orthopedic Surgery, University of Miami-Jackson Memorial Hospital, Miami, Florida, USA
| | - Michael G Rizzo
- Department of Orthopedic Surgery, University of Miami-Jackson Memorial Hospital, Miami, Florida, USA
| | - Julianne Munoz
- University of Miami Sports Medicine Institute, Miami, Florida, USA
| | | | - Amiethab Aiyer
- Department of Orthopedic Surgery, University of Miami-Jackson Memorial Hospital, Miami, Florida, USA
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13
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Tramer JS, Khalil LS, Jildeh TR, Sattar M, Ziedas A, Abbas MJ, Kolowich PA, Okoroha KR. Association of Prior Anterior Cruciate Ligament Tear With Decreased Career Longevity in Women's National Basketball Association. Orthop J Sports Med 2021; 9:23259671211009248. [PMID: 34250170 PMCID: PMC8239980 DOI: 10.1177/23259671211009248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 12/21/2021] [Indexed: 11/16/2022] Open
Abstract
Background The incidence of anterior cruciate ligament (ACL) injuries in women's basketball exceeds that of men. There is a paucity of data regarding career performance in Women's National Basketball Association (WNBA) athletes with a history of ACL reconstruction. Purpose To determine whether WNBA athletes with a history of ACL injury prior to professional play have reduced career game utilization, defined as games played and started and minutes per game (MPG), as well as statistical performance, defined by player efficiency rating (PER). Study Design Cohort study; Level of evidence, 3. Methods Included were 42 WNBA players from 1997 to 2018 who had a history of ACL reconstruction before entering professional leagues. Body mass index (BMI), age, and position were collected for each player. Career data and performance statistics were likewise collected for each player's entire WNBA career. A control group of WNBA players with no history of ACL injury were matched by position, BMI, and age at the time of WNBA debut. Statistics compared game utilization and performance to assess the impact of ACL reconstruction. Results Athletes who sustained an ACL tear before entering the league played in fewer games per season in their first 3 professional seasons compared with healthy controls (24.2 ± 8.4 vs 28.2 ± 6.1; P = .02). Among athletes with a history of ACL reconstruction, 11 (26.2%) played only a single WNBA season, while no control athletes played in just 1 season. Additionally, athletes who had a previous ACL tear started significantly fewer games per season (9.0 ± 9.4 vs 14.0 ± 9.0; P < .01) and played fewer MPG (15.5 ± 7.2 vs 20.7 ± 5.5; P < .01) during their WNBA career. Athletes with a history of ACL tear had significantly shorter WNBA careers (4.8 ± 4.1 vs 8.1 ± 3.3 seasons; P < .001). Total professional play duration (WNBA + overseas) was significantly reduced in players with an ACL tear compared with controls (P < .05). PER was not significantly different between cohorts at any time point. Conclusion WNBA athletes with a history of an ACL tear before professional play had decreased career game utilization and workload throughout their career despite having similar PER compared with healthy controls.
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Affiliation(s)
- Joseph S Tramer
- Department of Orthopedic Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Lafi S Khalil
- Department of Orthopedic Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Toufic R Jildeh
- Department of Orthopedic Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Mohammad Sattar
- Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Alexander Ziedas
- Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Muhammad J Abbas
- Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Patricia A Kolowich
- Department of Orthopedic Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Kelechi R Okoroha
- Department of Orthopedic Surgery, Henry Ford Hospital, Detroit, Michigan, USA
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14
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Lam WK, Cheung CC, Huang Z, Leung AK. Effects of shoe collar height and arch-support orthosis on joint stability and loading during landing. Res Sports Med 2021; 30:115-127. [PMID: 33579163 DOI: 10.1080/15438627.2021.1888102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study examined the effects of shoe collar height and foot orthosis on ground reaction force (GRF), ankle and knee mechanics during landing. Sixteen male university basketball players performed drop landing when wearing different shoes with collar height (high vs. low) and foot orthoses (arch-support vs. flat). Biomechanical variables included vertical peak GRF and joint angles and moments in sagittal and coronal planes were analysed with two-way ANOVA with repeated measures (α = 0.05). Results indicated that high-collar shoes had significantly smaller peak ankle dorsiflexion (P < 0.001), smaller ankle sagittal total RoM (P < 0.001), higher forefoot peak GRF (P = 0.009) and peak knee valgus moment (P < 0.001) compared with low-collar shoes. Wearing arch-support orthoses induced higher forefoot peak GRF (P < 0.001) but smaller ankle inversion moment (P = 0.001) compared to flat-orthoses. Furthermore, significant interactions between collar-height and orthosis were found only for initial ankle plantarflexion (P = 0.023) and knee flexion (P = 0.035), but not in any kinetics variables. The findings suggest increased collar height and arch-support orthoses appear to reduce the risks of ankle sprains during landing, but might increase loading at adjacent joints.
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Affiliation(s)
- Wing-Kai Lam
- Guangdong Provincial Engineering Technology Research Center for Sports Assistive Devices, Guangzhou Sport University, Guangzhou, China.,Department of Kinesiology, Shenyang Sport University, Shenyang, China.,Li Ning Sports Science Research Center, Li Ning (China) Sports Goods Company, Beijing, China
| | - Chris C Cheung
- Li Ning Sports Science Research Center, Li Ning (China) Sports Goods Company, Beijing, China.,Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Zhiguan Huang
- Guangdong Provincial Engineering Technology Research Center for Sports Assistive Devices, Guangzhou Sport University, Guangzhou, China
| | - Aaron K Leung
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
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15
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Allahabadi S, Su F, Lansdown DA. Systematic Review of Orthopaedic and Sports Medicine Injuries and Treatment Outcomes in Women's National Basketball Association and National Basketball Association Players. Orthop J Sports Med 2021; 9:2325967120982076. [PMID: 33623799 PMCID: PMC7878958 DOI: 10.1177/2325967120982076] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 08/31/2020] [Indexed: 11/15/2022] Open
Abstract
Background: Athletes in the Women’s National Basketball Association (WNBA) and National Basketball Association (NBA) are subject to high injury rates given the physical demands of the sport. Comprehensive data regarding injury patterns and rates in these athletes are limited. Purpose: To summarize available data on orthopaedic and sports medicine–related injuries through 2020 in professional female and male basketball players. Study Design: Systematic review; Level of evidence, 4. Methods: A search was conducted using PubMed and Embase through April 5, 2020, to identify injury studies regarding WNBA and NBA players. Studies were included if the injury or surgery was considered a direct consequence of game play including musculoskeletal/orthopaedic, concussion, ophthalmologic, and craniomaxillofacial injuries. Systematic reviews, screening studies, or studies without sufficient WNBA or NBA player subgroup analysis were excluded. Results: A total of 49 studies met inclusion criteria, 43 (87.8%) of which detailed musculoskeletal injuries. The lower extremity represented 63.3% of studies. A majority (59.2%) of studies were level 4 evidence. The source of data was primarily comprehensive online search (n = 33; 67.3%), followed by official databases (n = 11; 22.4%). Only 3 studies concerned WNBA athletes compared with 47 that concerned NBA athletes. The lowest return-to-play rates were cited for Achilles tendon repairs (61.0%-79.5%). Variability in return-to-play rates existed among studies even with similar seasons studied. Conclusion: The majority of literature available on orthopaedic and sports medicine–related injuries of NBA and WNBA athletes is on the lower extremity. The injuries that had the greatest effect on return to play and performance were Achilles tendon ruptures and knee cartilage injuries treated using microfracture. The reported outcomes are limited by heterogeneity and overlapping injury studies. There are limited available data on WNBA injuries specifically.
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Affiliation(s)
- Sachin Allahabadi
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Favian Su
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Drew A Lansdown
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
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16
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Webster KE. Return to Sport and Reinjury Rates in Elite Female Athletes After Anterior Cruciate Ligament Rupture. Sports Med 2021; 51:653-660. [PMID: 33415667 DOI: 10.1007/s40279-020-01404-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2020] [Indexed: 01/14/2023]
Abstract
While there has been significant interest in the documentation of return to sport outcomes following anterior cruciate ligament (ACL) injury, the elite level female athlete has not been a focus of this research. This is despite women being at increased risk for ACL injury and considerable global growth in women participating in sport. Therefore, the focus of this review was to examine the available literature regarding return to sport outcomes in elite level women with an ACL injury. The topics of discussion focus on return to sport rates, timing and determinants of return to sport, longevity of play, return to sport performance, and further ACL injury. Knee health in the longer term is also briefly discussed along with the limitations of the existent literature.
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Affiliation(s)
- Kate E Webster
- School of Allied Health, Human Services and Sport, La Trobe University, Kingsbury Drive, Bundoora, VIC, 3086, Australia.
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17
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Taberner M, van Dyk N, Allen T, Jain N, Richter C, Drust B, Betancur E, Cohen DD. Physical preparation and return to performance of an elite female football player following ACL reconstruction: a journey to the FIFA Women's World Cup. BMJ Open Sport Exerc Med 2020; 6:e000843. [PMID: 34422284 PMCID: PMC8323467 DOI: 10.1136/bmjsem-2020-000843] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2020] [Indexed: 01/08/2023] Open
Abstract
ACL injuries are among the most severe knee injuries in elite sport, with a high injury burden and re-injury risk. Despite extensive literature on the injury and the higher incidence of injury and re-injury in female athletes, there is limited evidence on the return to sport (RTS) of elite female football players following ACL reconstruction (ACLR). RTS is best viewed on a continuum aligning the recovery and rehabilitation process with the ultimate aim — a return to performance (RTPerf). We outline the RTS and RTPerf of an elite female football player following ACLR and her journey to the FIFA Women’s World Cup, including the gym-based physical preparation and the on-pitch/sports-specific reconditioning. We used the ‘control–chaos continuum’ as a framework for RTS, guiding a return above pre-injury training load demands while considering the qualitative nature of movement in competition. We then implemented the ‘RTPerf pathway’ to facilitate a return to team training, competitive match play and a RTPerf. Objective information, clinical reasoning and shared decision-making contributed to this process and helped the player to reach her goal of representing her country at the FIFA Women’s World Cup.
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Affiliation(s)
- Matt Taberner
- School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Nicol van Dyk
- High Performance Unit, Irish Rugby Football Union, Dublin, Ireland
| | - Tom Allen
- Performance and Research Department, Arsenal Football Club, London, UK
| | - Neil Jain
- The Manchester Institute of Health and Performance, Manchester, UK
| | - Chris Richter
- Sports Surgery Clinic, Dublin, Ireland.,University of Roehampton, London, UK
| | - Barry Drust
- School of Sports, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Esteban Betancur
- Sports Science Center (CCD), Colombian Ministry of Sport (Mindeporte), Colombia
| | - Daniel D Cohen
- Sports Science Center (CCD), Colombian Ministry of Sport (Mindeporte), Colombia.,Masira Research Institute, Universidad de Santander, Bucaramanga, Colombia
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18
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Tramer JS, Khalil LS, Ziedas A, Mehran N, Okoroha KR. Return to Play and Performance in the Women's National Basketball Association After Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2020; 8:2325967120947078. [PMID: 32984422 PMCID: PMC7498979 DOI: 10.1177/2325967120947078] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 04/06/2020] [Indexed: 01/13/2023] Open
Abstract
Background: The incidence of anterior cruciate ligament (ACL) injuries in Women’s
National Basketball Association (WNBA) athletes continues to increase. There
is a paucity of data regarding return-to-play (RTP) rates and performance
after ACL reconstruction in these athletes. Purpose: To quantify RTP rates and performance after ACL reconstruction in WNBA
athletes. Study Design: Cohort study; Level of evidence, 3. Methods: All ACL tears sustained in the WNBA from 1997 through 2018 were identified.
Body mass index (BMI), age, and position at the time of injury were
collected for each player. RTP rates were calculated, and performance data
were collected for each player before and after injury to determine changes
in playing time and statistical performance. Players who successfully
returned to play after ACL reconstruction were compared with a group of
healthy controls who were matched by age, years of experience, position,
height, and BMI. Statistics at 1 and 3 years after injury were compared to
assess acute and longitudinal changes in performance relative to preinjury
baseline. Results: A total of 59 WNBA players sustained ACL tears during the study period, and
41 (69.5%) were able to successfully RTP. Players played a mean of 7.5 ±
12.8 fewer games, played 5.0 ± 9.2 fewer minutes per game, and scored 3.7 ±
5.0 fewer points per game in their first year after RTP compared with the
year before injury. Athletes with ACL reconstruction demonstrated
significantly decreased performance measures regarding games played, games
started, minutes, rebounds, assists, and blocks per game in their first
season after RTP compared with control athletes in the same indexed year;
however, these differences resolved by year 3 after surgery. Conclusion: WNBA athletes have a high RTP rate after ACL reconstruction. Players may
experience an initial decrease in playing time and performance when
returning to play; however, these variables were found to return to baseline
over time.
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Affiliation(s)
- Joseph S Tramer
- Department of Orthopedic Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Lafi S Khalil
- Department of Orthopedic Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Alexander Ziedas
- Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Nima Mehran
- Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA
| | - Kelechi R Okoroha
- Department of Orthopedic Surgery, Henry Ford Hospital, Detroit, Michigan, USA
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19
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Lam WK, Cheung CCW, Leung AKL. Shoe collar height and heel counter-stiffness for shoe cushioning and joint stability in landing. J Sports Sci 2020; 38:2374-2381. [PMID: 32600128 DOI: 10.1080/02640414.2020.1785728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study examined the effects of shoe collar-height and counter-stiffness on ground reaction force (GRF), ankle and knee mechanics in landing. Eighteen university basketball players performed drop landing when wearing shoes in different collar height (high vs. low) and counter-stiffness (stiffer vs. less stiff). Biomechanical variables were measured with force platform and motion capturing systems. Two-way repeated measures ANOVA was performed with α = 0.05. Wearing high collar shoes exhibited smaller peak ankle dorsiflexion and total sagittal RoM, peak knee extension moment, but larger peak knee varus moment than the low collar shoes. Stiffer counter-stiffness shoes related to smaller ankle inversion at touchdown and total coronal RoM, but larger peak knee flexion and increased total ankle and knee sagittal RoM than the less stiff counter-stiffness. Furthermore, wearing stiffer counter-stiffness shoes increased forefoot GRF peak at high collar condition, while no significant differences between counter-stiffness at low collar condition. These results suggest that although higher collar height and/or stiffness heel counter used can reduce ankle motion in coronal plane, it would increase the motion and loading at knee joint, which is susceptible to knee injuries. These findings could be insightful for training and footwear development in basketball.
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Affiliation(s)
- Wing-Kai Lam
- Guangdong Provincial Engineering Technology Research Center for Sports Assistive Devices, Guangzhou Sport University , Guangzhou, China.,Department of Kinesiology, Shenyang Sport University , Shenyang, China.,Li Ning Sports Science Research Center, Li Ning (China) Sports Goods Limited Company , Beijing, China
| | - Chris Chi-Wai Cheung
- Li Ning Sports Science Research Center, Li Ning (China) Sports Goods Limited Company , Beijing, China.,Department of Biomedical Engineering, The Hong Kong Polytechnic University , Hong Kong, China
| | - Aaron Kam-Lun Leung
- Department of Biomedical Engineering, The Hong Kong Polytechnic University , Hong Kong, China
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20
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Porter A, Yang S, Chauhan A, Early S, Challa S, D'Angelo J, Keefe D, Hoenecke H, Fronek J. Professional Advancement and Performance of Amateur Baseball Players Selected in the Major League Baseball Draft With Previous Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2020; 48:581-587. [PMID: 31990575 DOI: 10.1177/0363546519898194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The effect that an anterior cruciate ligament injury requiring reconstructive surgery has on the professional advancement and performance of amateur baseball players selected in the Major League Baseball draft is not known. Return to sports after anterior cruciate ligament reconstruction (ACLR) in professional athletes has been shown to be high, but mixed results with regard to performance and return to preinjury level have been demonstrated in other sports. PURPOSE To (1) investigate the highest level of professional advancement among Major League Baseball draftees with a history of ACLR before entering the draft, (2) examine how much time these players spent on the disabled list (DL) and determine if it was related to the knee, and (3) compare the batting and pitching performance of these players against healthy matched controls. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Predraft medical records of all players selected in the Major League Baseball draft from 2004 to 2008 were reviewed. Players with a documented anterior cruciate ligament injury treated with ACLR before the draft were included. For each study player, 3 controls were identified. Data were accumulated from the time when players were drafted through the 2015 season. Outcome variables included highest professional level of advancement, DL time, and batting and pitching performance. RESULTS Forty draftees with a history of ACLR (22 pitchers, 18 position players) were identified and matched to 120 controls (66 pitchers, 54 position players). The difference in the highest level of professional advancement between the groups was not statistically significant (P = .488). The mean total number of times and the mean total number of days on the DL were similar between the groups (1.83 vs 1.47, P = .297; 121.54 vs 109.62, P = .955); however, the mean number of times on the DL because of a knee injury was significantly different (0.28 vs 0.11, P = .004), as was the mean number of days on the DL because of a knee injury (17.36 vs 7.72, P = .009). Among pitchers, there were no differences in performance. Similarly, there were no differences among position players in batting performance. CONCLUSION There was no difference between draftees with a history of ACLR and their controls in terms of advancement from the minor to the major leagues. Additionally, pitching and batting performance were similar. Although the 2 groups spent similar time on the DL, the ACLR group spent more time on the DL because of a knee injury than the control group.
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Affiliation(s)
- Anthony Porter
- Division of Sports Medicine, Department of Orthopedic Surgery, Scripps Clinic, La Jolla, California, USA
| | - Shawn Yang
- Division of Sports Medicine, Department of Orthopedic Surgery, Scripps Clinic, La Jolla, California, USA
| | - Aakash Chauhan
- Division of Sports Medicine, Department of Orthopedic Surgery, Scripps Clinic, La Jolla, California, USA
| | - Samuel Early
- Division of Sports Medicine, Department of Orthopedic Surgery, Scripps Clinic, La Jolla, California, USA
| | - Sravya Challa
- Division of Sports Medicine, Department of Orthopedic Surgery, Scripps Clinic, La Jolla, California, USA
| | | | - Daniel Keefe
- Division of Sports Medicine, Department of Orthopedic Surgery, Scripps Clinic, La Jolla, California, USA
| | - Heinz Hoenecke
- Division of Sports Medicine, Department of Orthopedic Surgery, Scripps Clinic, La Jolla, California, USA
| | - Jan Fronek
- Division of Sports Medicine, Department of Orthopedic Surgery, Scripps Clinic, La Jolla, California, USA
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21
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Lam WK, Jia SW, Baker JS, Ugbolue UC, Gu Y, Sun W. Effect of consecutive jumping trials on metatarsophalangeal, ankle, and knee biomechanics during take-off and landing. Eur J Sport Sci 2020; 21:53-60. [PMID: 32077371 DOI: 10.1080/17461391.2020.1733671] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study examined the differences in single and consecutive jumps on ground reaction forces (GRF) as well as metatarsophalangeal (MTP), ankle and knee kinematics and kinetics during jumping take-off and landing. Eighteen basketball players performed countermovement jumps in both single and consecutive movement sessions. Synchronised force platform and motion capture systems were used to measure biomechanical variables during take-off and landing. Paired t-tests (or Wilcoxon signed-rank tests) were performed to examine any significant differences regarding mean and coefficient of variation in each of the variables tested. A Holm-Bonferroni correction was applied to P-values to control the false discovery rate of 5%. The findings indicated that consecutive jumps had lower jump height, take-off velocity and landing impact. During take-off, consecutive jumps demonstrated larger peak MTP and ankle extension velocities, knee extension moments as well as larger values for ankle and knee power generation; During landing, the consecutive jumps had larger peak MTP flexion angle, joint velocities (MTP, ankle and knee), and peak knee flexion moments and power absorption. Additionally, consecutive jumps had higher within-trial reliability (i.e. smaller CV) for peak MTP flexion angle at landing (P < 0.05), but lower reliability (i.e. higher CV) for peak knee flexion velocity and power absorption at landing. These results suggest that the consecutive jump trials led to distinct movement kinematics and higher loading responses in jump take-off and landing.
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Affiliation(s)
- Wing-Kai Lam
- Guangdong Provincial Engineering Technology Research Center for Sports Assistive Devices, Guangzhou Sport University, Guangzhou, People's Republic of China.,Department of Kinesiology, Shenyang Sport University, Shenyang, People's Republic of China.,Li Ning Sports Science Research Center, Beijing, People's Republic of China
| | - Sheng-Wei Jia
- Guangdong Provincial Engineering Technology Research Center for Sports Assistive Devices, Guangzhou Sport University, Guangzhou, People's Republic of China.,Faculty of Sports Science, Ningbo University, Ningbo, People's Republic of China
| | - Julien S Baker
- School of Health and Life Sciences, Institute for Clinical Exercise & Health Science, University of the West of Scotland, South Lanarkshire, G72 0LH, Scotland, UK
| | - Ukadike C Ugbolue
- School of Health and Life Sciences, Institute for Clinical Exercise & Health Science, University of the West of Scotland, South Lanarkshire, G72 0LH, Scotland, UK
| | - Yaodong Gu
- Faculty of Sports Science, Ningbo University, Ningbo, People's Republic of China
| | - Wei Sun
- School of Physical Education and Coaching, Shanghai University of Sport, Shanghai, People's Republic of China
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22
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Erickson BJ, Chalmers PN, D'Angelo J, Ma K, Dahm DL, Romeo AA, Ahmad CS. Performance and Return to Sport After Anterior Cruciate Ligament Reconstruction in Professional Baseball Players. Orthop J Sports Med 2019; 7:2325967119878431. [PMID: 31696134 PMCID: PMC6822199 DOI: 10.1177/2325967119878431] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Anterior cruciate ligament reconstruction (ACLR) is the gold standard treatment for ACL tears to allow baseball players to return to sport (RTS). The optimal graft type and femoral tunnel drilling technique are currently unknown. Hypothesis: There is a high rate of RTS in professional baseball players after ACLR, with no significant difference in RTS rates or performance between cases and controls or between graft types or femoral drilling techniques. Study Design: Cohort study; Level of evidence, 3. Methods: All professional baseball players who underwent ACLR between 2010 and 2015 were included. Demographic and performance data (pre- and postoperative) for each player were recorded. Performance metrics were then compared between cases and matched controls. Results: A total of 124 players (mean age, 23.7 ± 4.1 years; 83% minor league players) underwent ACLR. Of these, 80% returned to sport (73% to the same or higher level) at a mean 310 ± 109 days overall and 333 ± 126 days at the same or higher level. The most common graft type was an ipsilateral bone–patellar tendon–bone (BTB) autograft (n = 87; 70%). A total of 91 players underwent concomitant meniscal debridement or repair. No significant difference in any of the primary performance metrics existed from before to after ACLR. Compared with matched controls, no significant difference existed in RTS rates or any performance metrics after ACLR. No significant difference existed in RTS rates or primary performance outcome measures between graft types or femoral drilling techniques. Conclusion: The RTS rate for professional baseball players after ACLR was 80%. No significant difference in performance metrics existed between BTB and hamstring autografts or between femoral drilling techniques. Furthermore, no significant difference in performance or RTS rates existed between cases and matched controls. Femoral drilling technique and graft type did not affect performance and RTS rates in professional baseball players after ACLR.
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Affiliation(s)
| | - Peter N Chalmers
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - John D'Angelo
- Major League Baseball Commissioner's Office, New York, New York, USA
| | - Kevin Ma
- Major League Baseball Commissioner's Office, New York, New York, USA
| | - Diane L Dahm
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Christopher S Ahmad
- Department of Orthopedic Surgery, Columbia University, New York, New York, USA
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Sochacki KR, Jack RA, Hirase T, Vickery J, McCulloch PC, Lintner DM, Echo A, Harris JD. Performance and Return to Sport After Femoroacetabular Impingement Surgery in National Football League Players. Orthopedics 2019; 42:e423-e429. [PMID: 30964540 DOI: 10.3928/01477447-20190403-01] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 10/10/2018] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to determine the (1) return-to-sport rate for National Football League (NFL) players following femoroacetabular impingement surgery, (2) postoperative career length and games per season, (3) pre- and postoperative performance, and (4) postoperative performance compared with control players matched by position, age, years of experience, and performance. National Football League athletes who underwent hip arthroscopy for femoroacetabular impingement and matched controls were identified. A Bonferroni correction was used to control for multiple comparisons, with statistical significance set at P≤.007. Fifty-five players (63 surgeries) were analyzed (mean age, 27.5±3.4 years; mean years in NFL at time of surgery, 4.7±2.9). Forty-seven (53 surgeries, 84.1%) NFL players returned to sport at a mean of 6.7±3.8 months following surgery. There was no difference (P>.007) in the mean career length of players in the control group (3.7±2.2 years) vs players who underwent hip arthroscopy (3.5±2.1 years). There was no difference (P>.007) in mean games played per season of players in the control group (12.5±3.1) vs those who underwent hip arthroscopy (12.1±4.0). Quarterbacks had significantly better postoperative performance scores when compared with post-index matched controls (P=.007). The return-to-sport rate is high for NFL athletes after hip arthroscopy for femoroacetabular impingement. There were similar games per season and career lengths postoperatively compared with preoperatively and matched controls. Quarterbacks had significantly better postoperative performance when compared with matched controls. All other positions had similar postoperative performance compared with preoperatively and matched controls. [Orthopedics. 2019; 42(5):e423-e429.].
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Performance and Return to Sport After Hip Arthroscopy for Femoroacetabular Impingement in Professional Athletes Differs Between Sports. Arthroscopy 2019; 35:1422-1428. [PMID: 30979626 DOI: 10.1016/j.arthro.2018.10.153] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 10/18/2018] [Accepted: 10/27/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine (1) return-to-sport rates for National Football League, Major League Baseball, National Basketball Association, and National Hockey League (NHL) athletes after hip arthroscopy for femoroacetabular impingement syndrome, (2) postoperative return-to-sport rate differences between sports, (3) differences in postoperative career length and games per season, (4) differences in preoperative and postoperative performance, and (5) postoperative performance compared with that of matched control players. METHODS Professional athletes who underwent hip arthroscopy for femoroacetabular impingement syndrome were identified. Matched control players were identified by position, age, experience, and performance. Return to sport was defined as playing in at least 1 game after surgery. Continuous variables for each group were compared by using a 2-tailed paired-samples Student t test or χ2 test. A Bonferroni correction was used to control for multiple comparisons with statistical significance defined by a P value < .002. RESULTS One hundred seventy-two players (86.4%) (mean age, 28.8 ± 5.2 years) were able to return to sport at an average of 7.1 ± 4.1 months. Athletes played 3.5 ± 2.4 years after surgery without significant differences between sports (P > .002). NHL players who underwent surgery played significantly fewer years (4.4 vs 3.3 years) (P < .001) and fewer games per season (4 fewer games) (P <.001) after surgery compared with control players. NHL players also had a significant decrease in performance after surgery compared with their performance before surgery (P < .001). In National Football League, Major League Baseball, and National Basketball Association athletes, no significant differences were found in games per season, career length, or preoperative performance compared with postoperative performance and performance of matched control players (P > .002). CONCLUSION The RTS rate for professional athletes after surgery for femoroacetabular impingement syndrome is high. Only NHL athletes had significantly shorter careers and played significantly fewer games per season compared with matched control players, with no difference between sports. NHL athletes had significantly worse postoperative performance compared with preoperative performance, with all other sports demonstrating a career-related decline similar to that of matched control players.
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Ling DI, Chiaia TA, deMille P, Marx RG. Return to sport testing after anterior cruciate ligament reconstruction has marginal psychological impact: a randomised controlled trial. J ISAKOS 2019. [DOI: 10.1136/jisakos-2018-000225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Mohtadi NG, Chan DS. Return to Sport-Specific Performance After Primary Anterior Cruciate Ligament Reconstruction: A Systematic Review. Am J Sports Med 2018; 46:3307-3316. [PMID: 29028445 DOI: 10.1177/0363546517732541] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Physicians counseling athletes on the prognosis of sport-specific performance outcomes after anterior cruciate ligament reconstruction (ACLR) depend on the published literature. However, critical appraisal of the validity and biases in these studies is required to understand how ACLR affects an athlete's ability to return to sport, the athlete's sport-specific performance, and his or her ability to achieve preinjury levels of performance. PURPOSE This review identifies the published prognostic studies evaluating sport-specific performance outcomes after ACLR. A risk of bias assessment and summaries of return to sport and career longevity results are provided for each included study. STUDY DESIGN Systematic review. METHODS Electronic databases (Ovid MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and PUBMED) were searched via a defined search strategy with no limits, to identify relevant studies for inclusion in the review. A priori defined eligibility criteria included studies measuring sport-specific performance within an athlete's sport, before and after primary ACLR. Reference lists of eligible studies were hand-searched for additional relevant studies. Data extraction was performed by use of a standardized spreadsheet. Each included study was assessed by use of 6 bias domains of the Quality in Prognosis Studies tool to critically appraise study participation, study attrition, prognostic factors, outcome measurement, confounders, and statistical analysis and reporting. Two authors independently performed each stage of the review and reached consensus through discussion. RESULTS Fifteen pertinent prognostic studies evaluated sport-specific performance outcomes and/or return to play after ACLR for athletes participating in competitive soccer, football, ice hockey, basketball, Alpine ski, X-Games ski and snowboarding, and baseball. Twelve of these studies were considered to have a high level of bias. CONCLUSION This review demonstrated that most high-performance or professional athletes returned to their preinjury level of sport after ACLR. The bulk of evidence suggests there was a measurable decrease in performance statistics, although this is highly sport-specific. A paucity of literature is available that addresses sport-specific performance in athletes after ACLR. This review has determined that the available literature is highly biased and must be read with caution. CLINICAL RELEVANCE By better understanding the validity and biases in the published literature, physicians can provide more informed prognoses about return to sport-specific performance after ACLR while considering risk factors relevant to their patients. REGISTRATION CRD42016046709 (International Prospective Register of Systematic Reviews, https://www.crd.york.ac.uk/prospero/ ).
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Affiliation(s)
| | - Denise S Chan
- University of Calgary Sport Medicine Centre, Calgary, Alberta, Canada
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Jack RA, Burn MB, Sochacki KR, McCulloch PC, Lintner DM, Harris JD. Performance and Return to Sport After Tommy John Surgery Among Major League Baseball Position Players. Am J Sports Med 2018; 46:1720-1726. [PMID: 29601208 DOI: 10.1177/0363546518762397] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The anterior bundle of the medial ulnar collateral ligament (UCL) is the primary restraint to valgus stress at the elbow and is often injured among overhead throwing athletes. Despite prevention strategies, injuries to the elbow UCL are on the rise. PURPOSE To determine (1) the return-to-sport (RTS) rate of Major League Baseball (MLB) position players after elbow medial UCL reconstruction, (2) postoperative career length and games per season, (3) pre- and postoperative performance, (4) postoperative performance versus matched control players, and (5) whether position players changed positions after UCL reconstruction. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS MLB players who underwent elbow UCL reconstruction were identified (cases). Demographic and performance data were collected for each player. Matched controls were identified. RTS in MLB was defined as playing in at least 1 MLB game after UCL reconstruction. Comparisons between case and control groups and pre- and postoperative time points were made via paired samples Student t tests. RESULTS Thirty-three players (34 surgical procedures) were identified with a mean ± SD age of 30.2 ± 4.2 years and a mean experience in the MLB of 6.3 ± 3.9 years at the time of surgery. Twenty-eight players (84.8%) were able to RTS in MLB at a mean 336.9 ± 121.8 days. However, players ≥30 years old demonstrated a significantly lower RTS rate (53.3%) than players <30 years old (89.4%; P < .05). Catchers had a significantly shorter postoperative career length (2.8 ± 1.8 years) versus matched controls (6.1 ± 1.9 years; P < .05). Outfielders had a significantly lower wins above replacement postoperatively (0.8 ± 0.7) versus preoperatively (1.5 ± 1.1; P < .05). There were no performance differences between cases and matched controls. Twelve players (48%) returned to a different position postoperatively. CONCLUSION The RTS rate for MLB position players after elbow UCL reconstruction is similar to that of pitchers. Catchers had a significantly shorter career length than that of matched controls. Outfielders performed worse postoperatively versus preoperatively. There is a high rate of position change after Tommy John surgery for infielders and outfielders.
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Affiliation(s)
- Robert A Jack
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, USA
| | - Matthew B Burn
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, USA
| | - Kyle R Sochacki
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, USA
| | | | - David M Lintner
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, USA
| | - Joshua D Harris
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, USA
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Athletic performance and career longevity following anterior cruciate ligament reconstruction in the National Basketball Association. Knee Surg Sports Traumatol Arthrosc 2017; 25:3031-3037. [PMID: 26971105 DOI: 10.1007/s00167-016-4060-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Accepted: 02/16/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE To identify the impact of anterior cruciate ligament (ACL) reconstruction on performance and career longevity for National Basketball Association (NBA) players. METHODS Seventy-nine players (80 knees) with acute ACL tears in the NBA between the 1984-2014 seasons, and 112 age, height, weight, and performance-matched controls were identified. Pre- and post-injury performance outcomes including seasons played, games played, games started, minutes per game, points per game, field goals, 3-point shots, rebounds, assists, steals, blocks, turnovers, personal fouls, usage percentage and player efficiency ratings were compared between cases and controls using independent samples t tests and Fisher's exact tests. RESULTS Sixty-eight of seventy-nine players (86.1 %) returned to play in the NBA following ACL reconstruction. Mean length of post-operative play was 1.84 years shorter than matched controls (P = 0.001). There was a significantly higher rate of attrition from professional basketball for players with a history of ACL reconstruction (P = 0.014). In the first full season following surgery, players started in 15.5 fewer games (P = 0.001), they played in 17.3 fewer games (P < 0.001), and had combined player efficiency ratings 2.35 points lower (P = 0.001) when compared to matched controls. Over the length of their careers, players competed in 22.2 fewer games per season (P = 0.009). CONCLUSIONS There is a high rate of return to sport in the NBA following ACL reconstruction, although playing time, games played, player efficiency ratings and career lengths are significantly impacted in the post-operative period. These data should be used to manage patients' expectations regarding their abilities to return to elite levels of athletic performance.
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Riff AJ, Luchetti TJ, Weber AE, Chahal J, Bach BR. Thirty-Year Experience With ACL Reconstruction Using Patellar Tendon: A Critical Evaluation of Revision and Reoperation. Orthop J Sports Med 2017; 5:2325967117724345. [PMID: 28890904 PMCID: PMC5580852 DOI: 10.1177/2325967117724345] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background: During the preoperative discussion prior to anterior cruciate ligament reconstruction (ACLR), patients are often interested in data regarding rates of revision reconstruction, reoperation, concomitant pathologic changes, and future contralateral ACL injury. Purpose: To analyze a single surgeon’s experience with primary and revision ACLR over a 30-year interval, focusing on incidence and risk factors for revision and reoperation. Study Design: Case series; Level of evidence, 4. Methods: Patients who underwent ACLR from 1986 to 2016 were identified from a prospectively maintained database. Covariates of interest included age, sex, time, and graft selection. Outcomes of interest included revision and reoperation rates. Results: A total of 2450 ACLRs (mean patient age, 29 years; 58% male) were reviewed. Among primary ACLRs performed (n = 2225), 68% entailed bone–patellar tendon–bone (BTB) autograft and 30% entailed BTB allograft. Patients undergoing ACLR with autograft and allograft had a mean age of 22 and 37 years, respectively. The rate of revision ACLR was 1.8% and 3.5% for primary and revision cases, respectively. An increased rate of revision was noted among females compared with males (2.6% vs 1.2%) and among allografts compared with autografts (2.7% vs 1.3%). Low-dose irradiation did not affect allograft revision rates. The nonrevision reoperation rate following primary ACLR was 12%. The nonrevision reoperation rate was lower among primary cases reconstructed with allograft than autograft (9% vs 13%). Seventeen percent of cases involved concomitant meniscal repair and, among these, 13% required revision meniscal surgery. The rate of contralateral ACLR was 5.3% Conclusion: This information is useful in the informed consent process, for perioperative decision making regarding graft choice, and for identifying patients who are at risk for injuring the uninvolved knee.
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Affiliation(s)
- Andrew J Riff
- Rush University Medical Center, Chicago, Illinois, USA
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Open versus arthroscopic anterior cruciate ligament reconstruction: a systematic review of randomized controlled trials. CURRENT ORTHOPAEDIC PRACTICE 2017. [DOI: 10.1097/bco.0000000000000547] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Nwachukwu BU, Anthony SG, Lin KM, Wang T, Altchek DW, Allen AA. Return to play and performance after anterior cruciate ligament reconstruction in the National Basketball Association: surgeon case series and literature review. PHYSICIAN SPORTSMED 2017; 45:303-308. [PMID: 28449611 DOI: 10.1080/00913847.2017.1325313] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To investigate return to play (RTP) and functional performance after anterior cruciate ligament reconstruction (ACLR) in National Basketball Association (NBA) players and to perform a systematic review of the literature to understand RTP after ACLR in professional basketball. METHODS NBA players undergoing ACLR between 2008 and 2014 by two surgeons were identified. RTP and performance were assessed based on a review of publically available statistics. A systematic review of the literature was performed using the MEDLINE database. Inclusion criteria were: English language, ACL surgery outcome, professional basketball and RTP outcome. We reviewed studies for RTP rates and RTP performance. RESULTS Our study included 12 professional basketball players with NBA level experience. Eleven of the 12 players returned to their prior level of play. Eight of the 9 (88.9%) players actively playing in the NBA returned to play in the NBA at a mean 9.8 months. Among players returning to NBA play, during RTP season 1, mean per game statistics decreased for the following: minutes, points, rebounds, assists, steals, blocks, turnovers and personal fouls - none of these changes reached statistical significance. Player efficiency ratings significantly declined from pre-injury (12.5) to the first RTP season (7.6) (p = 0.05). By RTP season 2, player performance metrics approximated pre-injury levels and were not significantly different. Six studies met inclusion criteria; reported RTP rates ranged from 78-86%. Identified studies similarly found a decline in functional performance after RTP. CONCLUSION There is a high rate (89%) of return to NBA play for NBA players undergoing ACLR. After RTP, however, there is a quantitative decline in initial season 1 RTP statistics with a significant decrease in player efficiency rating. By RTP season 2, performance metrics demonstrated an improvement compared to RTP season 1 but did not reach pre-injury functional performance, though performance metrics are not significantly different between pre-injury and RTP season 2.
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Affiliation(s)
- Benedict U Nwachukwu
- a Department of Orthopaedic Surgery , Hospital for Special Surgery , New York , NY , USA
| | - Shawn G Anthony
- b Mount Sinai St. Luke's and Mount Sinai West , The Mount Sinai Hospital Department of Orthopaedic Surgery , New York , NY , USA
| | - Kenneth M Lin
- a Department of Orthopaedic Surgery , Hospital for Special Surgery , New York , NY , USA
| | - Tim Wang
- a Department of Orthopaedic Surgery , Hospital for Special Surgery , New York , NY , USA
| | - David W Altchek
- a Department of Orthopaedic Surgery , Hospital for Special Surgery , New York , NY , USA
| | - Answorth A Allen
- a Department of Orthopaedic Surgery , Hospital for Special Surgery , New York , NY , USA
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Jack RA, Evans DC, Echo A, McCulloch PC, Lintner DM, Varner KE, Harris JD. Performance and Return to Sport After Sports Hernia Surgery in NFL Players. Orthop J Sports Med 2017; 5:2325967117699590. [PMID: 28451612 PMCID: PMC5400145 DOI: 10.1177/2325967117699590] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Recognition, diagnosis, and treatment of athletic pubalgia (AP), also known as sports hernia, once underrecognized and undertreated in professional football, are becoming more common. Surgery as the final treatment for sports hernia when nonsurgical treatment fails remains controversial. Given the money involved and popularity of the National Football League (NFL), it is important to understand surgical outcomes in this patient population. Hypothesis: After AP surgery, players would: (1) return to sport (RTS) at a greater than 90% rate, (2) play fewer games for fewer years than matched controls, (3) have no difference in performance compared with before AP surgery, and (4) have no difference in performance versus matched controls. Study Design: Cohort study; Level of evidence, 3. Methods: Internet-based injury reports identified players who underwent AP surgery from January 1996 to August 2015. Demographic and performance data were collected for each player. A 1:1 matched control group and an index year analog were identified. Control and case performance scores were calculated using a standardized scoring system. Groups were compared using paired Student t tests. Results: Fifty-six NFL players (57 AP surgeries) were analyzed (mean age, 28.2 ± 3.1 years; mean years in NFL at surgery, 5.4 ± 3.2). Fifty-three players were able to RTS. Controls were in the NFL longer (P < .05) than players who underwent AP surgery (3.8 ± 2.4 vs 3.2 ± 2.1 years). Controls played more games per season (P < .05) than post-AP players (14.0 ± 2.3 vs 12.0 ± 3.4 games per season). There was no significant (P > .05) difference in pre- versus post-AP surgery performance scores and no significant (P > .05) difference in postoperative performance scores versus controls post-index. Conclusion: There was a high RTS rate after AP surgery without a significant difference in postoperative performance, though career length and games per season after AP surgery were significantly less than that of matched controls.
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Affiliation(s)
- Robert A Jack
- Houston Methodist Orthopedics & Sports Medicine, Houston, Texas, USA
| | - David C Evans
- Houston Methodist Orthopedics & Sports Medicine, Houston, Texas, USA
| | - Anthony Echo
- Houston Methodist Plastic & Reconstructive Surgery, Houston, Texas, USA
| | | | - David M Lintner
- Houston Methodist Orthopedics & Sports Medicine, Houston, Texas, USA
| | - Kevin E Varner
- Houston Methodist Orthopedics & Sports Medicine, Houston, Texas, USA
| | - Joshua D Harris
- Houston Methodist Orthopedics & Sports Medicine, Houston, Texas, USA
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Erickson BJ, Chalmers PN, Axe MJ, Romeo AA. Exceeding Pitch Count Recommendations in Little League Baseball Increases the Chance of Requiring Tommy John Surgery as a Professional Baseball Pitcher. Orthop J Sports Med 2017; 5:2325967117695085. [PMID: 28451602 PMCID: PMC5400140 DOI: 10.1177/2325967117695085] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Empirical evidence has suggested a connection between youth pitch counts and subsequent elbow injury. For players within the Little League World Series (LLWS), detailed historical player data are available. Some of these players progress to both professional play and require an ulnar collateral ligament reconstruction (UCLR). Purpose: To determine the percentage of LLWS pitchers who proceed to play professional (major or minor league) baseball, the rate of UCLR in former LLWS pitchers who played professional baseball, and the risk to those who exceeded current pitch count recommendations while playing in the LLWS. Study Design: Cohort study; Level of evidence, 3. Methods: All LLWS pitchers from 2001 through 2009 from all teams and countries were identified, and all performance data were extracted. A professional (major and minor league) baseball database was then searched to determine whether each former LLWS pitcher played professional baseball. These professional players were then searched for using publicly available databases to determine whether they underwent UCLR. Results: Overall, 638 adolescents pitched in the LLWS between 2001 and 2009; 62 (10%) progressed to professional play. Of the 56 minor league players, 25 (45%) pitched. Of the 6 Major League Baseball players, 3 (50%) pitched. Three former LLWS pitchers (5%) who played professionally underwent UCLR. In former LLWS pitchers who exceeded pitch counts and played professionally, 50% (2/4) required UCLR, while only 1.7% (1/58) of those who did not exceed pitch count recommendations required UCLR (P = .009). Similarly, among former LLWS pitchers who subsequently played professionally, 23.1% of those who played as a pitcher required UCLR while 0% of those who also played other positions required UCLR (P = .008). Conclusion: Progression from LLWS pitching to professional baseball is uncommon. Among youth players, both diversification (playing other positions besides pitcher) as well as following current pitch limit regulations may protect against UCLR.
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Affiliation(s)
- Brandon J Erickson
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Peter N Chalmers
- Department of Orthopaedic Surgery, Shoulder and Elbow Division, University of Utah, Salt Lake City, Utah, USA
| | - Michael J Axe
- Department of Orthopaedic Surgery, First State Orthopaedics, Newark, Delaware, USA
| | - Anthony A Romeo
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
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Lai CCH, Ardern CL, Feller JA, Webster KE. Eighty-three per cent of elite athletes return to preinjury sport after anterior cruciate ligament reconstruction: a systematic review with meta-analysis of return to sport rates, graft rupture rates and performance outcomes. Br J Sports Med 2017; 52:128-138. [DOI: 10.1136/bjsports-2016-096836] [Citation(s) in RCA: 226] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2017] [Indexed: 01/10/2023]
Abstract
ObjectivesThe primary objective was to calculate the rate of return to sport (RTS) following anterior cruciate ligament (ACL) reconstruction in elite athletes. Secondary objectives were to estimate the time taken to RTS, calculate rates of ACL graft rupture, evaluate postsurgical athletic performance and identify determinants of RTS.DesignPooled RTS and graft rupture rates were calculated using random effects proportion meta-analysis. Time to RTS, performance data and determinants of RTS were synthesised descriptively.Data sourcesMEDLINE, EMBASE, AMED, CINAHL, AMI, PEDro, SPORTDiscus and The Cochrane Library were searched from inception to 19 January 2016. Hand searching of 10 sports medicine journals and reference checking were also performed.Eligibility criteria for selecting studiesStudies were included if they reported the ratio of elite athletes who returned to their preinjury level of sport following ACL reconstruction. Twenty-four studies were included.ResultsThe pooled RTS rate was 83% (95% CI 77% to 88%). The mean time to RTS ranged from 6 to 13 months. The pooled graft rupture rate was 5.2% (95% CI 2.8% to 8.3%). Six out of nine studies that included a noninjured control group found no significant deterioration in athletic performance following ACL reconstruction. Indicators of greater athletic skill or value to the team were associated with RTS.Summary and conclusionsEighty-three per cent of elite athletes returned to sport following ACL reconstruction, while 5.2% sustained a graft rupture. Most athletes who returned to sport performed comparably with matched, uninjured controls. This information may assist in guiding expectations of athletes and clinicians following ACL reconstruction.
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Mehran N, Williams PN, Keller RA, Khalil LS, Lombardo SJ, Kharrazi FD. Athletic Performance at the National Basketball Association Combine After Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2016; 4:2325967116648083. [PMID: 27294169 PMCID: PMC4887878 DOI: 10.1177/2325967116648083] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Background: Anterior cruciate ligament (ACL) injuries are significant injuries in elite-level basketball players. In-game statistical performance after ACL reconstruction has been demonstrated; however, few studies have reviewed functional performance in National Basketball Association (NBA)–caliber athletes after ACL reconstruction. Purpose: To compare NBA Combine performance of athletes after ACL reconstruction with an age-, size-, and position-matched control group of players with no previous reported knee injury requiring surgery. We hypothesized that there is no difference between the 2 groups in functional performance. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 1092 NBA-caliber players who participated in the NBA Combine between 2000 and 2015 were reviewed. Twenty-one athletes were identified as having primary ACL reconstruction prior to participation in the combine. This study group was compared with an age-, size-, and position-matched control group in objective functional performance testing, including the shuttle run test, lane agility test, three-quarter court sprint, vertical jump (no step), and maximum vertical jump (running start). Results: With regard to quickness and agility, both ACL-reconstructed athletes and controls scored an average of 11.5 seconds in the lane agility test and 3.1 seconds in the shuttle run test (P = .745 and .346, respectively). Speed and acceleration was measured by the three-quarter court sprint, in which both the study group and the control group averaged 3.3 seconds (P = .516). In the maximum vertical jump, which demonstrates an athlete’s jumping ability with a running start, the ACL reconstruction group had an average height of 33.6 inches while the controls averaged 33.9 inches (P = .548). In the standing vertical jump, the ACL reconstruction group averaged 28.2 inches while the control group averaged 29.2 inches (P = .067). Conclusion: In athletes who are able to return to sport and compete at a high level such as the NBA Combine, there is no significant difference in any combine performance test between players who have had primary ACL reconstruction compared with an age-, size-, and position-matched control group. Clinical Relevance: Athletes with previous ACL reconstruction who are able to return to high-level professional basketball have equivalent performance measures with regard to speed, quickness, and jumping ability as those athletes who have not undergone knee surgery.
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Affiliation(s)
- Nima Mehran
- Kerlan-Jobe Orthopaedic Clinic, Los Angeles, California, USA
| | | | | | - Lafi S Khalil
- Wayne State University School of Medicine, Detroit, Michigan, USA
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Erickson BJ, Cvetanovich G, Waliullah K, Khair M, Smith P, Bach B, Sherman S. Two-Stage Revision Anterior Cruciate Ligament Reconstruction. Orthopedics 2016; 39:e456-64. [PMID: 27045480 DOI: 10.3928/01477447-20160324-01] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 10/04/2015] [Indexed: 02/03/2023]
Abstract
The number of primary anterior cruciate ligament (ACL) tears is rapidly increasing. In patients who wish to return to their preoperative level of function, specifically as it pertains to participation in sports, the gold standard of treatment following an ACL tear remains an anterior cruciate ligament (ACL) reconstruction. Despite a majority of good/excellent results following primary ACL reconstruction, there is a growing subset of patients with persistent or recurrent functional instability who require revision ACL reconstruction. Preoperative planning for revision ACL reconstruction requires a careful understanding of the root cause of ACL failure, including possible technical causes of primary ACL failure and the presence of combined knee pathology that was not addressed at the index ACL reconstruction. The decision to perform 2-stage revision ACL reconstruction is multifactorial and is reached by technical considerations that may make a 1-stage revision less optimal, including tunnel widening, arthrofibrosis, active infection, and others. Concomitant knee pathology such as meniscal deficiency, malalignment (including an increase in posterior tibial slope), chondral lesions, and other ligamentous laxity may also require a staged approach to treatment. This evidence-based review covers the indications for 2-stage revision ACL reconstruction, surgical techniques, evidence for and technique of bone grafting prior ACL tunnels, and outcomes of 2-stage revision stratified by initial cause of ACL reconstruction failure. With proper preoperative planning and an understanding of the cause of failure following the primary ACL reconstruction, revision ACL reconstruction can offer excellent outcomes in the motivated patient. [Orthopedics. 2016; 39(3):e456-e464.].
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Frank RM, Tilton AK, Campbell KA, Bach BR. Managing Perioperative Extensor Mechanism Injuries and the Patellar Defect After Anterior Cruciate Ligament Reconstruction. OPER TECHN SPORT MED 2016. [DOI: 10.1053/j.otsm.2015.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
In athletes, significant advances in anterior cruciate ligament reconstruction techniques and rehabilitation have led to improved surgical outcomes and increased expectations for return to play. Although an expeditious return to sport has become an achievable and often realistic goal, the factors that most influence safe, timely, and successful return to play remain unknown. The literature offers mainly anecdotal evidence to guide the team physician in the decision-making process, with a paucity of criteria and consensus guidelines available to help determine return to sport. Attempts have been made to introduce criteria-based progression in the rehabilitation process, but validation of subjective and objective criteria has been difficult. Nevertheless, several pertinent factors in the preoperative, intraoperative, and postoperative periods may affect return to play following anterior cruciate ligament reconstruction. Further research is warranted to validate reliable, consensus guidelines with objective criteria to facilitate the return to play process.
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Ardern CL, Taylor NF, Feller JA, Whitehead TS, Webster KE. Sports participation 2 years after anterior cruciate ligament reconstruction in athletes who had not returned to sport at 1 year: a prospective follow-up of physical function and psychological factors in 122 athletes. Am J Sports Med 2015; 43:848-56. [PMID: 25583757 DOI: 10.1177/0363546514563282] [Citation(s) in RCA: 182] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND A return to their preinjury level of sport is frequently expected within 1 year after anterior cruciate ligament (ACL) reconstruction, yet up to two-thirds of athletes may not have achieved this milestone. The subsequent sports participation outcomes of athletes who have not returned to their preinjury level sport by 1 year after surgery have not previously been investigated. PURPOSE To investigate return-to-sport rates at 2 years after surgery in athletes who had not returned to their preinjury level sport at 1 year after ACL reconstruction. STUDY DESIGN Case series; Level of evidence, 4. METHODS A consecutive cohort of competitive- and recreational-level athletes was recruited prospectively before undergoing ACL reconstruction at a private orthopaedic clinic. Participants were followed up at 1 and 2 years after surgery with a sports activity questionnaire that collected information regarding returning to sport, sports participation, and psychological responses. An independent physical therapist evaluated physical function at 1 year using hop tests and the International Knee Documentation Committee knee examination form and subjective knee evaluation. RESULTS A group of 122 competitive- and recreational-level athletes who had not returned to their preinjury level sport at 1 year after ACL reconstruction participated. Ninety-one percent of the athletes returned to some form of sport after surgery. At 2 years after surgery, 66% were playing sport, with 41% playing their preinjury level of sport and 25% playing a lower level of sport. Having a previous ACL reconstruction to either knee, poorer hop-test symmetry and subjective knee function, and more negative psychological responses were associated with not playing the preinjury level sport at 2 years. CONCLUSION Most athletes who were not playing sport at 1 year had returned to some form of sport within 2 years after ACL reconstruction, which may suggest that athletes can take longer than the clinically expected time of 1 year to return to sport. However, only 2 of every 5 athletes were playing their preinjury level of sport at 2 years after surgery. When the results of the current study were combined with the results of athletes who had returned to sport at 1 year, the overall rate of return to the preinjury level sport at 2 years was 60%. Demographics, physical function, and psychological factors were related to playing the preinjury level sport at 2 years after surgery, supporting the notion that returning to sport after surgery is multifactorial.
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Affiliation(s)
- Clare L Ardern
- School of Allied Health, La Trobe University, Melbourne, Australia Division of Physiotherapy, Linköping University, Linköping, Sweden
| | | | - Julian A Feller
- School of Allied Health, La Trobe University, Melbourne, Australia OrthoSport Victoria, Epworth Healthcare, Melbourne, Australia
| | | | - Kate E Webster
- School of Allied Health, La Trobe University, Melbourne, Australia
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Frank RM, Mascarenhas R, Haro M, Verma NN, Cole BJ, Bush-Joseph CA, Bach BR. Closure of patellar tendon defect in anterior cruciate ligament reconstruction with bone-patellar tendon-bone autograft: systematic review of randomized controlled trials. Arthroscopy 2015; 31:329-38. [PMID: 25442654 DOI: 10.1016/j.arthro.2014.09.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 09/08/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE This study aimed to systematically review the highest level of evidence on anterior cruciate ligament (ACL) reconstruction with bone-patellar tendon-bone (BPTB) autografts with patellar tendon defect closure versus no closure after surgery. METHODS We performed a systematic review of multiple medical databases using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Level I and Level II randomized controlled trials comparing patellar tendon defect closure to no closure during ACL reconstruction with BPTB autografts were included. Two independent reviewers analyzed all studies. Descriptive statistics were calculated. Study methodological quality was analyzed using the Modified Coleman Methodology Score (MCMS) and Jadad scale. RESULTS Four studies with a combined 221 patients (154 male patients and 67 female patients) with an average age of 26.6 ± 2.4 years (range, 17 to 54 years) were included. All studies randomized patients before surgery into ACLR with BPTB autografts either with patellar tendon defect closure or without closure. There were no differences in clinical outcomes (Lysholm score, Tegner scale, International Knee Documentation Committee [IKDC] classification, modified Larsen score, and Lauridsen rating) between groups. There were no significant differences in knee pain between groups. All studies reported imaging findings of the patellar tendon defect, with 2 studies showing no difference in appearance between groups, one study showing excessive scar formation with defect repair, and one study showing improved restoration of normal tendon appearance with defect repair. The overall quality of the studies was poor, with all studies scoring less than 46 (average, 40.5 ± 4.7) on the MCMS and scoring 1 on the Jadad scale. CONCLUSIONS Based on this systematic review of 4 randomized trials, there are no statistically significant or clinically relevant differences in outcomes between patients who have the patellar tendon defect closed and those who have it left open after ACLR with BPTB autografts. The methodology of the included studies limits the interpretation of the data, as evidenced by low MCMS and Jadad scores. LEVEL OF EVIDENCE Level II, systematic review of Level I and Level II studies.
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Affiliation(s)
- Rachel M Frank
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A..
| | - Randy Mascarenhas
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Marc Haro
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Nikhil N Verma
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Brian J Cole
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Charles A Bush-Joseph
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Bernard R Bach
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
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Bauer M, Feeley BT, Wawrzyniak JR, Pinkowsky G, Gallo RA. Factors affecting return to play after anterior cruciate ligament reconstruction: a review of the current literature. PHYSICIAN SPORTSMED 2014; 42:71-9. [PMID: 25419890 DOI: 10.3810/psm.2014.11.2093] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Anterior cruciate ligament reconstruction has been reported to produce normal or near-normal knee results in > 90% of patients. A recent meta-analysis suggested that, despite normal or near-normal knees, many athletes do not return to sports. Rates and timing of return to competitive athletics are quite variable depending on the graft type, the age of the patient, the sport, and the level of play. Even when athletes do return to play, often they do not return to their previous level. Graft failure, subjective physical factors, and psychological factors, including fear of reinjury and lack of motivation, appear to play a large role in patients' ability to return to sporting activities.
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Affiliation(s)
- Matthew Bauer
- Department of Orthopaedic Surgery, Pennsylvania State University College of Medicine, Hershey, PA
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Erickson BJ, Harris JD, Tetreault M, Bush-Joseph C, Cohen M, Romeo AA. Is Tommy John Surgery Performed More Frequently in Major League Baseball Pitchers From Warm Weather Areas? Orthop J Sports Med 2014; 2:2325967114553916. [PMID: 26535277 PMCID: PMC4555545 DOI: 10.1177/2325967114553916] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background: Medial ulnar collateral ligament (UCL) reconstruction is a common procedure performed on Major League Baseball (MLB) pitchers with symptomatic UCL insufficiency, frequently due to overuse. Warm weather climates afford youth pitchers the opportunity to throw year-round, potentially placing them at risk for overuse elbow injuries. Purpose/Hypothesis: To determine whether the proportion of MLB pitchers who underwent medial UCL reconstruction and who pitched competitive youth baseball in warm weather areas is higher than those from cold weather areas. The hypothesis was that MLB pitchers from warm weather areas were more likely to undergo UCL reconstruction than pitchers from cold weather areas. Study Design: Descriptive epidemiological study. Methods: All MLB pitchers with symptomatic UCL deficiency who underwent UCL reconstruction as of June 1, 2014, were evaluated. The state/country where they played high school baseball was identified from online reference websites. Warm and cold weather areas were defined by latitude distance from the equator and mean annual temperatures. A chi-square test was used to compare the proportion of MLB pitchers from warm versus cold weather areas who underwent UCL reconstruction. The study was 99.6% powered to detect a 100% effect size (eg, 1% vs 2%) and 71.4% powered to detect a 50% effect size (eg, 1% vs 1.5%) with setting α = .05. Results: A total of 247 pitchers were identified who had undergone UCL reconstruction; 139 (56.3%) pitched high school baseball in warm weather areas, 108 (43.7%) pitched in cold weather areas. A significantly higher proportion of pitchers who underwent UCL reconstruction (2.2% [95% CI, 1.9%-2.6%]) were from warm weather areas compared with cold weather areas (0.94% [95% CI, 0.78%-1.1%]) (P < .0001). Warm weather pitchers had a mean (±SD) age of 27.6 ± 0.6 years and had played 4.0 ± 0.6 seasons in MLB at the time of surgery, while cold weather pitchers were aged 28.4 ± 0.8 years and had played 5.0 ± 0.9 seasons in MLB (P = .089 and P = .047, respectively). Conclusion: MLB pitchers who played high school baseball in warm weather climates have undergone medial UCL reconstruction more frequently and earlier in their MLB careers than pitchers who played in cold weather areas.
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Affiliation(s)
- Brandon J Erickson
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Joshua D Harris
- Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, Texas, USA. ; Weill Cornell College of Medicine, New York, New York, USA
| | - Matthew Tetreault
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Charles Bush-Joseph
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Mark Cohen
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Anthony A Romeo
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
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Erickson BJ, Harris JD, Cole BJ, Frank RM, Fillingham YA, Ellman MB, Verma NN, Bach BR. Performance and Return to Sport After Anterior Cruciate Ligament Reconstruction in National Hockey League Players. Orthop J Sports Med 2014; 2:2325967114548831. [PMID: 26535359 PMCID: PMC4555634 DOI: 10.1177/2325967114548831] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: Anterior cruciate ligament (ACL) rupture is a significant injury in male National Hockey League (NHL) players. Purpose: To determine (1) the return to sport (RTS) rate in the NHL following ACL reconstruction, (2) performance on RTS, and (3) the difference in RTS and performance between players who underwent ACL reconstruction and controls. Study Design: Cohort study; Level of evidence, 3. Methods: NHL players undergoing ACL reconstruction were evaluated. All demographic data were analyzed. Matched controls were selected from the NHL during the same years as those undergoing ACL reconstruction. The “index year” (relative to the number of years of experience in the NHL) in controls was the same as the year that cases underwent ACL reconstruction. RTS and performance in the NHL were analyzed and compared between cases and controls. Student t tests were performed for analysis of within- and between-group variables. Bonferroni correction was used in the setting of multiple comparisons. Results: A total of 36 players (37 knees) meeting the inclusion criteria underwent ACL reconstruction while in the NHL. Thirty-five players were able to RTS in the NHL (97%), and 1 player returned to the international Kontinental Hockey League. Of the players who RTS in the NHL, 100% were able to RTS the season after ACL reconstruction (mean, 7.8 ± 2.4 months). Length of career in the NHL after ACL reconstruction was 4.47 ± 3.3 years. The revision rate was 2.5%. There were significantly more cases playing in the NHL at 3 (P = .027) and 4 (P = .029) years following surgery compared with controls (index year). After ACL reconstruction, player performance was not significantly different from preinjury performance. Following ACL reconstruction (or index year in controls), cases played significantly more minutes, took more shots, had better shooting percentages, and scored more goals and points than did controls (P < .01 for all). Control players did not significantly outperform cases after ACL reconstruction in any performance measure. Conclusion: There is a high RTS rate in the NHL following ACL reconstruction. All players who RTS did so the season following surgery. Performance following ACL reconstruction was not significantly different from preinjury. Cases performed better than did controls in several performance measures. Controls did not outperform cases in any measured performance variable.
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Affiliation(s)
- Brandon J Erickson
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Joshua D Harris
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Brian J Cole
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Rachel M Frank
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Yale A Fillingham
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Michael B Ellman
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Nikhil N Verma
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Bernard R Bach
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
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College and Professional Women’s Basketball Players’ Lower Extremity Injuries: A Survey of Career Incidence. INTERNATIONAL JOURNAL OF ATHLETIC THERAPY & TRAINING 2014. [DOI: 10.1123/ijatt.2014-0020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Context:Lower extremity injuries in women’s basketball players are generally presented as seasonal team incidence. Available data were reported by team athletic trainers to overseeing bodies yielding estimates of injury rates as a percentage of all injuries sustained. By summarizing career incidence of women’s basketball players’ injuries, a new perspective indicating potential risk of injury can be considered.Objectives:To summarize the career incidence of lower extremity injuries in intercollegiate and professional women’s basketball players, examine the effect of anterior cruciate ligament (ACL) injury on professional basketball players’ career longevity, and explore the relationship between ankle sprains and knee injuries in this population.Design:Survey.Participants:246 elite-level women’s basketball players.Outcome Measures:Career incidence of lower extremity injury, professional career length, relationship between history of ankle sprain and ACL injury frequency calculations, and chi-square statistics.Results: Seventy-four of 85 (87.06%) professional Women’s National Basketball Association (WNBA) and 172/179 (96.09%) available collegiate Big East Conference (BEC) women’s basketball players completed the survey. Ankle sprains were the most frequently reported injury with 170/246 (69.11%) participants indicating at least one during their career. Patellar tendinopathy (28.46%), meniscal injury (22.76%), and ACL tear (21.54%) were also common. Professional career length in participants with an ACL reconstruction averaged 6.11 ± 3.20 seasons, more than the 5.70 ± 4.17 seasons reported by those without an ACL injury. Professional participants who did not report an ankle sprain were more likely to report an ACL tear (χ2= 10.96;p= .000932).Conclusion:Summarizing career incidence provides a new perspective of women’s basketball players’ injuries. Ankle sprains and knee injuries were commonly reported, both more frequently than by traditional research methods. These data may assist in developing injury prevention and rehabilitation strategies for injured athletes.
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Kumar NS, Chin M, O'Neill C, Jakoi AM, Tabb L, Wolf M. On-field performance of national football league players after return from concussion. Am J Sports Med 2014; 42:2050-5. [PMID: 25008256 DOI: 10.1177/0363546514539449] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There are few data examining the short-term effects of concussions on player performance upon return to play. This study examined changes in on-field performance and the influence of epidemiologic factors on performance and return to play. HYPOTHESIS On-field performance is different in players who return within 7 days after concussion compared with players who miss at least 1 game. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Players in the National Football League who were active during the 2008 to 2012 seasons were considered for inclusion. Weekly injury reports identified concussed players. All players played in at least 4 games before and after the game of injury (sentinel game) within the year of injury (sentinel year). Players who had missed games secondary to another injury or had sustained a second concussion within the sentinel year were excluded. The players' league profiles were used to determine age, position, body mass index, career experience, and games missed. ProFootballFocus performance scores determined player ratings. Statistical analysis used 2-sided t tests and both univariate and multivariate logistic regression models. RESULTS There were a total of 131 concussions in the 124 players who qualified for this study; 55% of these players missed no games. Defensive secondary, wide receiver, and offensive line were the most commonly affected positions. Players who missed at least 1 game were younger and less experienced. Preinjury ProFootballFocus performance scores were similar to postinjury performance in players without games missed (0.16 vs 0.33; P = .129) and players who missed at least 1 game (-0.06 vs 0.10; P = .219). Age, body mass index, experience, and previous concussion did not correlate with changes in postinjury scores (P > .05). Older, more experienced players and players with late-season concussions were more likely to return to play without missing games (P < .05). The odds of returning within 7 days increased by 18% for each career year and by 40% for each game before the sentinel game within the sentinel year; these same odds decreased by 85% after introduction of newer treatment guidelines in 2009. CONCLUSION No difference in player performance after concussion was found whether the player did or did not miss games before return. Return without missing games may be associated with experience and timing of injury within a season and less likely after newer guidelines.
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Affiliation(s)
- Neil S Kumar
- Department of Orthopaedic Surgery, Hahnemann University Hospital, Philadelphia, Pennsylvania, USA
| | - Matthew Chin
- Department of Orthopaedic Surgery, Hahnemann University Hospital, Philadelphia, Pennsylvania, USA
| | - Craig O'Neill
- Department of Orthopaedic Surgery, Hahnemann University Hospital, Philadelphia, Pennsylvania, USA
| | - Andre M Jakoi
- Department of Orthopaedic Surgery, Hahnemann University Hospital, Philadelphia, Pennsylvania, USA
| | - Loni Tabb
- Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, Pennsylvania, USA
| | - Michael Wolf
- Department of Orthopaedic Surgery, St Christopher's Hospital for Children, Philadelphia, Pennsylvania, USA
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Ardern CL, Taylor NF, Feller JA, Webster KE. Fifty-five per cent return to competitive sport following anterior cruciate ligament reconstruction surgery: an updated systematic review and meta-analysis including aspects of physical functioning and contextual factors. Br J Sports Med 2014; 48:1543-52. [PMID: 25157180 DOI: 10.1136/bjsports-2013-093398] [Citation(s) in RCA: 796] [Impact Index Per Article: 79.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND The aim of this study was to update our original systematic review of return to sport rates following anterior cruciate ligament (ACL) reconstruction surgery. METHOD Electronic databases were searched from April 2010 to November 2013 for articles reporting the number of patients returning to sport following ACL reconstruction surgery. Return to sport rates, physical functioning and contextual data were extracted and combined using random-effects meta-analyses. Data from the original review (articles published up to April 2010) were combined with data from the updated search. RESULTS Sixty-nine articles, reporting on 7556 participants, were reviewed. On average, 81% of people returned to any sport, 65% returned to their preinjury level of sport and 55% returned to competitive level sport after surgery. Symmetrical hopping performance (d=0.3) and the contextual factors of younger age (d=-0.3), male gender (OR=1.4), playing elite sport (OR=2.5) and having a positive psychological response (d=0.3) favoured returning to the preinjury level sport. Receiving a hamstring tendon autograft favoured returning to competitive level sport (OR=2.4), whereas receiving a patellar tendon autograft favoured returning to the preinjury level sport (OR=1.2). CONCLUSIONS Returning to sport varied according to different physical functioning and contextual factors, which could warrant additional emphasis in postoperative rehabilitation programmes to maximise participation.
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Affiliation(s)
- Clare L Ardern
- School of Allied Health, La Trobe University, Bundoora, Victoria, Australia
| | - Nicholas F Taylor
- School of Allied Health, La Trobe University, Bundoora, Victoria, Australia
| | - Julian A Feller
- School of Allied Health, La Trobe University, Bundoora, Victoria, Australia Epworth Healthcare, Richmond, Victoria, Australia
| | - Kate E Webster
- School of Allied Health, La Trobe University, Bundoora, Victoria, Australia
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Daruwalla JH, Greis PE, Hancock R, Xerogeanes JW. Rates and Determinants of Return to Play After Anterior Cruciate Ligament Reconstruction in NCAA Division 1 College Football Athletes: A Study of the ACC, SEC, and PAC-12 Conferences. Orthop J Sports Med 2014; 2:2325967114543901. [PMID: 26535351 PMCID: PMC4555574 DOI: 10.1177/2325967114543901] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND For competitive athletes, return to play (RTP) and return to preinjury levels of performance after anterior cruciate ligament (ACL) reconstruction are the main goals of surgery. Although outcomes of ACL surgery are well studied, details on factors influencing RTP in elite college football players have not been evaluated thoroughly. PURPOSE To determine the rate of RTP following ACL surgery among National Collegiate Athletic Association (NCAA) Division 1 collegiate football athletes and to examine variables that may affect these rates. The hypothesis was that the RTP rate in this cohort will be influenced by factors reflecting skill and accomplishment; that is, athletes higher on the depth chart, those on scholarship, and those later in their careers will have higher RTP rates. It was also predicted that graft type and concomitant procedures may have an effect on RTP rates. STUDY DESIGN Case series; Level of evidence, 4. METHODS Using athlete- and surgery-specific data from participating institutions in 3 major Division 1 college football conferences, information on athletes who had ACL reconstruction from 2004 through 2010 was collected. Statistical analyses were performed to determine the RTP rate as a function of the variables, such as depth chart position, in the data collected. RESULTS Of the 184-player cohort, 82% of the athletes, including 94% of starters, were able to RTP. Rates were greater among athletes higher on the depth chart (P = .004) and on scholarship (P = .008). Year of eligibility also affected RTP rates (P = .047), which increased from the redshirt and freshman year to the sophomore and junior years, but then decreased slightly into the senior and fifth-year senior seasons. The use of an autograft versus allograft was associated with increased RTP (P = .045). There was no significant difference (P = .18) between players who underwent an isolated ACL reconstruction versus those who underwent additional procedures. CONCLUSION More than 80% of football players at the Division 1 level were able to RTP following ACL reconstruction. Factors representative of a player's skill were associated with higher rates of RTP. Surgery-specific variables, in general, had no effect on RTP, except for the use of autograft, which was associated with a greater RTP rate.
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Affiliation(s)
| | - Patrick E. Greis
- University of Utah School of Medicine, Salt Lake City, Utah, USA
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Erickson BJ, Harris JD, Heninger JR, Frank R, Bush-Joseph CA, Verma NN, Cole BJ, Bach BR. Performance and return-to-sport after ACL reconstruction in NFL quarterbacks. Orthopedics 2014; 37:e728-34. [PMID: 25102509 DOI: 10.3928/01477447-20140728-59] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 01/30/2014] [Indexed: 02/03/2023]
Abstract
Anterior cruciate ligament (ACL) rupture is a significant injury in National Football League (NFL) quarterbacks. The purpose of this study was to determine (1) return-to-sport (RTS) rate in NFL quarterbacks following ACL reconstruction, (2) performance upon RTS, and (3) the difference in RTS and performance between players who underwent ACL reconstruction and controls. Thirteen quarterbacks (14 knees) who met inclusion criteria underwent ACL reconstruction while in the NFL. Matched controls were selected from the NFL during the same time span to compare and analyze age, body mass index (BMI), position, performance, and NFL experience. Student t tests were performed for analysis of within- and between-group variables. Bonferroni correction was used in the setting of multiple comparisons. Twelve quarterbacks (13 knees; 92%) were able to RTS in the NFL. Mean player age was 27.2±2.39 years. Mean career length in the NFL following ACL reconstruction was 4.85±2.7 years. Only 1 player needed revision ACL reconstruction. In both cases and controls, player performance was not significantly different from preinjury performance after ACL reconstruction (or index year in controls). There was also no significant performance difference between case and control quarterbacks following ACL reconstruction (or index year in controls). There is a high rate of RTS in the NFL following ACL reconstruction. In-game performance following ACL reconstruction was not significantly different from preinjury or from controls.
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Erickson BJ, Gupta AK, Harris JD, Bush-Joseph C, Bach BR, Abrams GD, San Juan AM, Cole BJ, Romeo AA. Rate of return to pitching and performance after Tommy John surgery in Major League Baseball pitchers. Am J Sports Med 2014; 42:536-43. [PMID: 24352622 DOI: 10.1177/0363546513510890] [Citation(s) in RCA: 254] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Medial ulnar collateral ligament (UCL) reconstruction is a common procedure performed on Major League Baseball (MLB) pitchers in the United States. PURPOSE To determine (1) the rate of return to pitching (RTP) in the MLB after UCL reconstruction, (2) the RTP rate in either the MLB and minor league combined, (3) performance after RTP, and (4) the difference in the RTP rate and performance between pitchers who underwent UCL reconstruction and matched controls without UCL injuries. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Major League Baseball pitchers with symptomatic medial UCL deficiency who underwent UCL reconstruction were evaluated. All player, elbow, and surgical demographic data were analyzed. Controls matched by age, body mass index, position, handedness, and MLB experience and performance were selected from the MLB during the same years as those undergoing UCL reconstruction. An "index year" was designated for controls, analogous to the UCL reconstruction year in cases. Return to pitching and performance measures in the MLB were compared between cases and controls. Student t tests were performed for analysis of within-group and between-group variables, respectively. RESULTS A total of 179 pitchers with UCL tears who underwent reconstruction met the inclusion criteria and were analyzed. Of these, 148 pitchers (83%) were able to RTP in the MLB, and 174 pitchers were able to RTP in the MLB and minor league combined (97.2%), while only 5 pitchers (2.8%) were never able to RTP in either the MLB or minor league. Pitchers returned to the MLB at a mean 20.5 ± 9.72 months after UCL reconstruction. The length of career in the MLB after UCL reconstruction was 3.9 ± 2.84 years, although 56 of these patients were still currently actively pitching in the MLB at the start of the 2013 season. The revision rate was 3.9%. In the year before UCL reconstruction, pitching performance declined significantly in the cases versus controls in the number of innings pitched, games played, and wins and the winning percentage (P < .05). After surgery, pitchers showed significantly improved performance versus before surgery (fewer losses, a lower losing percentage, lower earned run average [ERA], threw fewer walks, and allowed fewer hits, runs, and home runs) (P < .05). Comparisons between cases and controls for the time frame after UCL reconstruction (cases) or the index year (controls) demonstrated that cases had significantly (P < .05) fewer losses per season and a lower losing percentage. In addition, cases had a significantly lower ERA and allowed fewer walks and hits per inning pitched. CONCLUSION There is a high rate of RTP in professional baseball after UCL reconstruction. Performance declined before surgery and improved after surgery. When compared with demographic-matched controls, patients who underwent UCL reconstruction had better results in multiple performance measures. Reconstruction of the UCL allows for a predictable and successful return to the MLB.
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Affiliation(s)
- Brandon J Erickson
- Anthony A. Romeo, Midwest Orthopaedics at Rush, Rush University Medical Center, 1611 West Harrison Street, Suite 300, Chicago, IL 60612, USA.
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