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Mayer MA, Deliso M, Hong IS, Saltzman BM, Longobardi RS, DeLuca PF, Rizio L. Rehabilitation and Return to Play Protocols After Anterior Cruciate Ligament Reconstruction in Soccer Players: A Systematic Review. Am J Sports Med 2024:3635465241233161. [PMID: 38622858 DOI: 10.1177/03635465241233161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
BACKGROUND Rehabilitation after anterior cruciate ligament ACL reconstruction (ACLR) is crucial for safe return to play (RTP) and reducing the chances of a reinjury. Yet, there is no consensus on the ideal functional tests to assess rehabilitation progress in soccer players after ACLR. PURPOSE The primary objective was to highlight the existing gap in the literature concerning the most effective standardized rehabilitation protocols and testing for facilitating successful RTP among soccer players. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS A systematic review using PubMed, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) was conducted. Inclusion criteria encompassed original studies (level of evidence 1-4) that examined rehabilitation protocols, metrics of knee rehabilitation, and clinical outcomes after ACLR in soccer players. RESULTS This review incorporated 23 studies, predominantly retrospective case series, with a total number of 874 soccer players who underwent ACLR and rehabiliation. 5 (21.7%) studies utilized an accelerated rehabilitation protocol, while 7 (30.4%) of studies utilized a criterion-based rehabilitation. A wide heterogeneity of data was extracted including functional tests of rehabilitation and RTP such as strength test batteries, hop test batteries, and movement quality assessments. Of the 23 selected studies, 2 (8.7%) used all 3 test batteries, 8 (34.8%) used 2 test batteries, 12 (52.2%) used 1 test battery, and 1 (4.3%) used 0 of the test batteries. The mean time between surgery and RTP ranged from 3 to 8 months with only 2 (8.7%) studies reporting complications after ACLR. Lastly, out of the total studies examined, 9 (39.1%) assessed patient-reported outcome measures (PROMs), all of which demonstrated significant improvement from the initial assessment to the final follow up. CONCLUSION Soccer-specific rehabilitation after ACLR lacks standardization. Even though many studies have assessed protocols for optimal RTP and reduced secondary ACL injuries, there is a gap in the literature regarding the most effective protocols and RTP testing. The methodology reported by Kyritsis et al could serve as a foundation for future prospective randomized multicenter studies to establish a standard rehabilitation protocol and enable a successful return to soccer.
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Affiliation(s)
- McKenzie A Mayer
- Department of Orthopedic Surgery, Cooperman Barnabas Medical Center, Livingston, New Jersey, USA
- Department of Orthopedic Surgery, Jersey City Medical Center, Jersey City, New Jersey, USA
| | - Marisa Deliso
- Department of Orthopedic Surgery, Cooperman Barnabas Medical Center, Livingston, New Jersey, USA
- Department of Orthopedic Surgery, Jersey City Medical Center, Jersey City, New Jersey, USA
| | - Ian S Hong
- Department of Orthopedic Surgery, Cooperman Barnabas Medical Center, Livingston, New Jersey, USA
- Department of Orthopedic Surgery, Jersey City Medical Center, Jersey City, New Jersey, USA
| | - Bryan M Saltzman
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, USA
- Musculoskeletal Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Raphael S Longobardi
- Department of Sports Medicine, Cooperman Barnabas Medical Center, Livingston, New Jersey, USA
| | - Peter F DeLuca
- Department of Sports Medicine, Cooperman Barnabas Medical Center, Livingston, New Jersey, USA
| | - Louis Rizio
- Department of Sports Medicine, Cooperman Barnabas Medical Center, Livingston, New Jersey, USA
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Deliso M, Baskar S, Gencarelli P, Tang A, Jankowski JM, Liporace FA, Yoon RS. Reverse Total Shoulder Arthroplasty for Younger Patients: A Comparable Analysis of Patients Older and Younger Than 65 Years. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202306000-00012. [PMID: 37339241 DOI: 10.5435/jaaosglobal-d-22-00264] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 04/24/2023] [Indexed: 06/22/2023]
Abstract
INTRODUCTION Reverse total shoulder arthroplasty (rTSA) has become a popular option for the surgical management of rotator cuff arthropathy and complex fractures of the proximal humerus. However, there is a paucity of studies evaluating outcomes, especially between patients of different age groups. The purpose of this study was to compare functional outcomes and survivorship between patients older than 65 years (o65) and those 65 years and younger (y65). METHODS A retrospective review was conducted at a single academic medical center identifying a consecutive cohort of patients undergoing rTSA between 2018 and 2020. The minimum follow-up time was 2 years. Patients were stratified into two groups for comparative analyses (y65 and o65). Patient demographics, perioperative and postoperative data, and functional outcomes were collected. A Kaplan-Meier survival analysis was conducted to determine survivorship, defined as revision surgery or implant failure. RESULTS Forty-eight patients were included for final analysis. Nineteen patients comprised the y65 group while 29 patients comprised the o65 group. No difference was observed in Quick Disabilities of the Arm, Shoulder, and Hand scores at baseline nor at the latest follow-up between the two groups. Patients in the y65 group had significantly greater internal and external rotation (IR/ER) from 3 months to 2 years compared with patients in the o65 group (P ≤ 0.05). Finally, there were no differences in revision surgery rates between the y65 group and the o65 group (11% vs. 14%, P = 1.0). A KM survival analysis revealed no difference in implant failure, necessitating revision surgery between the two groups at the latest follow-up (P = 0.69). DISCUSSION Despite a notable difference in the number of baseline comorbidities, there were no notable differences in functional outcomes, survivorship, and revision surgery rates between each cohort. Although both groups had a similar function initially, by 3 months postoperatively, the y65 group had markedly greater range of motion in IR and ER. Longer term survivorship is needed; however, rTSA may offer a reliable option for shoulder reconstruction even in the y65 patient group.
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Affiliation(s)
- Marisa Deliso
- From the Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center - RWJBarnabas Health Jersey City, NJ
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Garg G, Deliso M, Li S, Sharma P, Abdelbaki A, Gupta N. Prostatosymphyseal fistula after transurethral resection of the prostate (TURP), a rare and difficult to recognize complication. Urol Case Rep 2018; 21:70-72. [PMID: 30211011 PMCID: PMC6134174 DOI: 10.1016/j.eucr.2018.07.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 07/25/2018] [Indexed: 11/05/2022] Open
Affiliation(s)
- Gunjan Garg
- Department of Radiology, Yale New Haven Health Bridgeport Hospital, 267 Grant Street, Bridgeport, CT, 06610, USA
| | - Marisa Deliso
- St. George's School of Medicine, 3500 Sunrise Highway, Building 300, Great River, NY, 11739, USA
| | - Shuo Li
- Department of Interventional Radiology, University of Miami Miller School of Medicine, 1611 Northwest 12th Avenue 2nd Floor West Wing- Room W203, Miami, FL, 33136, USA
| | - Pranav Sharma
- Department of Radiology, Yale New Haven Health Bridgeport Hospital, 267 Grant Street, Bridgeport, CT, 06610, USA
| | - Ahmed Abdelbaki
- Department of Radiology, Yale New Haven Health Bridgeport Hospital, 267 Grant Street, Bridgeport, CT, 06610, USA
| | - Nishant Gupta
- Columbia University Medical Center, 630 W 168th St, New York, NY, 10032, USA
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Manyevitch R, Protas M, Scarpiello S, Deliso M, Bass B, Nanajian A, Chang M, Thompson SM, Khoury N, Gonnella R, Trotz M, Moore DB, Harms E, Perry G, Clunes L, Ortiz A, Friedrich JO, Murray IV. Evaluation of Metabolic and Synaptic Dysfunction Hypotheses of Alzheimer's Disease (AD): A Meta-Analysis of CSF Markers. Curr Alzheimer Res 2018; 15:164-181. [PMID: 28933272 PMCID: PMC5769087 DOI: 10.2174/1567205014666170921122458] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 09/13/2017] [Accepted: 09/14/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Alzheimer's disease (AD) is currently incurable and a majority of investigational drugs have failed clinical trials. One explanation for this failure may be the invalidity of hypotheses focusing on amyloid to explain AD pathogenesis. Recently, hypotheses which are centered on synaptic and metabolic dysfunction are increasingly implicated in AD. OBJECTIVE Evaluate AD hypotheses by comparing neurotransmitter and metabolite marker concentrations in normal versus AD CSF. METHODS Meta-analysis allows for statistical comparison of pooled, existing cerebrospinal fluid (CSF) marker data extracted from multiple publications, to obtain a more reliable estimate of concentrations. This method also provides a unique opportunity to rapidly validate AD hypotheses using the resulting CSF concentration data. Hubmed, Pubmed and Google Scholar were comprehensively searched for published English articles, without date restrictions, for the keywords "AD", "CSF", and "human" plus markers selected for synaptic and metabolic pathways. Synaptic markers were acetylcholine, gamma-aminobutyric acid (GABA), glutamine, and glycine. Metabolic markers were glutathione, glucose, lactate, pyruvate, and 8 other amino acids. Only studies that measured markers in AD and controls (Ctl), provided means, standard errors/deviation, and subject numbers were included. Data were extracted by six authors and reviewed by two others for accuracy. Data were pooled using ratio of means (RoM of AD/Ctl) and random effects meta-analysis using Cochrane Collaboration's Review Manager software. RESULTS Of the 435 identified publications, after exclusion and removal of duplicates, 35 articles were included comprising a total of 605 AD patients and 585 controls. The following markers of synaptic and metabolic pathways were significantly changed in AD/controls: acetylcholine (RoM 0.36, 95% CI 0.24-0.53, p<0.00001), GABA (0.74, 0.58-0.94, p<0.01), pyruvate (0.48, 0.24-0.94, p=0.03), glutathione (1.11, 1.01- 1.21, p=0.03), alanine (1.10, 0.98-1.23, p=0.09), and lower levels of significance for lactate (1.2, 1.00-1.47, p=0.05). Of note, CSF glucose and glutamate levels in AD were not significantly different than that of the controls. CONCLUSION This study provides proof of concept for the use of meta-analysis validation of AD hypotheses, specifically via robust evidence for the cholinergic hypothesis of AD. Our data disagree with the other synaptic hypotheses of glutamate excitotoxicity and GABAergic resistance to neurodegeneration, given observed unchanged glutamate levels and decreased GABA levels. With regards to metabolic hypotheses, the data supported upregulation of anaerobic glycolysis, pentose phosphate pathway (glutathione), and anaplerosis of the tricarboxylic acid cycle using glutamate. Future applications of meta-analysis indicate the possibility of further in silico evaluation and generation of novel hypotheses in the AD field.
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Affiliation(s)
- Roni Manyevitch
- Department of Physiology and Neuroscience, School of Medicine, St George’s University, True Blue, St George’s, Grenada, W.I., USA
| | - Matthew Protas
- Department of Physiology and Neuroscience, School of Medicine, St George’s University, True Blue, St George’s, Grenada, W.I., USA
| | - Sean Scarpiello
- Department of Physiology and Neuroscience, School of Medicine, St George’s University, True Blue, St George’s, Grenada, W.I., USA
| | - Marisa Deliso
- Department of Physiology and Neuroscience, School of Medicine, St George’s University, True Blue, St George’s, Grenada, W.I., USA
| | - Brittany Bass
- Department of Physiology and Neuroscience, School of Medicine, St George’s University, True Blue, St George’s, Grenada, W.I., USA
| | - Anthony Nanajian
- Department of Physiology and Neuroscience, School of Medicine, St George’s University, True Blue, St George’s, Grenada, W.I., USA
| | - Matthew Chang
- Department of Physiology and Neuroscience, School of Medicine, St George’s University, True Blue, St George’s, Grenada, W.I., USA
| | - Stefani M. Thompson
- Department of Physiology and Neuroscience, School of Medicine, St George’s University, True Blue, St George’s, Grenada, W.I., USA
| | - Neil Khoury
- Department of Physiology and Neuroscience, School of Medicine, St George’s University, True Blue, St George’s, Grenada, W.I., USA
| | - Rachel Gonnella
- Department of Physiology and Neuroscience, School of Medicine, St George’s University, True Blue, St George’s, Grenada, W.I., USA
| | - Margit Trotz
- Department of Biochemistry, School of Medicine, St George’s University, Grenada, W.I., USA
| | - D. Blaine Moore
- Department of Biology, Kalamazoo College, Kalamazoo, MI, USA
| | - Emily Harms
- Department of Educational Services, St George’s University, Grenada, W.I., USA
| | - George Perry
- Department of Biology, University of Texas San Antonio, TX, USA
| | - Lucy Clunes
- Department of Pharmacology, School of Medicine, St George’s University, Grenada, W.I., USA
| | - Angélica Ortiz
- Department of Anatomy, School of Medicine, St George’s University, Grenada, W.I., USA
| | | | - Ian V.J. Murray
- Department of Physiology and Neuroscience, School of Medicine, St George’s University, True Blue, St George’s, Grenada, W.I., USA
- Department of Biology, University of Texas San Antonio, TX, USA
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