1
|
Al-Gburi M, Kristiansen JB, Christensen KB, Krogsgaard MR. Functional performance tests, clinical measurements, and patient-reported outcome measures do not correlate as outcomes 1 year after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2023; 31:5905-5912. [PMID: 37947829 PMCID: PMC10719130 DOI: 10.1007/s00167-023-07648-w] [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: 05/05/2023] [Accepted: 10/24/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE The results after anterior cruciate ligament reconstruction (ACLR) are evaluated by laxity measures, functional tests, and patients' perception by patient-reported outcome measures (PROMs). It is not known, if one of these evaluation instruments is representative or if outcome scores from all must be reported to obtain a full evaluation of the condition. The aim was to study the correlations between these three types of outcomes 1 year after primary ACLR. METHOD All adult patients (range 18-45 years) who had an ACLR between 1.1.2019 and 31.12.2021 were offered 1-year follow-up by an independent observer. Preoperative information about knee laxity and peroperative information about the condition of menisci and cartilage were registered. At 1-year follow-up clinical and instrumented knee stability and function assessed by four different hop tests were registered. Patients completed four PROMs (the Subjective International Knee Documentation Committee (IKDC) score, the Knee Numeric-Entity Evaluation Score (KNEES-ACL), the Knee injury and Osteoarthritis Outcome Score (KOOS) and the Lysholm score) and Tegner activity scale and answered anchor questions regarding satisfaction and willingness to repeat the operation. RESULTS A total of 190 adults attended the 1-year follow-up and 151 had all assessments. There were only a few positive and weak correlations between performance tests and PROMS and between clinical measurements and PROMS (r = 0.00-0.38), and the majority were of negligible strength. Tegner score had in general the highest correlation (low to moderate). The highest correlation was 0.53 (moderate) between the anchor question about patient satisfaction and Lysholm/IKDC scores. There was no difference in the correlations depending on meniscal condition. CONCLUSIONS In ACLR patients there was no clinically relevant correlation between scores obtained by PROMs, a battery of functional performance tests and instrumented laxity of the knee at 1-year follow-up. Therefore, one type of outcome cannot represent the others. This is an argument for always to include and report all three types of outcomes, and conclusions based on one type of outcome may not be sufficient. LEVEL OF EVIDENCE II.
Collapse
Affiliation(s)
- Mustafa Al-Gburi
- Sections for Sports Traumatology, Department of Orthopedic Surgery, Copenhagen University Hospital Bispebjerg, Copenhagen Ø, Denmark.
- Department of Physiotherapy, Copenhagen University Hospital Bispebjerg, Copenhagen Ø, Denmark.
- Section for Biostatistics, Copenhagen University, Copenhagen K, Denmark.
| | - Jakob Bredahl Kristiansen
- Sections for Sports Traumatology, Department of Orthopedic Surgery, Copenhagen University Hospital Bispebjerg, Copenhagen Ø, Denmark
- Department of Physiotherapy, Copenhagen University Hospital Bispebjerg, Copenhagen Ø, Denmark
- Section for Biostatistics, Copenhagen University, Copenhagen K, Denmark
| | - Karl Bang Christensen
- Sections for Sports Traumatology, Department of Orthopedic Surgery, Copenhagen University Hospital Bispebjerg, Copenhagen Ø, Denmark
- Department of Physiotherapy, Copenhagen University Hospital Bispebjerg, Copenhagen Ø, Denmark
- Section for Biostatistics, Copenhagen University, Copenhagen K, Denmark
| | - Michael Rindom Krogsgaard
- Sections for Sports Traumatology, Department of Orthopedic Surgery, Copenhagen University Hospital Bispebjerg, Copenhagen Ø, Denmark
- Department of Physiotherapy, Copenhagen University Hospital Bispebjerg, Copenhagen Ø, Denmark
- Section for Biostatistics, Copenhagen University, Copenhagen K, Denmark
| |
Collapse
|
2
|
Almeida GPL, Albano TR, Rodrigues CAS, Tavares MLA, de Paula Lima PO. _Combining return to sport, psychological readiness, body mass, hamstring strength symmetry, and hamstring/quadriceps ratio increases the risk of a second anterior cruciate ligament injury. Knee Surg Sports Traumatol Arthrosc 2023; 31:5087-5095. [PMID: 37728760 DOI: 10.1007/s00167-023-07559-w] [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: 02/28/2023] [Accepted: 08/29/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE To investigate the combinations of variables that comprise the biopsychosocial model domains to identify clinical profiles of risk and protection of second anterior cruciate ligament injury. METHODS One hundred and forty-five patients for return-to-sport testing after anterior cruciate ligament (ACL) reconstruction (ACLR) were contacted, and 97 were deemed eligible. All were evaluated between 6 and 24 months and followed up for 2 years. Participants answered the International Knee Documentation Committee (IKDC) and Anterior Cruciate Ligament-Return to Sport after Injury Scale (ACL-RSI), performed the postural stability assessment using the Biodex Balance System, and assessed muscle strength at 60° and 300°/s on the isokinetic dynamometer. Personal factors (age, gender, body mass index), body structures (graft type and concomitant injuries), and environmental factors (time between surgery and evaluation) were also collected. The participants were asked about the occurrence of a second ACL injury and return to sport after 2 years of follow-up. Classification and regression tree (CART) analysis was used to determine predictors of a second ACL injury. The receiver operating characteristic (ROC) curve was performed to verify the accuracy of the CART analysis, in addition to the sensitivity, specificity, and relative risk (RR) of the model. RESULTS Of the initial 97 participants, 88 (89.8%) responded to follow-up and 14 (15.9%) had a second ACL injury (11 graft ruptures and three contralateral ACL). CART analysis identified the following variables as predictors of second ACL injury: return to sport, hamstring strength symmetry at 300°/s, ACL-RSI score, hamstrings/quadriceps ratio at 60°/s, and body mass index (BMI). CART correctly identified 9 (64.3%) of the 14 participants who were reinjured and 71 (95.9%) of the 74 participants who were not. The total correct classification was 90.9%. The area under the ROC curve was 0.88 (95% CI 0.72-0.99; p < 0.001), and the model showed a sensitivity of 75% (95% CI 42.8-94.5), specificity of 93.4% (95% CI 85.3-97.8), and RR of 15.9 (95% CI 4.9-51.4; p < 0.0001). CONCLUSION The combination of hamstring strength symmetry, hamstring/quadriceps ratio (body functions); return to sport (activity and participation); psychological readiness; and BMI (personal factors) could identify three clinical risk profiles for a second ACL injury with good accuracy. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Gabriel Peixoto Leão Almeida
- Knee and Sports Research Group, Federal University of Ceará, Alexandre Baraúna Street, 949 - 1° andar - Rodolfo Teófilo, Fortaleza, CE, 60430-160, Brazil.
- Master Program in Physiotherapy and Functioning, Federal University of Ceará, Fortaleza, CE, Brazil.
| | - Thamyla Rocha Albano
- Knee and Sports Research Group, Federal University of Ceará, Alexandre Baraúna Street, 949 - 1° andar - Rodolfo Teófilo, Fortaleza, CE, 60430-160, Brazil
- Master Program in Physiotherapy and Functioning, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Carlos Augusto Silva Rodrigues
- Knee and Sports Research Group, Federal University of Ceará, Alexandre Baraúna Street, 949 - 1° andar - Rodolfo Teófilo, Fortaleza, CE, 60430-160, Brazil
- Master Program in Physiotherapy and Functioning, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Maria Larissa Azevedo Tavares
- Knee and Sports Research Group, Federal University of Ceará, Alexandre Baraúna Street, 949 - 1° andar - Rodolfo Teófilo, Fortaleza, CE, 60430-160, Brazil
- Master Program in Physiotherapy and Functioning, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Pedro Olavo de Paula Lima
- Knee and Sports Research Group, Federal University of Ceará, Alexandre Baraúna Street, 949 - 1° andar - Rodolfo Teófilo, Fortaleza, CE, 60430-160, Brazil
- Master Program in Physiotherapy and Functioning, Federal University of Ceará, Fortaleza, CE, Brazil
| |
Collapse
|
3
|
Moretti L, Bortone I, Delmedico M, Cassano DG, Caringella N, Bizzoca D, Moretti B. Clinical, Biomechanical, and Self-reported Health Status After ACL Reconstruction With Meniscal Repair in Soccer Players: Results at Minimum 1-Year Follow-up. Orthop J Sports Med 2023; 11:23259671231177309. [PMID: 37547078 PMCID: PMC10399262 DOI: 10.1177/23259671231177309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 02/22/2023] [Indexed: 08/08/2023] Open
Abstract
Background Performing meniscal repair with anterior cruciate ligament reconstruction (ACLR) has been shown to contribute to the long-term preservation of knee health and gait biomechanics. Purpose To evaluate the role of meniscal repair in the performance of semiprofessional soccer players who returned to sport after ACLR. Study Design Case series; Level of evidence, 4. Methods This study included 51 male soccer players (mean ± SD age, 28.82 ± 5.33 years) who underwent ACLR at a single institution between July 2018 and July 2019. The players were divided into 3 groups according to surgery type: ACLR only (n = 30), ACLR with lateral meniscal repair (n = 9), and ACLR with medial meniscal repair (n = 12). Outcomes were evaluated through clinical examination, self-reported health questionnaires (Cincinnati Knee Rating System, Tegner activity score, Tegner Lysholm Knee Scoring Scale, Tampa Scale of Kinesiophobia, and ACL-Return to Sport After Injury), and biomechanical performance evaluations (balance, strength, coordination, and symmetry tests). Parametric and nonparametric tests were carried out for multiple comparisons. Results The mean ± SD follow-up time was 20.75 ± 9.38 months. Although no significant differences emerged in clinical and self-reported health status, almost all the physical parameters tested resulted in lower performance in players treated with ACLR and meniscal repair. Moreover, patients with ACLR with lateral meniscal repair reported higher pain and fear of reinjury, with lower outcomes in terms of strength, symmetry, and coordination as compared with the other 2 groups. Balance abilities were significantly affected in players who underwent meniscal repair as compared with those who underwent ACLR only. Conclusion The findings showed that biomechanical performance measures and fear of reinjury were significantly worse in soccer players with associated meniscal repair at a minimum 1-year follow-up, especially in those with a lateral meniscal tear.
Collapse
Affiliation(s)
- Lorenzo Moretti
- Orthopaedic and Trauma Unit, Department of Translational Biomedicine and Neuroscience “DiBraiN,” University of Bari “Aldo Moro,” Bari, Italy
| | - Ilaria Bortone
- Orthopaedic and Trauma Unit, Department of Translational Biomedicine and Neuroscience “DiBraiN,” University of Bari “Aldo Moro,” Bari, Italy
| | - Michelangelo Delmedico
- Orthopaedic and Trauma Unit, Department of Translational Biomedicine and Neuroscience “DiBraiN,” University of Bari “Aldo Moro,” Bari, Italy
| | - Danilo Giuseppe Cassano
- Orthopaedic and Trauma Unit, Department of Translational Biomedicine and Neuroscience “DiBraiN,” University of Bari “Aldo Moro,” Bari, Italy
| | - Nuccio Caringella
- Orthopaedic and Trauma Unit, Department of Translational Biomedicine and Neuroscience “DiBraiN,” University of Bari “Aldo Moro,” Bari, Italy
| | - Davide Bizzoca
- Orthopaedic and Trauma Unit, Department of Translational Biomedicine and Neuroscience “DiBraiN,” University of Bari “Aldo Moro,” Bari, Italy
| | - Biagio Moretti
- Orthopaedic and Trauma Unit, Department of Translational Biomedicine and Neuroscience “DiBraiN,” University of Bari “Aldo Moro,” Bari, Italy
| |
Collapse
|
4
|
Ekizos A, Santuz A. "Biofeedback-based return to sport": individualization through objective assessments. Front Physiol 2023; 14:1185556. [PMID: 37378078 PMCID: PMC10291093 DOI: 10.3389/fphys.2023.1185556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/30/2023] [Indexed: 06/29/2023] Open
Abstract
Elite athletes are regularly exposed to high and repetitive mechanical stresses and impacts, resulting in high injury rates. The consequences of injury can range from time lost from training and competition to chronic physical and psychological burden, with no guarantee that the athlete will return to preinjury levels of sport activity and performance. Prominent predictors include load management and previous injury, highlighting the importance of the postinjury period for effective return to sport (RTS). Currently, there is conflicting information on how to choose and assess the best reentry strategy. Treating RTS as a continuum, with controlled progression of training load and complexity, seems to provide benefits in this process. Furthermore, objectivity has been identified as a critical factor in improving the effectiveness of RTS. We propose that assessments derived from biomechanical measurements in functional settings can provide the objectivity needed for regular biofeedback cycles. These cycles should aim to identify weaknesses, customize the load, and inform on the status of RTS progress. This approach emphasizes individualization as the primary determinant of RTS and provides a solid foundation for achieving it.
Collapse
Affiliation(s)
| | - Alessandro Santuz
- Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| |
Collapse
|
5
|
Rohde M, Ruhlemann A, Busch A, Grunwald U, Jaeger M, Mayer C. Evaluation of the Back-in-Action test Battery In Uninjured High School American Football Players. Int J Sports Phys Ther 2023; V18:746-757. [PMID: 37425120 PMCID: PMC10324321 DOI: 10.26603/001c.75367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 04/11/2023] [Indexed: 07/11/2023] Open
Abstract
Background Return to sport testing is an established routine, especially for athletes who have ruptured their anterior cruciate ligament (ACL). Various tests are performed, often combined in test batteries, such as the Back-in-action (BIA) test battery. Unfortunately, pre-injury performance is often unknown, and only few athletes pass the high demands of these test batteries. Purpose The aim of the study was to determine the performance of under 18 American football players on the BIA to establish pre-injury sport specific benchmarks for future RTS testing and to compare these values to data from an age-matched reference group. Methods Fifty-three healthy male American football players underwent a functional assessment using the "Back-in-action" test battery evaluating agility, speed (Parkour-Jumps and Quick-Feet test), balance (using a PC based balance board), and power (Counter-Movement-Jump [CMJ]) as objective measures. Their results were compared with a previously tested reference group (RP) and within the american football players (AF) through three subgroups according to field playing position. Results Overall, the American football (AF) athletes showed lower balance scores for both legs (AF: 3.71/3.57/3.61; RP: 3.4/3.2/3.2; p<0.002) compared to the reference population (RP). CMJ height and Quick-Feet results were not statistically different (p>0.05), Parkour-Jump times (AF: 8.18/ 8.13 sec.; RP: 5.9/5.9sec.; p<0.001) were significantly slower. Power output in all CMJ's (AF: 46.86/36.94/37.36 W/kg; RP: 43.2/29.5/29 W/kg; p<0.001) was significantly higher than the RP. Passing and running game involved players (G2 & G3) showed significantly better balance scores (G2+G3: 3.36/3.27/3.33; G1: 4.22/4.06/4.10; p<0.001), higher jump height (G2&G3: 38.87/24.02/24.96 cm; G1: 32.03/19.50/18.96 cm; p<0.001) and more watts/kg (G2&G3: 48.83/37.21/37.64 W/kg; G1: 43.95/36.88/36.53 W/kg; p<0.001) compared to blocking players like Linemen (G1) and to the age matched reference population (RP). Conclusion Only 53% of the healthy athletes would have been cleared for sport using the BIA test criteria, which highlights the challenging passing criteria. Despite significantly greater power measurements, scores of balance and agility were poorer compared to the reference group, especially for linemen. These data may serve as sport and position specific reference for high school American football players, instead of using the non-specific reference group data. Study design cross-sectional study. Level of evidence IIb.
Collapse
Affiliation(s)
- Marcel Rohde
- Orthopedics and Traumatology St. Marien Hospital Mulheim an der Ruhr
- Dean's office of the medical faculty University of Duisburg-Essen
- Orthopedics and Traumatology University of Duisburg-Essen
| | - Alina Ruhlemann
- Dean's office of the medical faculty university Duisburg Essen University of Duisburg-Essen
- Orthopedics and Traumatology University of Duisburg-Essen
| | - Andre Busch
- Orthopedics and Traumatology Katholisches Klinikum Philippusstift Essen
| | - Ulrich Grunwald
- Orthopedics and Traumatology Johannes Wesling Klinikum Minden
| | - Marcus Jaeger
- Head of the Chair of Orthopedics and Traumatology University of Duisburg-Essen
- Orthopedics and Traumatology St. Marien Hospital Mülheim an der Ruhr
| | - Constantin Mayer
- Orthopedics and Traumatology St. Marien Hospital Mülheim an der Ruhr
| |
Collapse
|
6
|
Protocol for a Randomized Crossover Trial to Evaluate the Effect of Soft Brace and Rigid Orthosis on Performance and Readiness to Return to Sport Six Months Post-ACL-Reconstruction. Healthcare (Basel) 2023; 11:healthcare11040513. [PMID: 36833047 PMCID: PMC9957425 DOI: 10.3390/healthcare11040513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 02/02/2023] [Accepted: 02/03/2023] [Indexed: 02/12/2023] Open
Abstract
A randomized crossover trial was designed to investigate the influence of muscle activation and strength on functional stability/control of the knee joint, to determine whether bilateral imbalances still occur six months after successful anterior cruciate ligament reconstruction (ACLR), and to analyze whether the use of orthotic devices changes the activity onset of these muscles. Furthermore, conclusions on the feedforward and feedback mechanisms are highlighted. Therefore, twenty-eight patients will take part in a modified Back in Action (BIA) test battery at an average of six months after a primary unilateral ACLR, which used an autologous ipsilateral semitendinosus tendon graft. This includes double-leg and single-leg stability tests, double-leg and single-leg countermovement jumps, double-leg and single-leg drop jumps, a speedy jump test, and a quick feet test. During the tests, gluteus medius and semitendinosus muscle activity are analyzed using surface electromyography (sEMG). Motion analysis is conducted using Microsoft Azure DK and 3D force plates. The tests are performed while wearing knee rigid orthosis, soft brace, and with no aid, in random order. Additionally, the range of hip and knee motion and hip abductor muscle strength under isometric conditions are measured. Furthermore, patient-rated outcomes will be assessed.
Collapse
|
7
|
Zhao D, Liang GH, Pan JK, Zeng LF, Luo MH, Huang HT, Han YH, Lin FZ, Xu NJ, Yang WY, Liu J. Risk factors for postoperative surgical site infections after anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Br J Sports Med 2023; 57:118-128. [PMID: 36517215 PMCID: PMC9872252 DOI: 10.1136/bjsports-2022-105448] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The primary aim was to evaluate risk factors for surgical site infections after anterior cruciate ligament reconstruction (ACLR). The secondary aim was to investigate the surgical site infection incidence rate and the mean time to postoperative surgical site infection symptoms. DESIGN Systematic review and meta-analysis. DATA SOURCES PubMed, Embase and Web of Science were searched from database inception to September 2021 and updated in April 2022. ELIGIBILITY CRITERIA Quantitative, original studies reporting potential risk factors for surgical site infections after ACLR were included. RESULTS Twenty-three studies with 3871 infection events from 469 441 ACLRs met the inclusion criteria. Male sex (OR 1.78, p< 0.00001), obesity (OR 1.82, p=0.0005), tobacco use (OR 1.37, p=0.01), diabetes mellitus (OR 3.40, p=0.002), steroid use history (OR 4.80, p<0.00001), previous knee surgery history (OR 3.63, p=0.02), professional athlete (OR 4.56, p=0.02), revision surgery (OR 2.05, p=0.04), hamstring autografts (OR 2.83, p<0.00001), concomitant lateral extra-articular tenodesis (OR 3.92, p=0.0001) and a long operating time (weighted mean difference 8.12, p=0.005) were identified as factors that increased the risk of surgical site infections (superficial and deep) after ACLR. Age, outpatient or inpatient surgery, bone-patellar tendon-bone autografts or allografts and a concomitant meniscus suture did not increase the risk of surgical site infections. The incidence of surgical site infections after ACLR was approximately 1% (95% CI 0.7% to 1.2%). The mean time from surgery to the onset of surgical site infection symptoms was approximately 17.1 days (95% CI 13.2 to 21.0 days). CONCLUSION Male sex, obesity, tobacco use, diabetes mellitus, steroid use history, previous knee surgery history, professional athletes, revision surgery, hamstring autografts, concomitant lateral extra-articular tenodesis and a long operation time may increase the risk of surgical site infections after ACLR. Although the risk of surgical site infections after ACLR is low, raising awareness and implementing effective preventions for risk factors are priorities for clinicians to reduce the incidence of surgical site infections due to its seriousness.
Collapse
Affiliation(s)
- Di Zhao
- The Second Clinical School of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China,Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, Guangdong, China
| | - Gui-Hong Liang
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, Guangdong, China,Department of Sports Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Jian-Ke Pan
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, Guangdong, China,Department of Sports Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Ling-Feng Zeng
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, Guangdong, China,Department of Sports Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Ming-Hui Luo
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, Guangdong, China,Department of Sports Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - He-Tao Huang
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, Guangdong, China,Department of Sports Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Yan-Hong Han
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, Guangdong, China,Department of Sports Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Fang-Zheng Lin
- The Second Clinical School of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China,Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, Guangdong, China
| | - Nan-Jun Xu
- The Second Clinical School of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China,Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, Guangdong, China
| | - Wei-Yi Yang
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, Guangdong, China,Department of Sports Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Jun Liu
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, Guangdong, China,Guangdong Second Traditional Chinese Medicine Hospital (Guangdong Province Enginering Technology Research Institute of Traditional Chinese Medicine), Guangzhou, China,The fifth Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| |
Collapse
|
8
|
Mayer C, Rühlemann A, Busch A, Jäger M. Measures of Knee Capability in Handball Players Differ by Age: A Cross Sectional Study. Sports Med Int Open 2022; 6:E60-E68. [PMID: 36575730 PMCID: PMC9790767 DOI: 10.1055/a-1926-0817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 08/08/2022] [Indexed: 12/30/2022] Open
Abstract
The return to sport after knee injury is challenging. This is burdensome for sports with a high incidence of injuries, such as team handball. Various tests guide decision making, but often the athlete's preinjury performance of these measures remains unknown. Moreover, objective return-to-sport criteria of a matching population are missing. The purpose of this study was to evaluate objective measures of knee capability in handball depending on players' age. Two hundred sixty-one handball players performed a functional test battery designed to evaluate knee capability after an anterior cruciate ligament injury: two- and one-legged stability analysis, jumps, speed tests, and agility assessments. For age-specific evaluation, athletes were divided into three age groups (16-19; 20-29;≥30 years). Male players showed differences in two and one-legged jumping height (p<0.02) as well as power per body weight (p<0.01) between age groups. Young female players reached better results in two-and one-legged stability. Besides the quick feet test, results of females did not differ between age groups. Functional knee stability in healthy handball players is partly influenced by age, and females show better results in stability and male athletes in power measurements. This aspect should be considered for return to sports testing and underlines the importance of performance measures in athletic testing.
Collapse
Affiliation(s)
- Constantin Mayer
- Orthopedics and Traumatology, St Marien-Hospital Mülheim an der
Ruhr, Mülheim, Germany,Correspondence Dr. Constantin
Mayer St Marien-Hospital Mülheim an der
RuhrOrthopedics and
TraumatologyKaiserstrasse
5045468
MülheimGermany+49
208 305 2202
| | - Alina Rühlemann
- Orthopedics and Traumatology, University of Duisburg-Essen Faculty of
Medicine, Essen, Germany
| | - Andre Busch
- Orthopedics and Traumatology, katholische Kliniken Philippusstift
Essen, Essen, Germany
| | - Marcus Jäger
- Orthopedics and Traumatology, St Marien-Hospital Mülheim an der
Ruhr, Mülheim, Germany,Orthopedics and Traumatology, University of Duisburg-Essen Faculty of
Medicine, Essen, Germany
| |
Collapse
|
9
|
Ronden AE, Koc BB, van Rooij L, Schotanus MG, Jansen EJ. Low percentage of patients passed the 'Back in Action' test battery 9 months after bone-patellar tendon-bone anterior cruciate ligament reconstruction. J Clin Orthop Trauma 2022; 34:102025. [PMID: 36147380 PMCID: PMC9486609 DOI: 10.1016/j.jcot.2022.102025] [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] [Received: 05/05/2022] [Revised: 08/28/2022] [Accepted: 09/07/2022] [Indexed: 11/21/2022] Open
Abstract
Background Anterior cruciate ligament (ACL) reconstruction is recommended in patients who intend to return to high-level sports. However, there is only a 55-80% return to pre-injury level of sports after ACL reconstruction, with a re-injury rate up to 20%. The aim of this study was to determine the percentage of patients passing the Back in Action (BIA) test 9 months after primary bone-patellar-tendon-bone (BPTB) ACL reconstruction, and evaluate the association between passing the BIA test and patient reported outcome measurements (PROMs). Methods Patients underwent the BIA test 9 months after BPTB ACL reconstruction. In total 103 patients were included. Passing the BIA test (PASSED-group) was defined as a normal or higher score at all sub-tests with limb symmetry index (LSI) ≥90% for the dominant leg and LSI >80% for the non-dominant leg. Patients who did not meet these criteria were defined as the FAILED-group. PROMs included the International Knee Documentation Committee, Knee injury Osteoarthritis Outcome Score and Anterior Cruciate Ligament-Return to Sport after Injury. Results Eighteen patients (17.5%) passed the BIA test 9 months after BPTB ACL reconstruction. PROMs were not statistically significant different between the PASSED- and FAILED-group. Conclusion Low percentage of patients passed the BIA test 9 months after BPTB ACL reconstruction. Although current PROMs cut-off values were met, the BIA test results show persistent functional deficits. Therefore, the BIA test could be of additional value in the decision-making process regarding return to sport (RTS). This study highlights the need for additional rehabilitation as RTS in a condition of incomplete recovery may increase the risk of re-injury. Level of evidence II.
Collapse
Affiliation(s)
- Annick E. Ronden
- Department of Orthopedic Surgery and Traumatology, Sports Orthopedic Research Center Zuyderland, Dr. H. van der Hoffplein 1, 6162 BG, Sittard-Geleen, the Netherlands
| | - Baris B. Koc
- Department of Orthopedic Surgery and Traumatology, Sports Orthopedic Research Center Zuyderland, Dr. H. van der Hoffplein 1, 6162 BG, Sittard-Geleen, the Netherlands
| | - Lize van Rooij
- Maastricht University, Faculty of Health Medicine & Life Sciences, Maastricht, the Netherlands
| | - Martijn G.M. Schotanus
- Department of Orthopedic Surgery and Traumatology, Sports Orthopedic Research Center Zuyderland, Dr. H. van der Hoffplein 1, 6162 BG, Sittard-Geleen, the Netherlands
- School of Care and Public Health Research Institute, Faculty of Health, Medicine & Life Sciences, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Edwin J.P. Jansen
- Department of Orthopedic Surgery and Traumatology, Sports Orthopedic Research Center Zuyderland, Dr. H. van der Hoffplein 1, 6162 BG, Sittard-Geleen, the Netherlands
| |
Collapse
|
10
|
Lim DGW, Chou ACC, Chang PCC, Tan ETS, Lie DTT. Delayed Surgery, Low Presurgery Activity, and Poor Preoperative IKDC Scores Are Correlated with Lower Rates of Return to Sports after ACL Reconstruction in an Asian Population. J Knee Surg 2022; 35:1079-1086. [PMID: 33389730 DOI: 10.1055/s-0040-1721789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
There is limited literature regarding the early postsurgical outcomes of anterior cruciate ligament (ACL) reconstruction in Asian populations, particularly in the rates of return to sports. We aimed to quantify early clinical outcomes for ACL reconstruction, determine the predictive value of surgeon- and patient-reported outcomes on the rate of return to sports in the early postoperative period, and identify factors predictive of return to sports. We analyzed the data of 55 patients who underwent ACL reconstruction at our tertiary medical center from 2015 to 2016. All patients underwent transportal ACL reconstruction and a standardized post-ACL reconstruction rehabilitation protocol. Patients with concurrent meniscal injury and repair were included. Patients were evaluated at the 3-month, 6-month, 1-year, and 2-year postoperative periods. Surgeon- and patient-reported outcome scores were collected at each follow-up through a systematic questionnaire designed to determine the patient's level of return to sport and reasons for not returning. Surgeon- and patient-reported outcome measures improved significantly over the 2-year postoperative period (p < 0.001). Overall rate of return to sports was 58.2%. The International Knee Documentation Committee (IKDC) subjective (p = 0.02), symptomatic (p = 0.001), composite (p = 0.005), Tegner (p < 0.001) and Lysholm (p = 0.049) scores at 2-year follow-up were significantly worse in patients who failed to return to sports. Earliest difference in scores manifested at 3-month postsurgery (p = 0.011). IKDC grade-D patients were 18.1 times less likely to return to sports (p = 0.035). Delayed surgery (p = 0.01) and presurgery inactivity (p = 0.023) were negatively predictive of return to sports. The rate of return to sport is consistent with the literature analyzing other ethnic populations. Both surgeon- and patient-reported outcome scores at 2-year postsurgery exhibited significant differences between those who did and did not return to sports. Patients should be advised to seek surgical treatment as soon as possible and stay active preoperatively to maximize return to sports.
Collapse
Affiliation(s)
- Dominic G W Lim
- Department of Orthopaedic Surgery, National University of Singapore, Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Andrew C C Chou
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Paul C C Chang
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Edwin T S Tan
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Denny T T Lie
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| |
Collapse
|
11
|
Blucher NC, Feller JA, Devitt BM, Klemm HJ, Whitehead TS, McClelland JA, Webster KE. Is There an Association in Young Patients Between Quadriceps or Hamstring Strength After ACL Reconstruction and Graft Rupture? Orthop J Sports Med 2022; 10:23259671221101003. [PMID: 35677023 PMCID: PMC9168858 DOI: 10.1177/23259671221101003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 04/05/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Younger patients who sustain anterior cruciate ligament (ACL) ruptures are at high risk for reinjury after ACL reconstruction. Restoring muscle strength before return to sports (RTS) is regarded as an important factor in reducing the reinjury risk, and quadriceps and hamstring strength assessment is commonly included in RTS testing. However, it is not clear whether reduced strength is a risk factor for subsequent graft rupture in this patient population. Purpose: To investigate the association between quadriceps and hamstring strength at 12 months after primary ACL reconstruction and ACL graft rupture in young patients. Study Design: Case-control study; Level of evidence, 3. Methods: The cohort consisted of 210 patients (100 men and 110 women) who were younger than 20 years at the time of primary ACL reconstruction with a hamstring tendon autograft and who had no previous contralateral ACL injury. Isokinetic strength testing (60 and 180 deg/s) of knee flexors and extensors was performed at 12 months postoperatively, and the limb symmetry index (LSI) for each strength outcome was calculated. RTS rates and the incidence of further ACL graft ruptures were recorded. Results: Measures of central tendency (mean and median) of LSI values ranged from 88 to 98. The percentage of patients with LSI ≥90 was 57% to 69% for quadriceps strength and 45% to 47% for hamstring strength. Overall, 19 patients (9%) sustained an ACL graft rupture. No significant differences were found between the patients who sustained an ACL graft rupture and those who did not in terms of quadriceps and hamstring strength at 12 months. No significant associations were found between achieving LSI ≥90 for quadriceps peak torque and subsequent ACL graft rupture. Conclusion: In young patients who underwent an ACL reconstruction, no association was noted between quadriceps and hamstring strength at 12 months postoperatively and subsequent graft ruptures. The role of strength testing as part of the RTS criteria after ACL reconstruction, and specifically the use of limb symmetry thresholds, warrants further investigation and clarification.
Collapse
Affiliation(s)
| | - Julian A. Feller
- OrthoSport Victoria Research Unit, Melbourne, Victoria, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Brian M. Devitt
- OrthoSport Victoria Research Unit, Melbourne, Victoria, Australia
| | - Haydn J. Klemm
- OrthoSport Victoria Research Unit, Melbourne, Victoria, Australia
| | | | - Jodie A. McClelland
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Kate E. Webster
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| |
Collapse
|
12
|
Daggett MC, Witte KA, Cabarkapa D, Cabarkapa DV, Fry AC. Evidence-Based Data Models for Return-to-Play Criteria after Anterior Cruciate Ligament Reconstruction. Healthcare (Basel) 2022; 10:healthcare10050929. [PMID: 35628066 PMCID: PMC9141289 DOI: 10.3390/healthcare10050929] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/11/2022] [Accepted: 05/17/2022] [Indexed: 02/04/2023] Open
Abstract
The anterior cruciate ligament (ACL) tear is one of the most common knee injuries in sports that require side-to-side pivoting movements. While the timeline and specific goals during rehabilitation protocols may vary, ACL reconstruction (ACLR) is the preferred procedure necessary to return these athletes to their respective field of play. However, there are no validated guidelines that define a specific timepoint when it is safe for an athlete to return-to-play, as functional movement deficit may be present much longer than six months post ACLR. A retrospective cross-sectional analysis was conducted on 33 subjects that underwent ACLR. As a part of standard of care, each subject completed a movement screening protocol at a singular timepoint during their rehabilitation process. An innovative three-dimensional markerless motion capture system was used to obtain three algorithm-derived biometric variables: mobility, alignment, and readiness. Significant gradual improvements in mobility and readiness were observed throughout a 3–6-month post ACLR procedure period. When examining the data trends, it was obvious that not all patients responded identically to treatment plans provided by clinical professionals. Therefore, the findings of the present study suggest that the decision regarding when it is safe to return to play needs to be determined on an individual basis.
Collapse
Affiliation(s)
| | - Kevin A. Witte
- Sano Orthopedics, Lee’s Summit, MO 64064, USA; (M.C.D.); (K.A.W.)
| | - Dimitrije Cabarkapa
- Jayhawk Athletic Performance Laboratory, Wu Tsai Human Performance Alliance, University of Kansas, Lawrence, KS 66045, USA; (D.V.C.); (A.C.F.)
- Correspondence:
| | - Damjana V. Cabarkapa
- Jayhawk Athletic Performance Laboratory, Wu Tsai Human Performance Alliance, University of Kansas, Lawrence, KS 66045, USA; (D.V.C.); (A.C.F.)
| | - Andrew C. Fry
- Jayhawk Athletic Performance Laboratory, Wu Tsai Human Performance Alliance, University of Kansas, Lawrence, KS 66045, USA; (D.V.C.); (A.C.F.)
| |
Collapse
|
13
|
Memmel C, Krutsch W, Szymski D, Pfeifer C, Henssler L, Frankewycz B, Angele P, Alt V, Koch M. Current Standards of Early Rehabilitation after Anterior Cruciate Ligament Reconstruction in German Speaking Countries-Differentiation Based on Tendon Graft and Concomitant Injuries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074060. [PMID: 35409745 PMCID: PMC8997891 DOI: 10.3390/ijerph19074060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 03/22/2022] [Accepted: 03/25/2022] [Indexed: 02/01/2023]
Abstract
Background: Although anterior cruciate ligament reconstruction (ACLR) is a well-established procedure and is standardly performed by orthopedic surgeons all over the world, there does not seem to be a standard protocol for early rehabilitation. The purpose of this study was to give answers to the following questions: (i) Does (a) the use of a specific tendon graft, and (b) potentially additional therapy of concomitant pathologies influence surgeons’ choice of a distinct postoperative rehabilitation protocol after ACLR? (ii) To what extent do these rehabilitation recommendations differ? Methods: Retrospective analysis of currently used early rehabilitation protocols after ACLR in German-speaking countries (GER, AUT and SUI) was conducted. Rehabilitation criteria included weight bearing, range of motion (ROM), the utilization of braces, continuous passive/active motion therapy (CPM/CAM), rehabilitation training and sport-specific training. Tendon grafts were differentiated as hamstring (HAM) and bone−patellar tendon−bone grafts (BTB). Concomitant pathologies included meniscus injuries (+M) and unhappy triad injuries (+UTI). Results: Most of the surveyed protocols were differentiated according to the used tendon graft or additional therapy of concomitant injuries (ACLR-differentiated, n = 147 vs. ACLR without graft differentiation, n = 58). When comparing ACLR-HAM and ACLR-BTB, significant differences were found regarding weight bearing (p = 0.01), ROM (p = 0.05) and the utilization of braces (p = 0.03). Regarding ACLR+M, an overall significant decelerated rehabilitation could be detected. After ACLR+UTI-therapy, a significant delayed start to full weight bearing (p = 0.002) and ROM (p < 0.001) was found. Conclusions: Most orthopedic surgeons from German-speaking countries differentiate early rehabilitation after ACLR according to the tendon graft used and therapy of concomitant pathologies. No consensus about early rehabilitation after ACLR is available. However, tendencies for an accelerated rehabilitation after ACLR-BTB and a more restrained rehabilitation of multiple injured knees were detected.
Collapse
Affiliation(s)
- Clemens Memmel
- Department of Paediatric Surgery and Orthopaedics, Clinic St. Hedwig, Barmherzige Brueder Regensburg, KUNO Paediatric University Medical Centre and FIFA Medical Centre of Excellence, University Medical Centre Regensburg, 93053 Regensburg, Germany
- Correspondence:
| | - Werner Krutsch
- Department of Trauma Surgery and FIFA Medical Centre of Excellence, University Medical Centre Regensburg, 93053 Regensburg, Germany; (W.K.); (D.S.); (C.P.); (L.H.); (B.F.); (P.A.); (V.A.); (M.K.)
- SportDocs Franken, 90455 Nuremberg, Germany
| | - Dominik Szymski
- Department of Trauma Surgery and FIFA Medical Centre of Excellence, University Medical Centre Regensburg, 93053 Regensburg, Germany; (W.K.); (D.S.); (C.P.); (L.H.); (B.F.); (P.A.); (V.A.); (M.K.)
| | - Christian Pfeifer
- Department of Trauma Surgery and FIFA Medical Centre of Excellence, University Medical Centre Regensburg, 93053 Regensburg, Germany; (W.K.); (D.S.); (C.P.); (L.H.); (B.F.); (P.A.); (V.A.); (M.K.)
- Department of Trauma Surgery, InnKlinikum Altoetting, 84503 Altoetting, Germany
| | - Leopold Henssler
- Department of Trauma Surgery and FIFA Medical Centre of Excellence, University Medical Centre Regensburg, 93053 Regensburg, Germany; (W.K.); (D.S.); (C.P.); (L.H.); (B.F.); (P.A.); (V.A.); (M.K.)
| | - Borys Frankewycz
- Department of Trauma Surgery and FIFA Medical Centre of Excellence, University Medical Centre Regensburg, 93053 Regensburg, Germany; (W.K.); (D.S.); (C.P.); (L.H.); (B.F.); (P.A.); (V.A.); (M.K.)
| | - Peter Angele
- Department of Trauma Surgery and FIFA Medical Centre of Excellence, University Medical Centre Regensburg, 93053 Regensburg, Germany; (W.K.); (D.S.); (C.P.); (L.H.); (B.F.); (P.A.); (V.A.); (M.K.)
| | - Volker Alt
- Department of Trauma Surgery and FIFA Medical Centre of Excellence, University Medical Centre Regensburg, 93053 Regensburg, Germany; (W.K.); (D.S.); (C.P.); (L.H.); (B.F.); (P.A.); (V.A.); (M.K.)
| | - Matthias Koch
- Department of Trauma Surgery and FIFA Medical Centre of Excellence, University Medical Centre Regensburg, 93053 Regensburg, Germany; (W.K.); (D.S.); (C.P.); (L.H.); (B.F.); (P.A.); (V.A.); (M.K.)
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland, Bruderholz, 4101 Basel, Switzerland
| |
Collapse
|
14
|
Abstract
BACKGROUND Sports injuries have increased dramatically in the pediatric and adolescent population. Return-to-sport testing and criteria are increasingly utilized, however, the guidelines for return to play in adolescents are unclear. The purpose of this study was to compare strength and function at the time of the return-to-sport progression to those with and without a failed anterior cruciate ligament reconstruction (ACLR). METHODS A total of 105 adolescent patients with primary ACLR were assessed at the time of return to sport. We identified graft failures/contralateral injury through medical records, clinic visits, or phone interviews at minimum 2 years of postsurgical follow-up. All patients completed bilateral isokinetic strength tests of the knee extensor/flexor groups and hop tests. Strength was expressed as torque-normalized-to-mass (Nm/kg), and limb-symmetry-index was expressed as a percentage of the uninvolved limb's strength. All patients completed outcome surveys. The χ2 analysis was used to compare failures between sexes and graft types. Independent sample t tests were used to compare knee extensor/flexor strength, symmetry, and hop test results between patients with and without secondary anterior cruciate ligament (ACL) injury. One-way analysis of variance was used to compare knee extensor/flexor strength and symmetry, hop test, and survey results between those (1) without secondary injury, (2) ACLR graft failure, and (3) contralateral ACL injury. RESULTS A total of 100 of 105 patients (95.2%) were included with 4±1.2 years of follow-up, with 28 (28%) sustaining subsequent injury (12% graft, 16% contralateral). Patients with graft failure demonstrated (1) stronger quadriceps strength (2.00±0.46 Nm/kg) compared with those with contralateral ACL injury (1.58±0.35 Nm/kg, P=0.039) and patients that did not have a secondary injury (1.58±0.44 Nm/kg, P=0.007), (2) greater quadriceps strength symmetry (85.7±0.11.2%) compared with patients without secondary injury ACL (72.9±17.9%, P=0.046), (3) a greater proportion of hamstring grafts compared with those without reinjury (P=0.028). CONCLUSIONS Adolescent patients who sustained ACLR graft failure had greater and more symmetric quadriceps strength at the time of return to sport compared with patients with no secondary injury. Objective measures of quadriceps strength at the time of the return-to-sport progression may not solely identify individuals that have a secondary ACL injury. STUDY DESIGN Level IV-retrospective cohort study.
Collapse
|
15
|
Hurley ET, Mojica ES, Haskel JD, Mannino BJ, Alaia M, Strauss EJ, Jazrawi LM, Gonzlaez-Lomas G. Return to play testing following anterior cruciate reconstruction - A systematic review & meta-analysis. Knee 2022; 34:134-140. [PMID: 34896962 DOI: 10.1016/j.knee.2021.11.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 10/04/2021] [Accepted: 11/19/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study is to systematically review the evidence regarding return to sport evaluation following ACL reconstruction and evaluate the relationship between testing and secondary ACL injury. METHODS A systematic review of the literature with PubMed, Ovid MEDLINE, Cochrane Reviews, was performed on June, 2020 based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were included if they compared outcomes following passing and failing RTP testing subsequent to ACLR. Clinical outcomes were compared, with all statistical analysis performed using Review Manager Version 5.3. Correlation was calculated with Spearman testing. RESULTS Overall, 8 studies with 1224 patients were included in the analysis. Overall, 34.3% (420/1224) patients passed the RTP testing. Those who passed the RTP testing had a statistically significant 47% lower rate of ACL graft re-rupture compared to those who did not pass the RTP testing (p = 0.03). However, there was a slightly higher, albeit not statistically significant, rate of contralateral ACL rupture in those who passed the RTP testing compared to those who did not (p = 0.42). There was a strong positive correlation between a high rate of patients passing the ACL RTP testing in studies and ACL graft rupture rate in those who failed (0.80). CONCLUSION Passing RTP testing following ACLR results in a lower rate of ACL graft rupture, but not contralateral ACL injury. Further evaluation and standardization of RTP testing is necessary in order to increase reliability in identifying patients at risk for re-injury after ACLR. LEVEL OF EVIDENCE Level of Evidence III.
Collapse
|
16
|
Fleming JD, Ritzmann R, Centner C. Effect of an Anterior Cruciate Ligament Rupture on Knee Proprioception Within 2 Years After Conservative and Operative Treatment: A Systematic Review with Meta-Analysis. Sports Med 2021; 52:1091-1102. [PMID: 34854058 PMCID: PMC9023382 DOI: 10.1007/s40279-021-01600-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The anterior cruciate ligament (ACL) plays a major role in knee proprioception and is thus responsible for maintaining knee joint stability and functionality. The available evidence suggests that ACL reconstruction diminishes somatosensory feedback and proprioceptive functioning, which are vital for adequate joint positioning and movement control. OBJECTIVE The aim of this systematic review and meta-analysis was to investigate the effect of an ACL rupture on knee proprioception after arthroscopic ACL repair surgery or conservative treatment. METHODS A systematic review with meta-analysis was conducted according to the Preferred Reporting Guidelines for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The literature search was performed in the following databases from inception to 10th October 2020: PubMed, Web of Science, SPORTDiscus, Cochrane Library and Scopus. Randomized and non-randomized studies that evaluated proprioception using the joint position sense (JPS) and threshold to detection of passive motion (TTDPM) techniques at 15°-30° knee flexion with an external healthy control group in a time period between 6 and 24 months post injury or operation were included in the analysis. RESULTS In total, 4857 studies were identified, from which 11 were included in the final quantitative analysis. The results demonstrated that proprioception after arthroscopic ACL repair surgery was significantly lower than in the healthy control group (JPS: standardized mean difference [SMD] 0.57, 95% confidence interval [CI] 0.27-0.87, p < 0.01, n = 6 studies; TTDPM: SMD 0.77, 95% CI 0.20-1.34, p < 0.01, n = 4 studies). There were no significant differences in proprioception between the conservative treatment group and the healthy control group (JPS: SMD 0.57, 95% CI - 0.69 to 1.84, p = 0.37, n = 4 studies; TTDPM: SMD 0.82, 95% CI - 0.02 to 1.65, p = 0.05, n = 2 studies), although measures for TTDPM were close to statistical significance. CONCLUSION The findings of the present systematic review and meta-analysis revealed that knee proprioception is persistently compromised 6-24 months following surgical treatment of ACL tears compared with healthy controls. The reduced kinesthetic awareness after ACL surgery is of high relevance for optimizing individual treatment plans in these patients. As the current literature is still scarce about the exact underlying mechanisms, further research is needed. TRIAL REGISTRATION The present systematic review was registered in PROSPERO (CRD42021198617).
Collapse
Affiliation(s)
- John Dick Fleming
- Department of Sport and Sport Science, University of Freiburg, Schwarzwaldstraße 175, 79117, Freiburg, Germany
| | | | - Christoph Centner
- Department of Sport and Sport Science, University of Freiburg, Schwarzwaldstraße 175, 79117, Freiburg, Germany. .,Praxisklinik Rennbahn, Muttenz, Switzerland.
| |
Collapse
|
17
|
Influence of Patient Demographics and Surgical Characteristics on Pass Rates of Return-to-Activity Tests in Anterior Cruciate Ligament-Reconstructed Patients Before Physician Clearance. Clin J Sport Med 2021; 31:e354-e362. [PMID: 32073476 DOI: 10.1097/jsm.0000000000000790] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 09/13/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To identify the frequency of passing return-to-activity tests after anterior cruciate ligament reconstruction (ACLR) and to investigate the influence of patient-specific factors on pass rates. We hypothesized that isolated strength tests would be most difficult to pass and that graft type would be the most influential factor. DESIGN Cross-sectional. SETTING Laboratory. PARTICIPANTS Eighty patients with a history of primary, unilateral ACLR, and 80 healthy controls participated. INTERVENTIONS Bilateral isokinetic strength, isometric strength, and single-leg hop tests were recorded during a single visit. The International Knee Documentation Committee (IKDC) Subjective Knee Evaluation measured subjective knee function, and the Tegner Activity Scale measured physical activity level. MAIN OUTCOME MEASURES Pass rates were calculated for 3 thresholds of absolute between-limb asymmetry: 0% to 10%, 11% to 15%, and 16% to 20%. Pass rates were compared by sex (male and female), graft type (patellar and hamstrings), meniscal procedure (yes and no), physical activity level (</≥ median Tegner), and time from surgery (</≥ 6 months). RESULTS Isokinetic quadriceps strength was consistently most difficult to pass, whereas the 6-meter timed hop and crossover hop tests were easiest. Graft type had the greatest influence on pass rates (isometric quadriceps and hamstring strength, hamstrings-to-quadriceps ratio), followed by time from surgery (6-meter timed hop and crossover hop), physical activity (IKDC), and meniscal procedure (6-meter timed hop). CONCLUSIONS Isokinetic quadriceps strength was the most difficult test to pass, and single-leg hop tests were the easiest. Patient-specific factors including graft type, time from surgery, physical activity level, and meniscal procedure may influence the ability to meet return-to-activity criterion after ACLR.
Collapse
|
18
|
Scinicarelli G, Trofenik M, Froböse I, Wilke C. The Reliability of Common Functional Performance Tests within an Experimental Test Battery for the Lower Extremities. Sports (Basel) 2021; 9:100. [PMID: 34357934 PMCID: PMC8309832 DOI: 10.3390/sports9070100] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/22/2021] [Accepted: 07/07/2021] [Indexed: 01/19/2023] Open
Abstract
The main aim of this study was to determine the test-retest reliability of an experimental functional test battery: Y-balance test (YBT), single-leg countermovement jump (SLCMJ), single-leg hop for distance (SLH), side-hop (SH), speedy-jump (SJ), agility-T (AT), and lower extremity functional test (LEFT). Secondary aims were (1) to determine the mean range for the limb symmetry index (LSI) and (2) to detect significant differences in performance between test-retest sessions. Twenty-two healthy adults (14 males, 8 females; age 23.3 ± 3.9) were tested by the same rater during two different sessions (T1-T2), with a seven-day interval, under the same conditions. Reliability analysis showed good-to-excellent reliability (0.89 < ICC < 0.97; 0.80 < α < 0.98) for the test battery. LSI ranged from 95.9 ± 6.7% (SH-T1) to 104.4 ± 12.5% (SLCMJ-T2). Repeated measures ANOVA detected significant performance differences between sessions in the LEFT (p = 0.009) and for non-dominant sides in the SLH (p = 0.015), SH (p = 0.007), and SJ (p = 0.011). The high reliability of the test battery suggests a potential use in clinical sports practice. The LSI range of ≥95% was proposed as a benchmark for healthy adults. Learning effect seems to have played a crucial role in the T2 improvements of the non-dominant side for hop performances (SLH, SH, SJ) and speed performance (LEFT).
Collapse
Affiliation(s)
- Giordano Scinicarelli
- Institute of Movement Therapy and Movement-Oriented Prevention and Rehabilitation Sciences, German Sport University, 50933 Cologne, Germany; (M.T.); (I.F.); (C.W.)
| | | | | | | |
Collapse
|
19
|
Bortone I, Moretti L, Bizzoca D, Caringella N, Delmedico M, Piazzolla A, Moretti B. The importance of biomechanical assessment after Return to Play in athletes with ACL-Reconstruction. Gait Posture 2021; 88:240-246. [PMID: 34126566 DOI: 10.1016/j.gaitpost.2021.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 05/14/2021] [Accepted: 06/06/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Barriers to successful return to previous level of activity following Anterior Cruciate Ligament Reconstruction (ACLR) are multifactorial and recent research suggests that athletic performance deficits persist after completion of the rehabilitation course in a large percentage of patients. RESEARCH QUESTION Do technology-based biomechanical assessments reveal underneath differences in both recreational and competitive athletes in Return to Play after ACL-Reconstruction? METHODS Thirty soccer athletes (26.9 ± 5.7 years old, male) with ACL injury were surgically treated with all-inside technique and semitendinosus tendon autograft. Before 2 years from surgery, they were called back for clinical examination, self-reported psychological scores, and biomechanical outcomes (balance, strength, agility and velocity, and symmetry). Athletes were classified into recreational (n = 15) and competitive (n = 15) according to the self-reported Return to Play Level based on the TALS post-injury. Nonparametric statistical tests have been adopted for group comparisons in terms of age, concomitant presence of meniscus tear, injury on dominant leg, presence of knee laxity, presence of varus/valgus, body sides, and return to different levels of sports. RESULTS Competitive athletes showed better in terms of strength (45.3 ± 5.4 W kg-1 vs 39.3 ± 3.4 W kg-1, P ≤ 0.01) associated with good self-reported outcomes (TLKS, CRSQ) and low fear of reinjury (TSK). However, all the athletes had a functional deficit in at least one subtest, and a safe return to sports could not have been recommended. Our findings confirmed that demographics, physical function, and psychological factors were related to playing the preinjury level sport at mean 2 years after surgery, supporting the notion that returning to sport after surgery is multifactorial. SIGNIFICANCE A strict qualitative and quantitative assessment of athletes' status should be performed at different follow-ups after surgery to guarantee a safe and controlled RTP.
Collapse
Affiliation(s)
- Ilaria Bortone
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro", AOU Consorziale Policlinico, Piazza Giulio Cesare 11, 70124 Bari, Italy.
| | - Lorenzo Moretti
- Orthopaedic & Trauma Unit, AOU Consorziale Policlinico, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Davide Bizzoca
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro", AOU Consorziale Policlinico, Piazza Giulio Cesare 11, 70124 Bari, Italy.
| | - Nuccio Caringella
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro", AOU Consorziale Policlinico, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Michelangelo Delmedico
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro", AOU Consorziale Policlinico, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Andrea Piazzolla
- Orthopaedic & Trauma Unit, AOU Consorziale Policlinico, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Biagio Moretti
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro", AOU Consorziale Policlinico, Piazza Giulio Cesare 11, 70124 Bari, Italy; Orthopaedic & Trauma Unit, AOU Consorziale Policlinico, Piazza Giulio Cesare 11, 70124 Bari, Italy
| |
Collapse
|
20
|
Vereijken A, van Trijffel E, Aerts I, Tassignon B, Verschueren J, Meeusen R. The Non-injured Leg Can Be Used as a Reference for the Injured Leg in Single-legged Hop Tests. Int J Sports Phys Ther 2021; 16:1052-1066. [PMID: 34386284 PMCID: PMC8329313 DOI: 10.26603/001c.25758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 06/15/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Single-legged hop tests are frequently used in substantiating return to sport decisions following lower extremity injury. Evidence for using the non-injured leg as a reference for the injured leg in the return to sport decision-making at the criterion-based point of return to sport following lower extremity injury is lacking. PURPOSE To compare absolute values in single-legged hop tests between the non-injured leg of athletes returning to high-impact sports after lower extremity injury and the matched leg of healthy athletes. STUDY DESIGN Cross-sectional study. METHODS One hundred and sixty-nine athletes returning to high-impact sports after lower extremity injury and 169 matched healthy athletes executed five single-legged hop tests. Differences between athletes returning to high-impact sports after lower extremity injury and matched healthy athletes on five single-legged hop tests were analyzed using paired t-tests. RESULTS There were no statistically significant differences between the non-injured leg of athletes returning to sport and the matched leg of healthy athletes. Effect sizes ranged from 0.05 to 0.14 indicating negligible effects. CONCLUSION Clinicians can use the non-injured leg as a reference for the injured leg in single-legged hop tests for deciding on return to high-impact sports after lower extremity injuries. LEVEL OF EVIDENCE 3b.
Collapse
Affiliation(s)
- Astrid Vereijken
- SOMT University of Physiotherapy; Human Physiology and Sports Physiotherapy research group, Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel; Annatommie MC
| | - Emiel van Trijffel
- SOMT University of Physiotherapy; Experimental Anatomy research department, Department of Physiotherapy, Human physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel; Ziekenhuisgroep Twente, ZGT Academy
| | | | - Bruno Tassignon
- Human Physiology and Sports Physiotherapy research group, Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel
| | - Jo Verschueren
- SOMT University of Physiotherapy; Human Physiology and Sports Physiotherapy research group, Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel
| | - Romain Meeusen
- Human Physiology and Sports Physiotherapy research group, Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel; Strategic Research Program 'Exercise and the Brain in Health & Disease: the added value of Human-Centered Robotics, Vrije Universiteit Brussel
| |
Collapse
|
21
|
Vereijken A, Aerts I, van Trijffel E, Tassignon B, Verschueren J, Meeusen R. Pre- and post-match hop test outcomes in soccer players returning to performance after lower extremity injury. J Sports Med Phys Fitness 2021; 62:953-960. [PMID: 34137573 DOI: 10.23736/s0022-4707.21.12576-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Most soccer injuries concern the lower extremity with a higher injury rate during the second half of matches. In advising safe return to sport, hop tests are usually assessed at the point of return to sport under non-fatigued conditions. No studies exist investigating hop test outcomes before and after a match in soccer players returning to performance after lower extremity injury and non-injured teammates. The objective is to assess differences in hop test outcomes before and after a match in and between soccer players returning to performance after lower extremity injury and their non-injured teammates. METHODS A repeated-measures design was used to measure outcomes on five hop tests before and after a soccer match. For analyzing differences in hop tests before and after a match, paired sample t-tests were used. Independent t-tests were used to analyze differences between soccer players after injury and non-injured teammates. Effect sizes were calculated using Cohen's d. RESULTS Hop tests were completed by 61 amateur soccer players after injury and 121 non-injured teammates. Differences in hop tests before and after the match within both groups had negligible to small effect sizes (d=0.00-0.49), except for the figure of 8 and 30 seconds side hop in the injured leg of RTPf soccer players (d=0.56 and d=0.71 respectively). Differences between both groups were negligible to small (d=0.00-0.36). CONCLUSIONS Soccer players returning to performance after a lower extremity injury showed similar scores on hop tests than their non-injured teammates. More demanding sport-specific performance test and measurement of quality of movement are additionally recommended for safe return to sport decision-making.
Collapse
Affiliation(s)
- Astrid Vereijken
- SOMT University of Physiotherapy, Amersfoort, the Netherlands - .,Human Physiology and Sports Physiotherapy research group, Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel, Brussels, Belgium - .,Annatommie MC, Amersfoort, the Netherlands -
| | - Inne Aerts
- SOMT University of Physiotherapy, Amersfoort, the Netherlands
| | | | - Bruno Tassignon
- Human Physiology and Sports Physiotherapy research group, Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Jo Verschueren
- SOMT University of Physiotherapy, Amersfoort, the Netherlands.,Human Physiology and Sports Physiotherapy research group, Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Romain Meeusen
- Human Physiology and Sports Physiotherapy research group, Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel, Brussels, Belgium.,Strategic Research Program Exercise and the Brain in Health & Disease, the added value of Human-Centered Robotics, Vrije Universiteit Brussel, Brussels, Belgium
| |
Collapse
|
22
|
Bodkin SG, Hertel J, Diduch DR, Saliba SA, Novicoff WM, Brockmeier SF, Miller MD, Gwathmey FW, Werner BC, Hart JM. Predicting ACL Reinjury from Return to Activity Assessments at 6-months Post-Surgery: A Prospective Cohort Study. J Athl Train 2021; 57:325-333. [PMID: 35439312 PMCID: PMC9020598 DOI: 10.4085/1062-6050-0407.20] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Return to activity(RTA) assessments are commonly administered following ACL-Reconstruction(ACLR) to manage post-operative progressions back to activity. To date, there is little knowledge on the clinical utility of these assessments to predict patient outcomes such as secondary ACL injury once returned to activity. OBJECTIVE To identify what measures of patient function at 6-months post-ACLR best predict return to activity and second ACL injury at a minimum of 2-years following ACLR. DESIGN Prospective-cohort Setting: Laboratory Patients: A total of 234 patients with primary, unilateral ACLR completed functional assessments at approximately 6-months post-ACLR. A total of 192(82%) completed follow-up ≥ 2-years post ACLR. MAIN OUTCOME MEASURES Six-month functional assessments consisted of patient reported outcomes, isokinetic knee flexor and extensor strength, and single-leg hopping. The ability to return to activity and secondary ACL injury were collected at a minimum of two-years following ACLR. RESULTS In patients who did RTA(n=155), a total of 44(28%) individuals had a subsequent ACL injury; graft n=24(15.5%), contralateral ACL n=20(13%). A greater proportion of females had a secondary injury to the contralateral ACL(15/24, 63%) whereas a greater proportion of males reinjured the ipsilateral ACL graft(15/20, 75%, P=.017) Greater knee extension symmetry at 6-months increased the probability of reinjury(B=.016, P=.048). In patients who RTA before 8-months, every 1% increase in quadriceps strength symmetry at 6-months increased the risk of reinjury by 2.1%(B=.021, P=.05). In patients who RTA after 8-months, every month that RTA was delayed reduced the risk of reinjury by 28.4%(B=-284, P=.042). CONCLUSIONS Patients with more symmetric quadriceps strength at 6-months post ACLR were more likely to experience another ACL rupture, especially in those who returned to sport earlier than 8-months after the index surgery. Clinicians should be cognizant that returning high functioning patients to activity earlier than 8-months post-ACLR may place them at an increased risk for reinjury.
Collapse
Affiliation(s)
- S G Bodkin
- Department of Physical Medicine and Rehabilitation. University of Colorado Anschutz Medical Campus. Aurora, CO
| | - J Hertel
- Department of Kinesiology. University of Virginia, Charlottesville, VA
| | - D R Diduch
- Department of Orthopaedic Surgery. University of Virginia, Charlottesville, VA
| | - S A Saliba
- Department of Kinesiology. University of Virginia, Charlottesville, VA
| | - W M Novicoff
- Public Health Sciences, University of Virginia, Charlottesville, VA
| | - S F Brockmeier
- Department of Orthopaedic Surgery. University of Virginia, Charlottesville, VA
| | - M D Miller
- Department of Orthopaedic Surgery. University of Virginia, Charlottesville, VA
| | - F W Gwathmey
- Department of Orthopaedic Surgery. University of Virginia, Charlottesville, VA
| | - B C Werner
- Department of Orthopaedic Surgery. University of Virginia, Charlottesville, VA
| | - J M Hart
- Department of Kinesiology. University of Virginia, Charlottesville, VA.,Department of Orthopaedic Surgery. University of Virginia, Charlottesville, VA
| |
Collapse
|
23
|
Gassner C. [25/m-Knee distortion during basketball : Preparation for the medical specialist examination: part 62]. Unfallchirurg 2021; 124:171-178. [PMID: 33755762 DOI: 10.1007/s00113-021-00978-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Christoph Gassner
- Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, LMU Klinikum München, Marchioninistr. 15, 81377, München, Deutschland.
| |
Collapse
|
24
|
Matassi F, Innocenti M, Andrea CL, Zanna L, Malone J, Civinini R, Innocenti M. Timing for Safe Return to Sport after Medial Patellofemoral Ligament Reconstruction: The Role of a Functional Test Battery. J Knee Surg 2021; 34:363-371. [PMID: 31486055 DOI: 10.1055/s-0039-1696647] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The purpose of this article was to analyze clinical and functional results after medial patellofemoral ligament (MPFL) reconstruction and to establish if a computer-assisted physical test battery could determine a "safe timing" to return to sport. We hypothesized that "time-based" criteria to declare safe return to sport could not be reliable to predict functional recover. Fifty-eight young athletic patients were selected after isolated reconstruction of MPFL. The minimum follow-up was 8 months. All the patients were evaluated subjectively with Kujala and Short Form 36 (SF-36) scores and objectively through a standardized computer-assisted physical battery of seven tests (Back in Action, Corehab). No patient was lost at the end point of follow-up and no recurrence of patellar dislocation was reported. At 8 months, 31 patients (53.4%) returned to sport at preoperative levels, and 23 (39.6%) participated in sports at lower levels. The subjective evaluation reported an increase of Kujala (60-92.7) and SF-36 score (28.6/25.4-52.2/53.6). At computer-assisted objective assessment, only 23 patients (39.6%) fulfilled the criteria for safe return to sport, while 31 (53.4%) got an insufficient outcome and 4 (6.9%) failed to complete the test. From our data, clinical scores after MPFL reconstruction provide only little insight into return to sport. The introduction of a computer-assisted objective analysis in the decision-making process for proper return to sport is necessary to evaluate functional recovery and dynamic knee stability.
Collapse
Affiliation(s)
| | | | | | - Luigi Zanna
- University of Florence, Orthopaedic Clinic CTO, Florence, Italy
| | - Joseph Malone
- Department of Internal Medicine/Orthopaedics, Torshovsdalen Legesenter and Oslo Legevakt, Oslo, Norway
| | | | | |
Collapse
|
25
|
Burroughs PJ, Kahan JB, Moore HG, Grauer JN, Gardner EC. Temporal Utilization of Physical Therapy Visits After Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2021; 9:2325967120982293. [PMID: 33681401 PMCID: PMC7900793 DOI: 10.1177/2325967120982293] [Citation(s) in RCA: 11] [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] [Received: 07/26/2020] [Accepted: 08/10/2020] [Indexed: 12/14/2022] Open
Abstract
Background: Physical therapy (PT) rehabilitation is critical to successful
outcomes after anterior cruciate ligament reconstruction (ACLR).
Later-stage rehabilitation, including sport-specific exercises,
is increasingly recognized for restoring high-level knee
function. However, supervised PT visits have historically been
concentrated during the early stages of recovery after ACLR. Purpose/Hypothesis: To assess the number and temporal utilization of PT visits after
ACLR in a national cohort. We hypothesized that PT visits would
be concentrated early in the postoperative period. Study Design: Descriptive epidemiological study. Methods: The Humana PearlDiver database was searched to identify patients
who underwent ACLR between 2007 and 2017. Patients with
additional structures treated were excluded. The mean ± SD,
median and interquartile range (IQR), and range of number of PT
visits for each patient were determined for the 52 weeks after
ACLR. PT visits over time were also assessed in relation to
patient age and sex. Results: In total, 11,518 patients who underwent ACLR met the inclusion
criteria; the mean age was 32.62 ± 13.70 years, and 42.7% were
female patients. Of this study cohort, 10,381 (90.4%) had
documented PT postoperatively; the range of PT visits was 0 to
121. On average, patients had 16.90 ± 10.60 PT visits (median
[IQR], 16 [9-22]) after ACLR. Patients completed a mean of 52%
of their PT visits in the first 6 weeks, 75% in the first 10
weeks, and 90% in the first 16 weeks after surgery. Patients
aged 10 to 19 years had the highest number of PT visits (mean ±
SD, 19.67 ± 12.09; median [IQR], 18 [12-25]), significantly
greater than other age groups (P <
.001). Conclusion: PT after ACLR is concentrated in the early postoperative period.
Physicians, therapists, and patients may consider adjusting the
limited access to PT to optimize patient recovery. Clinical Relevance: As supervised PT visits may be limited, the appropriate temporal
utilization of supervised PT visits must be maximized.
Strategies to ensure sessions for later neuromuscular and
activity-specific rehabilitation are needed.
Collapse
|
26
|
Buerba RA, Zaffagnini S, Kuroda R, Musahl V. ACL reconstruction in the professional or elite athlete: state of the art. J ISAKOS 2021; 6:226-236. [PMID: 34272299 DOI: 10.1136/jisakos-2020-000456] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 10/27/2020] [Accepted: 11/07/2020] [Indexed: 01/26/2023]
Abstract
Anterior cruciate ligament (ACL) injuries are on the rise at all levels of sport, including elite athletics. ACL injury can have implications on the athlete's sport longevity, as well as other long-term consequences, such as the development of future knee osteoarthritis. In the elite athlete, ACL injury can also have ramifications in terms of contract/scholastic obligations, sponsorships and revenue-generating potential. Although the goal of anterior cruciate ligament reconstruction (ACLR) is to return any athlete to the same preinjury level of sport, management of ACL injuries in the elite athlete come with the additional challenge of returning him or her to an extremely high level of physical performance. Despite outcome studies after ACLR in elite athletes showing a high return-to-sport rate, these studies also show that very few athletes are able to return to sport at the same level of performance. They also show that those athletes who undergo ACLR have careers that are more short-lived in comparison to those without injury. Thus, returning an elite athlete to 'near peak' performance may not be good enough for the athletic demands of elite-level sports. A possible explanation for the variability in outcomes is the great diversity seen in the management of ACL injuries in the elite athlete in terms of rehabilitation, graft choices, portal drilling and reconstruction techniques. Recently, the advent of anatomical, individualised ACLR has shown improved results in ACLR outcomes. However, larger-scale studies with long-term follow-ups are needed to better understand the outcomes of modern ACLR techniques-particularly with the rise of quadriceps tendon as an autograft choice and the addition of lateral extra-articular tenodesis procedures. The purpose of this article was thus to provide an up-to-date state-of-the-art review in the management of ACL injuries in the elite athlete.
Collapse
Affiliation(s)
| | - Stefano Zaffagnini
- 2nd Orthopaedic Surgery and Traumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Ryosuke Kuroda
- Orthopaedic, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Volker Musahl
- Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
27
|
Franck F, Saithna A, Vieira TD, Pioger C, Vigne G, Le Guen M, Rogowski I, Fayard JM, Thaunat M, Sonnery-Cottet B. Return to Sport Composite Test After Anterior Cruciate Ligament Reconstruction (K-STARTS): Factors Affecting Return to Sport Test Score in a Retrospective Analysis of 676 Patients. Sports Health 2021; 13:364-372. [PMID: 33550916 DOI: 10.1177/1941738120978240] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Return to sport (RTS) to the preinjury level is the main purpose after anterior cruciate ligament (ACL) reconstruction but the factors affecting the RTS are not completely known. Knee Santy Athletic Return to Sport (K-STARTS) is a composite test designed to assess readiness for RTS after ACL reconstruction. PURPOSE To determine the key factors that influence K-STARTS scores in a large cohort of patients after ACL reconstruction. STUDY DESIGN Case-control study. LEVEL OF EVIDENCE Level 3. METHODS A retrospective analysis of prospectively collected data was undertaken. All patients who underwent ACL reconstruction surgery between March 2016 and May 2017 and also had a K-STARTS assessment at 6 months postoperatively were included. To identify factors influencing the K-STARTS score, an analysis of variance was performed. Age, sex, sports level, delay between injury and surgery, concomitant lesions, graft type, additional lateral tenodesis procedure, and participation in the RTS program were analyzed to identify factors influencing the K-STARTS score. RESULTS A total of 676 patients were included in the study. The K-STARTS score was significantly higher in male patients than in female patients (13.9 vs 12.4; P < 0.001), in younger patients (those aged <30 years vs older patients; 14.2 vs 12; P < 0.001), ACL reconstructions performed with hamstring tendon autografts compared with bone-patellar tendon-bone (13.5 vs 13.1; P = 0.03) and in those who completed a specific RTS program in addition to standard rehabilitation, compared with those who did not participate (17.1 vs 13.1; P < 0.001). However, the only factor that significantly influenced the K-STARTS score beyond the minimal detectable change threshold was the completion of the additional RTS program. The preinjury frequency of sports participation, whether the dominant limb was injured, time from injury to surgery, the presence of associated meniscal injuries, and whether a lateral tenodesis was performed did not significantly influence the K-STARTS score. CONCLUSION Completion of a specific RTS program, in addition to standard rehabilitation, was the most important factor influencing the K-STARTS composite functional and psychological RTS test score at 6 months after ACL reconstruction. CLINICAL RELEVANCE This study shows that the completion of a specific RTS program affects positively the RTS test score at 6 months after ACL reconstruction.
Collapse
Affiliation(s)
- Florent Franck
- Centre Orthopédique Santy, Lyon, France.,Hopital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Adnan Saithna
- Arizona Brain, Spine & Sports Injuries Center, Scottsdale, Arizona
| | - Thais Dutra Vieira
- Centre Orthopédique Santy, Lyon, France.,Hopital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Charles Pioger
- Centre Orthopédique Santy, Lyon, France.,Hopital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | | | | | - Isabelle Rogowski
- Laboratoire Interuniversitaire de Biologie de la Motricité, Université de Lyon, Villeurbanne Cedex, France
| | - Jean-Marie Fayard
- Centre Orthopédique Santy, Lyon, France.,Hopital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Mathieu Thaunat
- Centre Orthopédique Santy, Lyon, France.,Hopital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Bertrand Sonnery-Cottet
- Centre Orthopédique Santy, Lyon, France.,Hopital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| |
Collapse
|
28
|
Albano TR, Rodrigues CAS, Melo AKP, de Paula PO, Almeida GPL. Clinical Decision Algorithm Associated With Return to Sport After Anterior Cruciate Ligament Reconstruction. J Athl Train 2020; 55:691-698. [PMID: 32396470 DOI: 10.4085/1062-6050-82-19] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Understanding the factors that predict return to sport (RTS) after anterior cruciate ligament reconstruction facilitates clinical decision making. OBJECTIVE To develop a clinical decision algorithm that could predict RTS and non-RTS based on the differences in the variables after anterior cruciate ligament reconstruction. DESIGN Cross-sectional study. SETTING University laboratory. PATIENTS OR OTHER PARTICIPANTS A total of 150 athletes in any sport involving deceleration, jumping, cutting, or turning enrolled in the study. All participants answered the International Knee Documentation Committee and Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) questionnaires and performed balance and isokinetic tests. MAIN OUTCOME MEASURE(S) The classification and regression tree (CART) was used to determine the clinical decision algorithm associated with RTS at any level and RTS at the preinjury level. The diagnostic accuracy of the CART was verified. RESULTS Of the 150 participants, 57.3% (n = 86) returned to sport at any level and 12% (n = 18) returned to sport at the preinjury level. The interactions among the peak torque extension at 300°/s >93.55 Nm, ACL-RSI score >27.05 (P = .06), and postoperative time >7.50 months were associated with RTS at any level identified by CART and were factors associated with RTS. An ACL-RSI score >72.85% was the main variable associated with RTS at the preinjury level. The interaction among an ACL-RSI score of 50.40% to 72.85%, agonist : antagonist ratio at 300°/s ≤63.6%, and anteroposterior stability index ≤2.4 in these participants was the second factor associated with RTS at the preinjury level. CONCLUSIONS Athletes who had more quadriceps strength tended to RTS at any level more quickly, even with less-than-expected psychological readiness. Regarding a return at the preinjury level, psychological readiness was the most important factor in not returning, followed by a better agonist : antagonist ratio and better balance.
Collapse
Affiliation(s)
- Thamlya Rocha Albano
- Knee and Sports Research Group, Federal University of Ceará, Fortaleza, Brazil.,Master Program in Physiotherapy and Functioning, Federal University of Ceará, Fortaleza, Brazil
| | - Carlos Augusto Silva Rodrigues
- Knee and Sports Research Group, Federal University of Ceará, Fortaleza, Brazil.,Master Program in Physiotherapy and Functioning, Federal University of Ceará, Fortaleza, Brazil
| | - Antonio Kayro Pereira Melo
- Knee and Sports Research Group, Federal University of Ceará, Fortaleza, Brazil.,Master Program in Physiotherapy and Functioning, Federal University of Ceará, Fortaleza, Brazil
| | - Pedro Olavo de Paula
- Knee and Sports Research Group, Federal University of Ceará, Fortaleza, Brazil.,Master Program in Physiotherapy and Functioning, Federal University of Ceará, Fortaleza, Brazil
| | | |
Collapse
|
29
|
Webster KE, Feller JA. Who Passes Return-to-Sport Tests, and Which Tests Are Most Strongly Associated With Return to Play After Anterior Cruciate Ligament Reconstruction? Orthop J Sports Med 2020; 8:2325967120969425. [PMID: 33415177 PMCID: PMC7750778 DOI: 10.1177/2325967120969425] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 07/02/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Return-to-sport (RTS) testing after anterior cruciate ligament (ACL)
reconstruction (ACLR) surgery has become popular. It has been recommended
that such testing should incorporate several domains, or set of tests, but
it is unclear which are most associated with a successful RTS. Purpose: To determine (1) the proportion of patients who can pass a set of self-report
and functional tests at 6 months after ACLR; (2) age, sex, and activity
level differences between patients who pass and those who do not; and (3)
whether specific types of tests are associated with a return to competitive
sport at 12 months. Study Design: Cohort study; Level of evidence, 2. Methods: This was a prospective longitudinal study of 450 patients who had primary
ACLR. At 6 months postoperatively, patients completed 2 self-report
measures, the International Knee Documentation Committee (IKDC) subjective
knee form and ACL–Return to Sport after Injury (ACL-RSI) scale, and 3
functional measures: single hop and triple crossover hop for distance and
isokinetic quadriceps strength. Limb symmetry index scores of ≥90 for
functional tests, IKDC scores ≥85, and ACL-RSI scores ≥65 were considered
indicators of satisfactory recovery. Proportional statistics and contingency
analysis were used to determine associations between age, sex, preinjury
sports level, and (1) meeting test thresholds and (2) RTS at 12 months. Results: Only 17 (3.8%) patients met all 5 test criteria at 6 months, and 95 (21%)
patients did not pass any test. More of the younger patients (<21 years)
passed all of the functional tests (P < .01), and more
male patients met the IKDC threshold (P = .03). Patients
who played level I sports before injury had the same pass rates as those who
played level II/III sports. Patients who passed the thresholds for the
ACL-RSI and IKDC scales had 4 and 3 times the odds, respectively, of RTS at
12 months (both P < .0001). Meeting the threshold for
quadriceps strength or either of the hop tests at 6 months was not
associated with RTS. Conclusion: At 6 months after ACLR, few patients met all of the thresholds of the common
tests used to assess RTS ability, although younger patients had higher rates
of passing the functional tests. Self-perceived symptoms/function and
psychological readiness were associated with a return at 12 months.
Collapse
Affiliation(s)
- Kate E Webster
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Julian A Feller
- OrthoSport Victoria, Epworth HealthCare, Melbourne, Australia
| |
Collapse
|
30
|
Springer B, Bechler U, Koller U, Windhager R, Waldstein W. Online Videos Provide Poor Information Quality, Reliability, and Accuracy Regarding Rehabilitation and Return to Sport After Anterior Cruciate Ligament Reconstruction. Arthroscopy 2020; 36:3037-3047. [PMID: 32679296 DOI: 10.1016/j.arthro.2020.07.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 07/06/2020] [Accepted: 07/06/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the information quality available on YouTube regarding rehabilitation and return to sport (RTS) after anterior cruciate ligament reconstruction (ACLR). METHODS By use of The Onion Router software and predefined search terms, 140 YouTube videos regarding rehabilitation and RTS after ACLR were systematically included. Three scoring systems were used to analyze the included videos: (1) Journal of the American Medical Association (JAMA) benchmark criteria; (2) Global Quality Score (GQS); and (3) self-developed scores for rehabilitation after ACLR and RTS after ACLR, following American Academy of Orthopaedic Surgeons guidelines and current evidence. RESULTS The vast majority of the included videos offered poor information quality, reliability, and accuracy. Videos that were uploaded by medically trained professionals showed significantly higher information quality regarding rehabilitation (P = .006 for JAMA score, P < .001 for GQS, and P = .001 for rehabilitation score) and regarding RTS (P < .001 for JAMA score, P < .001 for GQS, and P < .001 for RTS score) compared with commercial videos or personal-testimony videos. Multivariate linear regression also revealed medically trained professionals as significant predictors of higher information quality regarding rehabilitation (β = 0.496 [P < .001] for JAMA score, β = 1.3 [P < .001] for GQS, and β = 3.7 [P < .001] for rehabilitation score) and RTS (β = 0.754 [P < .001] for JAMA score, β = 1.3 [P < .001] for GQS, and β = 5.3 [P < .001] for RTS score). CONCLUSIONS The average information quality, reliability, and accuracy of YouTube videos regarding rehabilitation and RTS after ACLR are poor. The information quality of related YouTube videos from medically trained professionals is significantly higher compared with commercial videos or personal-testimony videos. CLINICAL RELEVANCE Current YouTube videos regarding rehabilitation and RTS after ACLR do not meet the necessary quality standards. Physicians should also be able to provide alternative sources of high-quality information.
Collapse
Affiliation(s)
- Bernhard Springer
- Department of Orthopaedic and Trauma Surgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Ulrich Bechler
- Department of Orthopaedics, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Ulrich Koller
- Department of Orthopaedic and Trauma Surgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Reinhard Windhager
- Department of Orthopaedic and Trauma Surgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Wenzel Waldstein
- Department of Orthopaedic and Trauma Surgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.
| |
Collapse
|
31
|
Zhao L, Lu M, Deng M, Xing J, He L, Wang C. Outcome of bone-patellar tendon-bone vs hamstring tendon autograft for anterior cruciate ligament reconstruction: A meta-analysis of randomized controlled trials with a 5-year minimum follow-up. Medicine (Baltimore) 2020; 99:e23476. [PMID: 33235137 PMCID: PMC7710199 DOI: 10.1097/md.0000000000023476] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 09/19/2020] [Accepted: 10/31/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Many systematic reviews have compared the short-term outcomes of anterior cruciate ligment (ACL)reconstruction with hamstring and patellar tendon autograft,but few differences have been observed. The purpose of this meta-analysis was to compare the medium-term outcome of bone-patellar tendon-bone and hamstring tendon autograft for anterior cruciate ligament reconstruction in terms of clinical function, knee stability, postoperativecomplications, and osteoarthritis changes. METHODS This meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The PubMed, Embase, and the Cochrane Library databases were searched from inception to November 2, 2019. This meta-analysis included only randomized controlled trials that compared BPTB and HT autografts for ACL reconstruction with a 5-year minimum follow-up. The Cochrane Collaboration's risk-of-bias tool was used to estimate the risk-of-bias for all included studies. RevMan 5.3 software was used to performed statistical analysis of the outcomes. RESULTS Fifteen RCTs, involving 1298 patients (610 patients in the BPTB group and 688 patients in the HT group) were included. In terms of clinical function, no significant difference was found in the objective International Knee Documentation Committee score (OR = 0.94, 95%CI: 0.64-1.37, P = .75), Lysholm knee score (MD = -2.26, 95%CI: -4.56 to 0.05, P = .06), return to preinjury activity level (OR = 1.01, 95%CI: 0.67-1.52, P = .96), and Tegner activity level (OR = 0.03, 95%CI: -0.36 to 0.41, P = .89). There was no statistically significant difference in the Lachman test (OR = 0.86, 95%CI: 0.5-1.32, P = .50), pivot-shift test (OR = 0.68, 95%CI: 0.44-1.06, P = .09), and side-to-side difference (MD = -0.32, 95%CI: -0.81 to 0.16, P = .19). As for postoperative complications and OA changes, there were no statistically significant difference in flexion loss (OR = 1.09, 95%CI: 0.47-2.54, P = .85) and OA changes (OR = 0.76, 95%CI: 0.52-1.10, P = .15), but we found significant differences in favor of the HT group in the domains of kneeling pain (OR = 1.67, 95%CI: 1.04-2.69, P = .03), anterior knee pain (OR = 2.90, 95%CI: 1.46-5.77, P = .002), and extension loss (OR = 1.75, 95%CI: 1.12-2.75, P = .01). There was a significant difference in favor of the BPTB group in the domain of graft failure (OR = 0.59, 95%CI: 0.38-0.91, P = .02). CONCLUSIONS Based on the results above, HT autograft is comparable with the BPTB autograft in terms of clinical function, postoperative knee stability, and OA changes, with a medium-term follow-up. The HT autograft for ACL reconstruction carries a lower risk of complications, such as anterior knee pain, kneeling pain, and extension loss, but an increased incidence of graft failure. Patients should be informed of the differences when deciding on graft choice with their physician.
Collapse
Affiliation(s)
- Lilian Zhao
- Department of Sports Medicine, Foshan Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Foshan
| | - Mingfeng Lu
- Department of Sports Medicine, Foshan Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Foshan
| | - Mingcong Deng
- Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jisi Xing
- Department of Sports Medicine, Foshan Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Foshan
| | - Lilei He
- Department of Sports Medicine, Foshan Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Foshan
| | - Changbing Wang
- Department of Sports Medicine, Foshan Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Foshan
| |
Collapse
|
32
|
Riesterer J, Mauch M, Paul J, Gehring D, Ritzmann R, Wenning M. Relationship between pre- and post-operative isokinetic strength after ACL reconstruction using hamstring autograft. BMC Sports Sci Med Rehabil 2020; 12:68. [PMID: 33292502 PMCID: PMC7602313 DOI: 10.1186/s13102-020-00215-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 10/15/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) ruptures are of major concern in sports. As mostly young and active individuals are affected there is an emphasis on the rapid and safe return to sports (RTS). Strengthening the ventral and dorsal thigh muscles is a prerequisite for a successful RTS after ACL reconstruction (ACLR), as persistent muscle weakness may increase the incidence for secondary injuries and impair performance. Aiming to increase evidence on the importance of preoperative muscle strength and the coaching of patients, the purpose of this study is to compare thigh muscle strength pre- and post-operatively after ACLR. METHODS We performed a retrospective analysis of 80 patients with primary, isolated ACLR using a four-stranded hamstring autograft. We performed bilateral isokinetic concentric strength measurement (60°/s) before and six months after ACLR. Primary outcomes were the maximal knee extension and flexion torque, hamstrings-to-quadriceps ratio (H/Q ratio) and the corresponding limb symmetry indices (LSI). Pearson correlations were calculated for pre- and post-surgical values. RESULTS The operated as well as the unaffected leg increased maximal knee extension (+ 18% ± 7% p < 0.05; + 11% ± 5% p < 0.05) and flexion torque (+ 9% ± 5% p < 0.05, + 10% ± 6% p < 0.05) throughout the 6 months of rehabilitation. The H/Q ratio remained unaffected (- 2% ± 3% p = 0.93; - 4% ± 4% p = 0.27). LSI of knee extension strength increased significantly (6% ± 3% p < 0.05), while flexion strength remained unaffected (+ 2% ± 4% p = 0.27). Positive correlations underline the interrelationship between the strength pre- and post-surgery for the knee extension (r = 0.788 p < 0.05) and knee flexion strength (r = 0.637 p < 0.05) after ACLR. CONCLUSIONS Preoperative leg extension and flexion strength normalized to body mass are strongly correlated to postoperative strength performance after ACLR. Therefore, pre-operative quadriceps and hamstring muscle strength deficits may have a significant negative impact on functional performance following ACLR. This emphasizes the need for intensive preoperative screening and subsequent treatment to achieve the best possible preoperative leg strength before ACLR. TRIAL REGISTRATION DRKS00020210 .
Collapse
Affiliation(s)
| | - M Mauch
- Rennbahnklinik, Muttenz, Basel, Switzerland
| | - J Paul
- Rennbahnklinik, Muttenz, Basel, Switzerland
| | - D Gehring
- Department of Sport and Sport Science, University of Freiburg, Freiburg, Germany
| | - R Ritzmann
- Rennbahnklinik, Muttenz, Basel, Switzerland
| | - M Wenning
- Rennbahnklinik, Muttenz, Basel, Switzerland. .,Department of Sport and Sport Science, University of Freiburg, Freiburg, Germany. .,Department of Orthopedic and Trauma Surgery, Medical Faculty, University Medical Center, Freiburg, Germany.
| |
Collapse
|
33
|
Vereijken A, Aerts I, Jetten J, Tassignon B, Verschueren J, Meeusen R, van Trijffel E. Association between Functional Performance and Return to Performance in High-Impact Sports after Lower Extremity Injury: A Systematic Review. J Sports Sci Med 2020; 19:564-576. [PMID: 32874110 PMCID: PMC7429422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 06/06/2020] [Indexed: 06/11/2023]
Abstract
After lower extremity injury, only half of the injured athletes return to their pre-injury sports level. Even though functional performance tests are often used to make return to sport decisions, it is unknown whether functional performance is associated with return to performance after such injuries. The aim of this systematic review was to identify, critically appraise, and analyze studies that investigated the association of functional performance tests with return to performance after lower extremity injuries in athletes participating in high-impact sports. MEDLINE, Embase, Web of Science, and CINAHL were systematically searched for relevant studies. Articles were independently screened by two authors and data were obtained from each included study using a data extraction form. Two authors independently scored methodological quality using the Quality In Prognosis Studies tool. A qualitative best evidence synthesis was conducted. Eight studies reported the association of functional performance with return to performance after lower extremity injuries, involving 1,246 athletes after anterior or posterior cruciate ligament reconstruction. No studies were found on the association of functional performance with return to performance for lower extremity injuries other than after anterior or posterior cruciate ligament reconstruction. All included studies had a high risk of bias. Two studies found significant but small associations for selected hop tests after anterior cruciate ligament reconstruction. Low evidence of association between functional performance and return to performance was present after anterior cruciate ligament reconstruction for the triple hop for distance, the 6-meter timed hop, the side hop in female athletes, and for the combination of the single and crossover hop for distance. In athletes after posterior cruciate ligament reconstruction, the vertical jump showed a significant but small association with return to performance. There is no high-quality evidence that functional performance is associated with return to performance after lower extremity injuries in athletes practicing high-impact sports. Low quality evidence suggests small associations after anterior and posterior cruciate ligament reconstruction. No evidence exists for lower extremity injuries other than after anterior or posterior cruciate ligament reconstruction. Therefore, research on functional performance associated with return to performance is recommended in high-quality prospective cohort studies including athletes with any type of lower extremity injury.
Collapse
Affiliation(s)
- Astrid Vereijken
- SOMT University of Physiotherapy, Amersfoort, the Netherlands
- Human Physiology and Sports Physiotherapy research group, Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel, Brussels, Belgium
- Annatommie MC, Utrecht, the Netherlands
| | - Inne Aerts
- SOMT University of Physiotherapy, Amersfoort, the Netherlands
| | - Jorrit Jetten
- SOMT University of Physiotherapy, Amersfoort, the Netherlands
- Annatommie MC, Utrecht, the Netherlands
| | - Bruno Tassignon
- Human Physiology and Sports Physiotherapy research group, Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Jo Verschueren
- Human Physiology and Sports Physiotherapy research group, Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel, Brussels, Belgium
- SOMT University of Physiotherapy, Amersfoort, the Netherlands
| | - Romain Meeusen
- Human Physiology and Sports Physiotherapy research group, Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel, Brussels, Belgium
- Strategic Research Program 'Exercise and the Brain in Health & Disease: the added value of Human-Centered Robotics, Vrije Universiteit Brussel, Brussels, Belgium
| | - Emiel van Trijffel
- SOMT University of Physiotherapy, Amersfoort, the Netherlands
- Experimental Anatomy research department, Department of Physiotherapy, Human physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| |
Collapse
|
34
|
Passing return to sports tests after ACL reconstruction is associated with greater likelihood for return to sport but fail to identify second injury risk. Knee 2020; 27:949-957. [PMID: 32247810 DOI: 10.1016/j.knee.2020.03.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 02/26/2020] [Accepted: 03/21/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND A limited number of patients return to sport (RTS) after an anterior cruciate ligament reconstruction (ACLR) and patients who RTS have a relatively high risk for second ACL injury. The purpose of the current study was to compare the results of a test battery between patients who returned to the pre-injury level of sport (RTS group) and patients who did not (NO-RTS group). It was hypothesized that the RTS group showed better test results. METHODS Sixty-four patients (age 27.8 ± 8.8 years) were included. The results of a multicomponent test battery (jump-landing task assessed with the Landing Error Scoring System (LESS), three hop tests, isokinetic strength test for quadriceps and hamstring) were compared between groups with a 2 × 2 ANOVA. RESULTS The RTS group showed a significantly lower LESS score (p = 0.010), significantly higher absolute scores on hop tests with both legs (injured leg: single leg hop test p = 0.013, triple leg hop test p = 0.024, side hop test p = 0.021; non-injured leg: single leg hop test p = 0.011, triple leg hop test p = 0.023, side hop test p = 0.032) and significantly greater hamstring strength in the injured leg (p = 0.009 at 60°/s, p = 0.012 at 180°/s and p = 0.013 at 300°/s). No differences in test results were identified between patients who sustained a second ACL injury and patients who did not. CONCLUSION Patients after ACLR with better jump-landing patterns, hop performance and greater hamstring strength have greater likelihood for RTS. However, our findings show that RTS criteria fail to identify patients who are at risk for a second ACL injury.
Collapse
|
35
|
Webster KE, Hewett TE. Is There Value and Validity for the Use of Return to Sport Test Batteries After Anterior Cruciate Ligament Injury and Reconstruction? Arthroscopy 2020; 36:1500-1501. [PMID: 32259646 DOI: 10.1016/j.arthro.2020.03.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 03/20/2020] [Indexed: 02/02/2023]
Abstract
Is there value and validity for the use of return-to-sport (RTS) test batteries? With regard to RTS testing, there has been marked interest and rapid growth in studies that document RTS criteria after anterior cruciate ligament reconstruction. A set of criteria or "test-battery" is typically used to "clear" the athlete for RTS. Although most RTS testing is done with aim of assessing safety, the same measurements can be as used to determine the amount of functional capacity regained. It is suggested that RTS test batteries incorporate multiple domains of risk factors. If testing "works," patients who pass should have a lower risk of reinjury than patients who fail but nonetheless return to sport. More recent studies have attempted to cover a broad range of risk factors, with as many as 15 to 20 RTS tests. This is possibly due to a lack of clear evidence as to what are the most important risk factors for second injury. As a result, few patients pass these combined criteria. Findings from a meta-analysis showed that there is a low rate of passing RTS testing (23%). The findings from this and a second meta-analyses are quite similar, as both showed there was no effect of passing RTS test batteries on overall subsequent anterior cruciate ligament injury. There was a 7% to 9% reduction in risk difference of graft injuries with passing of RTS; however, there was a 4% to 9% risk difference or 176% to 235% increased risk of a contralateral injury with passing of RTS criteria. There remain several problems with RTS test batteries, which include low rates of meeting thresholds, many athletes return without meeting RTS thresholds, evidence for predictive value is limited, small sample sizes in many studies (only 2 studies >100 patients), and many studies don't document RTS rates. Additional issues include questions as to whether testing should be staged, how to monitor progression of rehabilitation, and should these RTS batteries be tailored to age groups?
Collapse
Affiliation(s)
- Kate E Webster
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia.
| | | |
Collapse
|
36
|
Rühlemann A, Mayer C, Haversath M, Jäger M. Functional Knee Performance Differences in Handball are Depending on
Playing Class. Int J Sports Med 2020; 41:652-660. [DOI: 10.1055/a-1121-7635] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
AbstractHandball is one of the most traumatic sports. The knee is the most commonly
injured joint. To prevent knee injuries, optimal functional knee stability is of
great importance. Nevertheless, there is still no consensus about objective
criteria for knee function. Depending on playing class, injury rates seem to
differ. The purpose of this study was to evaluate knee function in handball
depending on playing class and to establish reference data for functional knee
stability. 261 handball players (25.1±5.8 years) performed a functional
test including two- and one-legged stability assessments, jump tests, speed and
agility analysis. Except for balance, differences between playing classes were
detected in all tests with superior performance of high-class players
(Germany’s 1st (“Oberliga”) and 2nd
(“Verbandsliga”) non-elite playing class). High-class players
achieved significant better results in jumping height
(p≤0.011–0.029), relative power per body weight in the
two-legged counter movement jump (p≤0.023) and speed and agility tests
(p≤0.001). This study illustrates the relevance of playing class
specific screening. Sports and playing class-specific databases will help to
identify individual deficits and strengths in order to prevent injury and
increase performance. Moreover, objective criteria for return to sports can be
established.
Collapse
Affiliation(s)
- Alina Rühlemann
- Chair of Orthopaedics and Trauma Surgery, University of Duisburg-Essen,
Faculty of Medicine, Essen, Germany
| | - Constantin Mayer
- Department of Orthopaedics, Trauma and Reconstruction Surgery, St.
Marien-Hospital Mülheim an der Ruhr, Mülheim an der Ruhr,
Germany
| | - Marcel Haversath
- Department of Orthopaedics and Trauma Surgery, St. Vinzenz-Hospital
Düsseldorf, Düsseldorf, Germany
| | - Marcus Jäger
- Chair of Orthopaedics and Trauma Surgery, University of Duisburg-Essen,
Faculty of Medicine, Essen, Germany
- Department of Orthopaedics, Trauma and Reconstruction Surgery, St.
Marien-Hospital Mülheim an der Ruhr, Mülheim an der Ruhr,
Germany
| |
Collapse
|
37
|
Waldhelm A, Gubler C, Sullivan K, Witte C, Buchheister D, Bartz-Broussard J. INTER-RATER AND TEST-RETEST RELIABILITY OF TWO NEW SINGLE LEG SIT-TO-STAND TESTS. Int J Sports Phys Ther 2020; 15:388-394. [PMID: 32566375 PMCID: PMC7296996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023] Open
Abstract
BACKGROUND The single leg sit-to-stand test (SLSTST) is a functional test that assesses quadriceps strength. The original SLSTST was used to diagnose lumbar nerve root impingement/radiculopathy - specifically at the L3 and L4 level. The original SLSTST used one repetition as the requirement for a successful test, therefore it may not identify quadriceps weakness in highly functional individuals with or recovering from an athletic injury. PURPOSE/HYPOTHESIS The purpose of this study was to determine the interrater and test-retest reliability of two new SLSTSTs, one for maximum number of repetitions over 30 seconds and one for time to complete five repetitions. STUDY DESIGN Cross-sectional, reliability study. METHODS Twenty healthy college-aged individuals (12 males, age: 22.5 years ± 1.37, height: 1.72 m ± 0.09; weight: 70.2 kg ± 11.0) participated in the study. Two testing sessions were held three to seven days apart, and two second-year physical therapy students served as examiners. The objective of the 30-second SLSTST was for the participant to perform as many single leg sit-to-stand repetitions they could in thirty seconds, while the five repetitions SLSTST measured how quickly the subjects could perform five single leg sit to stand repetitions. Both lower extremities were tested and Intraclass Correlation Coefficients (ICC) were calculated to determine reliability. RESULTS Both SLSTSTs were found to have excellent interrater and good to excellent test-retest reliability. The 30-second SLSTSTs had inter-rater ICC = 0.99 on the right and 0.98 on the left while the test-retest ICCs ranged from 0.92 to 0.94. The five repetition SLSTSTs had an inter-rater ICC = .99 on both legs while the test-retest ICC ranged from 0.87 to 0.94. CONCLUSIONS The results of the current study indicate that the two new SLSTSTs had good to excellent test-retest and excellent inter-rater reliability. However, more research is needed to determine if SLSTSTs can be used to identify quadriceps weakness in individuals with recovering from an athletic injury or to be used as a return-to-sport (RTS) assessment. LEVELS OF EVIDENCE Level 2.
Collapse
Affiliation(s)
- Andy Waldhelm
- University of South Alabama, Department of Physical Therapy, Mobile, AL, USA
| | - Coral Gubler
- University of South Alabama, Department of Physical Therapy, Mobile, AL, USA
| | - Katie Sullivan
- University of South Alabama, Department of Physical Therapy, Mobile, AL, USA
| | - Chris Witte
- University of South Alabama, Department of Physical Therapy, Mobile, AL, USA
| | - Devin Buchheister
- University of South Alabama, Department of Physical Therapy, Mobile, AL, USA
| | | |
Collapse
|
38
|
Criteria-Based Return to Sport Decision-Making Following Lateral Ankle Sprain Injury: a Systematic Review and Narrative Synthesis. Sports Med 2020; 49:601-619. [PMID: 30747379 DOI: 10.1007/s40279-019-01071-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The aim of this systematic review was to identify prospective studies that used a criteria-based return to sport (RTS) decision-making process for patients with lateral ankle sprain (LAS) injury. DESIGN Systematic review and narrative synthesis. DATA SOURCES The PubMed (MEDLINE), Web of Science, PEDro, Cochrane Library, SPORTDiscus (EBSCO), ScienceDirect, and Scopus databases were searched to 23 November 2018. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies were included if they prospectively applied a criteria-based RTS decision-making process for patients with LAS injury, but were excluded if they merely gathered outcome measures at the RTS time point. Studies were also excluded if patients were recovering from ankle fracture, high ankle sprain, medial ankle sprain, chronic ankle instability or complex ankle injury. RESULTS No studies were identified that used a criteria-based RTS decision-making process for patients with LAS injury. We were unable to conduct a quantitative synthesis or meta-analysis, therefore we provide a narrative synthesis of relevant questionnaires, as well as clinical and functional assessments commonly used in studies retrieved in the search. CONCLUSION There are currently no published evidence-based criteria to inform RTS decisions for patients with an LAS injury. Based on our narrative synthesis, we propose a number of variables that could be used to develop a criteria-based RTS decision paradigm. Future research should aim to reach consensus on these variables and apply them to actual RTS decisions within prospective study designs. Furthermore, we suggest that complex systems theory and the RTS continuum could be used to inform the development of an RTS decision-making paradigm for athletes with LAS injury.
Collapse
|
39
|
Rühlemann A, Mayer C, Albrecht T, Jäger M. Functional knee stability in non-elite handball: balance and jump performance differ based on players' position. Knee Surg Sports Traumatol Arthrosc 2020; 28:1212-1220. [PMID: 31471725 DOI: 10.1007/s00167-019-05693-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 08/22/2019] [Indexed: 01/10/2023]
Abstract
PURPOSE Despite the great evolvement of sports medicine, there is still a lack of consensus among sports physicians regarding the decision of return to sports after knee injury, especially in non-elite sports. Currently, no sport-specific reference data for an objective reliable evaluation of functional knee stability exist. The purpose of this study was to assess objective measures on knee joint stability from an established test battery in non-elite handball. It was assumed that players' knee stability differs depending on their field position. METHODS One-hundred and sixty-five non-elite handball players with a mean age of 24.3 ± 5.5 years underwent a test battery including two-legged and one-legged stability tests, two-legged and one-legged counter movement jumps, two-legged plyometric jumps, one-legged speedy jumps, and a quick feed test. RESULTS Athletes' physical performance differs in terms of field position. Significant differences between handball players of different positions were found in regard to two-legged stability (p < 0.036) and one-legged stability in the dominant leg (p < 0.009). Players of different positions differed in ground contact time of the plyometric jumps (p < 0.017), whereas the other functional tests did not show significant differences. CONCLUSION This study is first to report differences in functional knee stability of non-elite handball players on the basis of objective data. Significant differences of functional performance were noted, which were in congruence with position-specific demands. These findings demonstrate the importance of position-specific screening and training to prevent injuries. LEVEL OF EVIDENCE II.
Collapse
Affiliation(s)
- Alina Rühlemann
- Department of Orthopaedics and Trauma Surgery, University of Duisburg-Essen, Hufelandstrasse 55, D-45147, Essen, Germany
| | - Constantin Mayer
- Department of Orthopaedics and Trauma Surgery, University of Duisburg-Essen, Hufelandstrasse 55, D-45147, Essen, Germany
| | - Thomas Albrecht
- Department of Orthopaedics and Trauma Surgery, University of Duisburg-Essen, Hufelandstrasse 55, D-45147, Essen, Germany
| | - Marcus Jäger
- Department of Orthopaedics and Trauma Surgery, University of Duisburg-Essen, Hufelandstrasse 55, D-45147, Essen, Germany.
| |
Collapse
|
40
|
Physical Fitness after Anterior Cruciate Ligament Reconstruction: Influence of Graft, Age, and Sex. Sports (Basel) 2020; 8:sports8030030. [PMID: 32155933 PMCID: PMC7183074 DOI: 10.3390/sports8030030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 02/24/2020] [Accepted: 03/04/2020] [Indexed: 11/16/2022] Open
Abstract
Functional tests are used to facilitate return-to-sports decisions after anterior cruciate ligament reconstruction (ACLR). This study presents comprehensive physical fitness test data acquired in highly active patients within the first year after ACLR, for comparison between different grafts, age groups, and sexes. The outcomes from a specific seven-item test battery and isokinetic strength test data were extracted from a patient database. Results were compared to normative data from age- and sex-matched controls and between subgroups of patients. A total of 245 patients (94 women, 23.8 ± 8.4 years, pre-injury Tegner 7.4 ± 1.6) were tested 185 ± 44 days after surgery. In 116 patients (47.3%), one or more test results were classified as "poor" or "very poor" after comparison with normative data, with failures being most frequent during single-leg squat jump and plyometric strength tests. Test failures were more prevalent in adults than in adolescents <19 years (61.4%-62.2% vs. 24.5%, p < 0.001) and in men (61.6% vs. 24.5%, p < 0.001), but no differences were found between grafts. Isokinetic knee extensor strength was lower by 24.1% on the injured side. Six months after ACLR, nearly 50% of highly active patients presented with strength and functional fitness deficits. These deficits are particularly prevalent in older patients and men.
Collapse
|
41
|
Ekås GR, Ardern CL, Grindem H, Engebretsen L. Evidence too weak to guide surgical treatment decisions for anterior cruciate ligament injury: a systematic review of the risk of new meniscal tears after anterior cruciate ligament injury. Br J Sports Med 2020; 54:520-527. [PMID: 31959673 DOI: 10.1136/bjsports-2019-100956] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To investigate the risk of new meniscal tears after treatment for anterior cruciate ligament (ACL) injury, in children and adults with and without ACL reconstruction. DESIGN Prognosis systematic review (PROSPERO registration number CRD42016036788). METHODS We searched Embase, Ovid Medline, Cochrane, CINAHL, SPORTDiscus, PEDro and Google Scholar from inception to 3rd May 2018. Eligible articles included patients with ACL injury (diagnosis confirmed by MRI and/or diagnostic arthroscopy), reported the number of meniscal tears at the time of ACL injury diagnosis/start of treatment and reported the number of new meniscal tears that subsequently occurred. Articles with fewer than 20 patients at follow-up, and articles limited to ACL revision surgery or multi-ligament knee injuries were excluded. Two independent reviewers screened articles, assessed eligibility, assessed risk of bias and extracted data. We judged the certainty of evidence using the Grading of Recommendations Assessment Development and Evaluation (GRADE) working group methodology. RESULTS Of 75 studies included in the systematic review, 54 studies with 9624 patients and 501 new meniscal tears were appropriate for quantitative analysis. Heterogeneity precluded data pooling. The risk of new meniscal tears was 0%-21% when follow-up was <2 years, 0%-29% when follow-up was 2 to 5 years, 5%-52% when follow-up was 5 to 10 years and 4%-31% when follow-up was longer than 10 years. The proportion of studies with high risk of selection, misclassification and detection bias was 84%, 69% and 68%, respectively. Certainty of evidence was very low. CONCLUSION New meniscal tears occurred in 0%-52% of patients between 4 months and 20 years (mean 4.9±4.4 years) following treatment for ACL injury. The certainty of evidence was too low to guide surgical treatment decisions. This review cannot conclude that the incidence of new meniscal tears is lower if ACL injury is treated with surgery compared with treatment with rehabilitation only.
Collapse
Affiliation(s)
- Guri Ranum Ekås
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway .,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Oslo Sports Trauma Research Centre, Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
| | - Clare L Ardern
- Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia.,Unit of Physiotherapy, Department of Medicine, Health and Caring Sciences, Linköping University, Linköping, Sweden.,Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Hege Grindem
- Oslo Sports Trauma Research Centre, Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway.,Stockholm Sports Trauma Research Center, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Lars Engebretsen
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Oslo Sports Trauma Research Centre, Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
| |
Collapse
|
42
|
Ishibashi Y, Adachi N, Koga H, Kondo E, Kuroda R, Mae T, Uchio Y. Japanese Orthopaedic Association (JOA) clinical practice guidelines on the management of anterior cruciate ligament injury - Secondary publication. J Orthop Sci 2020; 25:6-45. [PMID: 31843222 DOI: 10.1016/j.jos.2019.10.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 10/12/2019] [Accepted: 10/16/2019] [Indexed: 02/09/2023]
Abstract
BACKGROUND This clinical guideline presents recommendations for the management of patients with anterior cruciate ligament (ACL) injury, endorsed by the Japanese Orthopaedic Association (JOA) and Japanese Orthopaedic Society of Knee, Arthroscopy and Sports Medicine (JOSKAS). METHODS The JOA ACL guideline committee revised the previous guideline based on "Medical Information Network Distribution Service Handbook for Clinical Practice Guideline Development 2014", which proposed a desirable method for preparing clinical guidelines in Japan. Furthermore, the importance of "the balance of benefit and harm" was also emphasized. This guideline consists of 21 clinical questions (CQ) and 23 background questions (BQ). For each CQ, outcomes from the literature were collected and evaluated systematically according to the adopted study design. RESULTS We evaluated the objectives and results of each study in order to make a decision on the level of evidence so as to integrate the results with our recommendations for each CQ. For BQ, the guideline committee proposed recommendations based on the literature. CONCLUSIONS This guideline is intended to be used by physicians, orthopedic surgeons, physical therapists, and athletic trainers managing ACL injuries. We hope that this guideline is useful for appropriate decision-making and improved management of ACL injuries.
Collapse
Affiliation(s)
- Yasuyuki Ishibashi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Japan.
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Hideyuki Koga
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Eiji Kondo
- Centre for Sports Medicine, Hokkaido University Hospital, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Japan
| | - Tatsuo Mae
- Department of Sports Medical Biomechanics, Osaka University Graduate School of Medicine, Japan
| | - Yuji Uchio
- Department of Orthopaedic Surgery, Shimane University School of Medicine, Japan
| |
Collapse
|
43
|
Batty LM, Feller JA, Hartwig T, Devitt BM, Webster KE. Single-Leg Squat Performance and Its Relationship to Extensor Mechanism Strength After Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2019; 47:3423-3428. [PMID: 31633995 DOI: 10.1177/0363546519878432] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Performance in strength and functional testing is important when considering return to sport after anterior cruciate ligament (ACL) reconstruction. Both knee extensor strength and the single-leg squat (SLS) have been used in this context. PURPOSE To evaluate the relationship between knee extensor strength and SLS performance after primary ACL reconstruction. STUDY DESIGN Cohort study (Diagnosis); Level of evidence, 3. METHODS A prospective cohort of 100 patients was assessed 6 and 12 months after primary ACL reconstruction with a hamstring tendon autograft. Knee extensor peak torque was measured. Three sequential SLSs were performed, and the maximum flexion angle identified from frame-by-frame video analysis was used as the measure of squat performance. A limb symmetry index (LSI) was calculated and satisfactory performance defined as ≥90%. RESULTS Extensor mechanism strength deficits were seen in 75% of patients at 6 months and 57% at 12 months postoperatively. Mean extensor mechanism strength showed a large improvement between 6 and 12 months (123.6 vs 147.8 N·m, respectively; P < .001; Cohen d = 1.10), and while there was also a statistically significant improvement in the mean maximum flexion angle, the change was small (66.1° vs 68.1°, respectively; P = .011; Cohen d = 0.26). There was a weak positive correlation between knee extensor strength and the SLS maximum flexion angle at 6 months (r = 0.342; P < .001) and 12 months (r = 0.245; P = .014). An SLS LSI <90% was 80% specific and 35% sensitive for extensor mechanism weakness at 6 months and 79% specific and 18% sensitive at 12 months. CONCLUSION Extensor mechanism strength deficits are common after ACL reconstruction but reduce between 6 and 12 months. The SLS maximum flexion angle has a weak linear relationship to knee extensor strength. SLS performance has high specificity but low sensitivity in identifying extensor mechanism strength deficits. The SLS maximum flexion angle is therefore a suboptimal surrogate test to identify extensor mechanism strength deficits as diagnosed by isokinetic dynamometric testing. However, unsatisfactory SLS performance indicates a very high chance of underlying extensor mechanism weakness.
Collapse
Affiliation(s)
| | | | | | | | - Kate E Webster
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| |
Collapse
|
44
|
Abstract
BACKGROUND Handball is one of the most popular team sports in Germany, as well as one of the most dangerous ones. Injury rates in Germany are higher amongst handball professionals than in soccer, with the knee being the most commonly injured joint. To prevent injuries, a functional inert stability is necessary, but definitions and objective measures are lacking. OBJECTIVES Establishing valid reference data of functional knee stability in amateur handball players with use of an established test battery giving objective measures METHODS: 261 athletes (f:130; m:131), mean age 25.1 ± 5.8 y were screened during the preseason. The test battery consisted of double and single-leg counter movement jumps, balance tests, agility, parkour, quick feet test and plyometric jumps. RESULTS Significant differences between males and females were noted in regard to balance scores (favour for females p ≤ 0.001), as well as jump height, agility and speed tests (favour for males [p ≤ 0.002-0.001]). CONCLUSION The noted differences once again bring focus to the interindividual presence of risk factors, because female and male handball athletes have gender-specific ground levels. These attributes have to be considered in further screening and prevention programs, as well as in the context of the return-to-sports decision after injury. The given data may serve as objective reference measures.
Collapse
Affiliation(s)
- C Mayer
- Universitätsklinik für Orthopädie und Unfallchirurgie, Pattbergstraße 1, 45239, Essen, Deutschland.
| | - A Rühlemann
- Universitätsklinik für Orthopädie und Unfallchirurgie, Pattbergstraße 1, 45239, Essen, Deutschland
| | - M Jäger
- Klinik für Unfall‑, Wiederherstellungs- & Orthopädische Chirurgie, St. Marien-Hospital Mülheim an der Ruhr, Mülheim/Ruhr, Deutschland
| |
Collapse
|
45
|
Medial patellofemoral ligament (MPFL) reconstruction using quadriceps tendon autograft provides good clinical, functional and patient-reported outcome measurements (PROM): a 2-year prospective study. Knee Surg Sports Traumatol Arthrosc 2019; 27:2426-2432. [PMID: 30374571 DOI: 10.1007/s00167-018-5226-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 10/17/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE The medial patellofemoral ligament (MPFL) is the most important ligamentous stabilizer preventing lateral patella dislocation. Numerous surgical procedures for MPFL reconstruction have been described in the literature. The aim of this study was to investigate the clinical, functional and patient-reported (PROM) outcomes 2 years after minimally invasive MPFL reconstruction performed using an autologous strip of the quadriceps tendon. METHODS Thirty-six patients (38 knees) were included in the study. For MPFL reconstruction, a partial thickness autologous quadriceps tendon graft was used. All patients were evaluated clinically and with patient-reported outcome questionnaires including the Tegner, Lysholm and Kujala scores as well as a visual analogue scale (VAS) for pain preoperatively and at 6, 12 and 24 months postoperatively. A functional Back-in-Action (BIA) test battery, including a total of seven stability, agility and jumping tests, was performed on 19 (50%) patients at the final follow-up. One patient was lost to follow-up at 24 months. RESULTS The mean age at the time of operation was 25.2 ± 6.1 years. No redislocations occurred during the period of investigation. The mean Lysholm score improved significantly from 79.3 ± 16.1 preoperatively to 83.2 ± 14.4 at 6 months, 88.1 ± 11.3 at 12 months and to 90.0 ± 9.6 at 24 months follow-up. No change throughout the study period was observed for the median Tegner Activity Score (median 6). The mean Kujala score increased from a preoperative value of 82.0 ± 12.4, to 84.5 ± 8.4 at 6 months, and 88.2 ± 5.8 at 12 months up to 88.7 ± 4.5 at 24 months follow-up. A total of 77.8% of the performed functional BIA tests were equal to or above the norm for patients of the corresponding ages and activity levels. CONCLUSIONS Minimally invasive MPFL reconstruction with a partial thickness strip of quadriceps tendon is a safe and effective treatment for patellofemoral instability. Good clinical, functional and subjective results were observed at the 2-year follow-up. LEVEL OF EVIDENCE Prospective cohort study, non-randomized, Level IV.
Collapse
|
46
|
Dan MJ, Lun KK, Dan L, Efird J, Pelletier M, Broe D, Walsh WR. Wearable inertial sensors and pressure MAT detect risk factors associated with ACL graft failure that are not possible with traditional return to sport assessments. BMJ Open Sport Exerc Med 2019; 5:e000557. [PMID: 31354961 PMCID: PMC6615852 DOI: 10.1136/bmjsem-2019-000557] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2019] [Indexed: 12/13/2022] Open
Abstract
Introduction Anterior cruciate ligament reconstruction (ACLR) is associated with poor return to sport and high graft re-rupture rates. This study explored the use of a wearable inertial sensor (ViMove) that incorporates an accelerometer and gyroscope, and MatScan pressure sensing mat (TekScan, South Boston, Massachusetts, USA) to provide objective return-to-sport measures. Methods Three cohorts’ ACLR patients, non-athletic controls and elite athletes (Australian seven’s rugby Olympic Gold medallist). Patients performed biometric and functional tests (thigh circumference and triple hop) and the ViMove knee module (consisting of single and double leg squats, hops and box drops) for lower limb alignment assessment, concurrently with force plate. Results Elite athletes had less varus/valgus (VV) movement during ViMove exercises compared with the ACLR cohort, who in turn had less VV malalignment than controls. When analysing side-to-side differences, single leg squats and box drop were asymmetrical in the ACL group, with greater malalignment in the reconstructed leg (p<0.05). Subgroup analysis failed to differentiate who passed or failed current return to sport assessment. TekScan pressure plate detected differences in double leg landing and flight time while hopping not detected with ViMove, suggesting ACL patients compensate by offloading the reconstructed leg to improve coronal alignment during double leg activity. Conclusion The inertial sensor detected differences in motion for patients following ACLR, which are known to be associated with graft rupture and were not detected with functional return to sport testing. Coupling the device with data from a pressure plate provides a powerful assessment tool detecting alignment differences known to be associate with graft failure only previously detected in formal gait analysis.
Collapse
Affiliation(s)
- Michael J Dan
- Surgical and Orthopaedic Research Laboratory, UNSW, Randwick, New South Wales, Australia
| | - Kimberly Kai Lun
- Surgical and Orthopaedic Research Laboratory, UNSW, Randwick, New South Wales, Australia
| | - Luke Dan
- Sports Medicine Department, Narrabeen Sports Medicine Faculty, Narrabeen, New South Wales, Australia
| | - Jimmy Efird
- HRMI, University of Newcastle, Callaghan, New South Wales, Australia
| | - Matthew Pelletier
- Surgical and Orthopaedic Research Laboratory, UNSW, Randwick, New South Wales, Australia
| | - David Broe
- Surgical and Orthopaedic Research Laboratory, UNSW, Randwick, New South Wales, Australia
| | - William R Walsh
- Surgical and Orthopaedic Research Laboratory, UNSW, Randwick, New South Wales, Australia
| |
Collapse
|
47
|
Leister I, Kulnik ST, Kindermann H, Ortmaier R, Barthofer J, Vasvary I, Katzensteiner K, Mattiassich G. Functional performance testing and return to sport criteria in patients after anterior cruciate ligament injury 12–18 months after index surgery: A cross-sectional observational study. Phys Ther Sport 2019; 37:1-9. [DOI: 10.1016/j.ptsp.2019.01.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 01/29/2019] [Accepted: 01/30/2019] [Indexed: 01/16/2023]
|
48
|
Bisciotti GN, Chamari K, Cena E, Bisciotti A, Bisciotti A, Corsini A, Volpi P. Anterior cruciate ligament injury risk factors in football. J Sports Med Phys Fitness 2019; 59:1724-1738. [PMID: 31062538 DOI: 10.23736/s0022-4707.19.09563-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Anterior cruciate ligament (ACL) lesion represents one of the most dramatic injuries in a football (soccer) player's career. There are many injury risk factors related to intrinsic (non-modifiable) and/or extrinsic (modifiable) factors of ACL injury. EVIDENCE ACQUISITION Research of the studies was conducted until September 2018 without publication data limitation or language restriction on the following databases: PubMed/MEDLINE, Scopus, ISI, EXCERPTA. EVIDENCE SYNTHESIS To date, evidence from the literature suggests that the risk of ACL injury is multifactorial and involves biomechanical, anatomical, hormonal, and neuromuscular factors. Despite this relative complexity, the mechanisms of injury are well known and rationally classified into two categories: mechanisms of injury based on contact or on non-contact with another player, with the non-contact injury mechanisms clearly prevailing over the mechanisms of contact injury. One of the most frequent biomechanical risk factors, associated with ACL non-contact injury, is represented by the valgus knee in the pivoting and cutting movements and in the landing phase after jumping. Gender-related risk factors show female populations to have a higher predisposition to ACL injury than males However, there are still some theoretical and practical aspects that need further investigation such as; genetic risks together with the role of estrogen and progesterone receptors in female populations, and the in-vivo interaction shoe-playing surface. In particular, the genetic risk factors of ACL lesion seem to be an interesting and promising field of investigation, where considerable progress has still to be made. CONCLUSIONS This narrative review provides an insight into the risk factors of ACL injury that could be used by practitioners for preventing injury in football (soccer).
Collapse
Affiliation(s)
- Gian Nicola Bisciotti
- Qatar Orthopedic and Sport Medicine Hospital, FIFA Center of Excellence, Doha, Qatar -
| | - Karim Chamari
- Qatar Orthopedic and Sport Medicine Hospital, FIFA Center of Excellence, Doha, Qatar
| | - Emanuele Cena
- Qatar Orthopedic and Sport Medicine Hospital, FIFA Center of Excellence, Doha, Qatar
| | | | | | | | - Piero Volpi
- FC Internazionale Milano, Milan, Italy.,Unit of Traumatology, Department of Knee Orthopedic and Sports, Humanitas Research Hospital, Rozzano, Milan, Italy
| |
Collapse
|
49
|
What is the Evidence for and Validity of Return-to-Sport Testing after Anterior Cruciate Ligament Reconstruction Surgery? A Systematic Review and Meta-Analysis. Sports Med 2019; 49:917-929. [DOI: 10.1007/s40279-019-01093-x] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
|
50
|
A research update on the state of play for return to sport after anterior cruciate ligament reconstruction. J Orthop Traumatol 2019; 20:10. [PMID: 30689073 PMCID: PMC6890902 DOI: 10.1186/s10195-018-0516-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 12/20/2018] [Indexed: 01/21/2023] Open
Abstract
Most athletes who undergo anterior cruciate ligament (ACL) reconstruction surgery plan to return to some level of sporting activity. However, rates of return to pre-injury sport are often less than might be expected and many factors influence whether individuals return to sport after this surgery. They include surgical and rehabilitation factors as well as social, psychological and demographic characteristics. The fate of the younger athlete who sustains an ACL injury is a topic that has received recent attention due to accumulating evidence that younger athletes are at considerable risk for not only one, but multiple ACL injuries. Little is known about how to determine when it is safe to return to sport following ACL reconstruction or how to predict whether an athlete will be able to successfully return. The notion that a set of return to sport criteria can be applied to reduce the risk of further injury has become popular with many different criteria proposed. Another risk of returning to sport following ACL reconstruction is that of sustaining injury to the menisci or articular surfaces, which may in turn increase the risk of developing osteoarthritis. Although there is some evidence that ACL reconstruction reduces the risk of osteoarthritis there is stronger evidence that it does little to protect the knee from long term degeneration. Therefore, it should be recognized that return to sport following ACL reconstruction is associated with a risk of further injury and potential development of osteoarthritis.Level of evidence: V.
Collapse
|