1
|
Mayer MA, Deliso M, Hong IS, Saltzman BM, Longobardi RS, DeLuca PF, Rizio L. Rehabilitation and Return to Play Protocols After Anterior Cruciate Ligament Reconstruction in Soccer Players: A Systematic Review. Am J Sports Med 2024:3635465241233161. [PMID: 38622858 DOI: 10.1177/03635465241233161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
BACKGROUND Rehabilitation after anterior cruciate ligament ACL reconstruction (ACLR) is crucial for safe return to play (RTP) and reducing the chances of a reinjury. Yet, there is no consensus on the ideal functional tests to assess rehabilitation progress in soccer players after ACLR. PURPOSE The primary objective was to highlight the existing gap in the literature concerning the most effective standardized rehabilitation protocols and testing for facilitating successful RTP among soccer players. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS A systematic review using PubMed, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) was conducted. Inclusion criteria encompassed original studies (level of evidence 1-4) that examined rehabilitation protocols, metrics of knee rehabilitation, and clinical outcomes after ACLR in soccer players. RESULTS This review incorporated 23 studies, predominantly retrospective case series, with a total number of 874 soccer players who underwent ACLR and rehabiliation. 5 (21.7%) studies utilized an accelerated rehabilitation protocol, while 7 (30.4%) of studies utilized a criterion-based rehabilitation. A wide heterogeneity of data was extracted including functional tests of rehabilitation and RTP such as strength test batteries, hop test batteries, and movement quality assessments. Of the 23 selected studies, 2 (8.7%) used all 3 test batteries, 8 (34.8%) used 2 test batteries, 12 (52.2%) used 1 test battery, and 1 (4.3%) used 0 of the test batteries. The mean time between surgery and RTP ranged from 3 to 8 months with only 2 (8.7%) studies reporting complications after ACLR. Lastly, out of the total studies examined, 9 (39.1%) assessed patient-reported outcome measures (PROMs), all of which demonstrated significant improvement from the initial assessment to the final follow up. CONCLUSION Soccer-specific rehabilitation after ACLR lacks standardization. Even though many studies have assessed protocols for optimal RTP and reduced secondary ACL injuries, there is a gap in the literature regarding the most effective protocols and RTP testing. The methodology reported by Kyritsis et al could serve as a foundation for future prospective randomized multicenter studies to establish a standard rehabilitation protocol and enable a successful return to soccer.
Collapse
Affiliation(s)
- McKenzie A Mayer
- Department of Orthopedic Surgery, Cooperman Barnabas Medical Center, Livingston, New Jersey, USA
- Department of Orthopedic Surgery, Jersey City Medical Center, Jersey City, New Jersey, USA
| | - Marisa Deliso
- Department of Orthopedic Surgery, Cooperman Barnabas Medical Center, Livingston, New Jersey, USA
- Department of Orthopedic Surgery, Jersey City Medical Center, Jersey City, New Jersey, USA
| | - Ian S Hong
- Department of Orthopedic Surgery, Cooperman Barnabas Medical Center, Livingston, New Jersey, USA
- Department of Orthopedic Surgery, Jersey City Medical Center, Jersey City, New Jersey, USA
| | - Bryan M Saltzman
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, USA
- Musculoskeletal Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Raphael S Longobardi
- Department of Sports Medicine, Cooperman Barnabas Medical Center, Livingston, New Jersey, USA
| | - Peter F DeLuca
- Department of Sports Medicine, Cooperman Barnabas Medical Center, Livingston, New Jersey, USA
| | - Louis Rizio
- Department of Sports Medicine, Cooperman Barnabas Medical Center, Livingston, New Jersey, USA
| |
Collapse
|
2
|
Yadav S, Rawal G. Advances in Understanding and Managing Floating Knee Injuries: A Comprehensive Review. Cureus 2024; 16:e57122. [PMID: 38681444 PMCID: PMC11055540 DOI: 10.7759/cureus.57122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2024] [Indexed: 05/01/2024] Open
Abstract
Fractures of the ipsilateral tibia and femur, frequently combined with soft tissue damage and dislocations, describe floating knee injuries, a complicated orthopedic condition. Epidemiological data suggest that floating knee injuries account for a small but significant proportion of traumatic orthopedic injuries, with a higher incidence observed in younger males engaged in high-risk activities. Anatomically, floating knee injuries involve fractures of the femur and tibia, ligamentous disruptions, and soft tissue damage, contributing to the complexity and severity of these injuries. An extensive analysis of floating knee injuries is given in this paper, including information about epidemiology, anatomy, pathophysiology, categorization, management approaches, complications, prognosis, and current and upcoming developments.
Collapse
Affiliation(s)
- Sankalp Yadav
- Medicine, Shri Madan Lal Khurana Chest Clinic, New Delhi, IND
| | - Gautam Rawal
- Respiratory Medical Critical Care, Max Super Speciality Hospital, New Delhi, IND
| |
Collapse
|
3
|
Dawkins J, Teel J, Kitziger R, Khair M. Anterior Cruciate Ligament Injury Prevention and Rehabilitation. HSS J 2023; 19:365-372. [PMID: 37435132 PMCID: PMC10331261 DOI: 10.1177/15563316231154475] [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: 07/20/2022] [Accepted: 09/23/2022] [Indexed: 07/13/2023]
Abstract
At all levels of American football, knee injuries are common, with injuries to the anterior cruciate ligament (ACL) making up a significant proportion. Historically, ACL injuries were career-altering for professional players, but innovative techniques in surgery and rehabilitation have returned many to the field. While there is a consensus on surgical techniques for ACL reconstruction, significant discrepancies remain on injury prevention and rehabilitation programs. This review article describes the burden of ACL injury on players in the National Football League, best practices in injury prevention and rehabilitation, and evidence-based recommendations for preparing injured athletes to return to play.
Collapse
Affiliation(s)
| | - Jordan Teel
- Baylor University Medical Center, Dallas, TX, USA
| | | | | |
Collapse
|
4
|
There Is Substantial Variation in Rehabilitation Protocols Following Anterior Cruciate Ligament Reconstruction: A Survey of 46 American Orthopaedic Surgeons. Arthroscopy 2023; 39:578-589.e20. [PMID: 35988795 DOI: 10.1016/j.arthro.2022.07.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 07/26/2022] [Accepted: 07/28/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE To identify the clinical practice preferences of orthopaedic surgeons regarding anterior cruciate ligament reconstruction (ACLR) rehabilitation through a survey of members of the Arthroscopy Association of North American (AANA) and the American Orthopaedic Society for Sports Medicine (AOSSM). METHODS An online survey was distributed to members of AANA and AOSSM between November 2020 and September 2021. Participants reported on their clinical preferences for ACLR protocol development and patient selection, use of technology in ACLR recovery and rehabilitation, and preferences for advancing through multiple phases of the rehabilitative process. RESULTS Responses from 46 orthopaedic surgeons were analyzed. Patient-reported outcome measures were not found to be utilized often at various phases of the perioperative period. Thirty-eight (82.6%) participants reported utilization of postoperative bracing. There was no consensus on when participants allow their patients to advance through rehabilitation, but most report waiting 3 to 4 months for advancement to jogging/lateral movement, 6 to 8 months for return to noncontact sport, and 9 months of more for return to unrestricted sport. Many participants utilize functional and strength testing with associated limb symmetry indices to determine patient readiness to return to sport, with 18, 26, and 25 participants reporting use of functional testing and 28, 26, and 27 participants reporting use of strength testing at the return to jogging/lateral movements, noncontact return to sport, and unrestricted return-to-sport phases, respectively. CONCLUSIONS This study provides an insight into the rehabilitative protocols and modalities utilized for ACLR by orthopaedic surgeons in practice across the United States. There is notably substantial variation in rehabilitative patterns and preferences, particularly with regards to what constitutes criteria for progressing patients through the phases of returning to unrestricted sport. Additionally, our findings show that while many surgeons believe that quantitative assessment technology could be beneficial in decision-making for returning patients to sport, there are still many barriers that stand in the way of its implementation into clinical practice. CLINICAL RELEVANCE Postoperative rehabilitative protocols after ACLR vary by surgeon.
Collapse
|
5
|
Lubowitz JH, Brand JC, Rossi MJ. Return-to-Sport Outcomes After Anterior Cruciate Ligament Surgical Treatment May Be Improved by Attention to Modifiable Factors and Consideration of Nonmodifiable Factors. Arthroscopy 2023; 39:571-574. [PMID: 36740280 DOI: 10.1016/j.arthro.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 12/07/2022] [Indexed: 02/07/2023]
Abstract
Today, we who treat athletes are able to effect immediate, significant improvement in anterior cruciate ligament (ACL) patient outcomes, regardless of surgical technique, by careful determination of when an athlete is ready to return to sport. "Prehabiliation," bracing, time after surgery to various rehabilitation activities, time after surgery until return to sport, functional testing, strength testing including limb symmetry indices, psychological readiness, age, gender, and type of sport are all factors influencing successful return to sport after ACL injury and treatment. Age and gender are not modifiable, and for some athletes, type of sport may be nonnegotiable. However, each of these factors could be thoughtfully considered before returning an athlete to sport after ACL treatment. All the other factors listed above, from prehab to bracing to strength to psychological readiness, may be modifiable.
Collapse
|
6
|
Zhou T, Xu Y, Zhou L, Wang S, Wang S, Xu W. Multi-planar instability, laxity and reduced knee flexion during the support phase of walking are determinants of return to sports. Front Bioeng Biotechnol 2022; 10:1047135. [PMID: 36406209 PMCID: PMC9669481 DOI: 10.3389/fbioe.2022.1047135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022] Open
Abstract
Background: After anterior cruciate ligament reconstruction, some patients are not recommended to return to high-level physical activity because they fail to pass return-to-sports tests. The kinematic difference between these patients and those who pass the return-to-sports tests is unclear. Methods: Eighty-two patients who received anatomic single-bundle anterior cruciate ligament (ACL) reconstruction for unilateral ACL injury underwent return-to-sport tests during a hospital visit at a minimum of 9 months (9–11 months) of follow-up. Fifteen patients who passed the return-to-sports tests (RTS group) and fifteen patients who did not (NRTS group) were randomly selected to perform a treadmill walk under dual-fluoroscopic imaging system surveillance for a 6 degrees of freedom kinematic evaluation. Results: Of the 82 patients, 53 passed the return-to-sports tests 9 months after surgery, with a return-to-sports rate of 64.6%. In the stance phase, the NRTS group had a larger anterior tibial translation (1.00 ± 0.03 mm vs. 0.76 ± 0.03 mm, p = 0.001), a larger lateral tibial movement (1.61 ± 0.05 mm vs. 0.77 ± 0.05 mm, p < 0.001), a larger distal tibial displacement (−3.09 ± 0.05 mm vs. −2.69 ± 0.05 mm, p < 0.001), a smaller knee flexion angle (6.72 ± 0.07° vs. 8.34 ± 0.07°, p < 0.001), a larger varus angle (−0.40 ± 0.03°VS. -0.01 ± 0.03°, p < 0.001) and a larger external rotation angle (1.80 ± 0.05° vs. 1.77 ± 0.05°, p < 0.001) than the RTS group. The maximum anterior tibial translation of the NRTS group is also larger than that of the RTS group (3.64 ± 0.42 mm vs. 3.03 ± 0.59 mm, p = 0.003). Conclusion: Compared with patients passing RTS tests, those who fail to pass show significant anterior, lateral, and rotational instability; knee laxity; and reduced flexion angle of the knee in the support phase during walking, which may be the possible factors hindering a return to sports.
Collapse
Affiliation(s)
- Tianping Zhou
- Department of Joint Surgery and Sports Medicine, Changhai Hospital Affiliated to Navy Medical University, Shanghai, China
| | | | - Lan Zhou
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai, China
| | - Siya Wang
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai, China
| | - Shaobai Wang
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai, China
- *Correspondence: Shaobai Wang, ; Weidong Xu,
| | - Weidong Xu
- Department of Joint Surgery and Sports Medicine, Changhai Hospital Affiliated to Navy Medical University, Shanghai, China
- *Correspondence: Shaobai Wang, ; Weidong Xu,
| |
Collapse
|
7
|
Bartels T, Schwesig R, Brehme K, Pyschik M, Pröger S, Laube W, Kurz E. Beurteilung des neuromuskulären Funktionszustands bei Berufssportlern. ARTHROSKOPIE 2022. [DOI: 10.1007/s00142-022-00548-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
ZusammenfassungIn den letzten Jahren wurden bedeutende Fortschritte in den chirurgischen Techniken, der postoperativen Rehabilitation und der Identifizierung von Risikofaktoren für eine zweite Verletzung des vorderen Kreuzbands (VKB) gemacht. Dies führte jedoch nicht zu einer Verringerung des sekundären VKB-Verletzungsrisikos. Die Wiederherstellung der anatomischen (operative Rekonstruktion) und anschließend insbesondere der trainingsbedingten funktionellen Stabilität sollte eine grundlegende Voraussetzung für die Rückkehr zu Pivot-Sportarten nach einer VKB-Verletzung sein. Das VKB hat eine bedeutende Rolle bei der Kniepropriozeption mit der Konsequenz einer eingeschränkten sensomotorischen Regulation im Verletzungsfall. Das Perturbationstraining stellt eine große Herausforderung in der spätrehabilitativen Phase nach VKB-Rekonstruktion dar. Die Diagnostik der Muskelaktivierung im Rehabilitationsverlauf nach VKB-Rekonstruktion hat deshalb eine enorme Bedeutung. Mit der entwickelten Software können Charakteristika der motorischen Einheiten knieführender Muskeln zeitnah objektiviert und somit eine mögliche Überlastung bei hochreaktivem Perturbationstraining im Rahmen der spätrehabilitativen Phase nach VKB-Rekonstruktion vermieden werden.
Collapse
|