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Mussell EA, Crawford AE, Ithurburn MP, Layton BO, Fleisig GS, Rothermich MA, Emblom BA, Ryan MK, Dugas JR, Andrews JR, Cain EL. Outcomes of Surgical Treatment for Multiligament Knee Injuries in a Cohort Including Competitive Athletes With Long-Term Follow-Up. Orthop J Sports Med 2024; 12:23259671241266619. [PMID: 39247533 PMCID: PMC11375643 DOI: 10.1177/23259671241266619] [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: 01/26/2024] [Accepted: 02/13/2024] [Indexed: 09/10/2024] Open
Abstract
Background There is a paucity of outcomes data on surgical reconstruction for multiligament knee injury (MLKI) in the orthopaedic literature. Purpose To examine functional and return-to-sports (RTS) outcomes and revision rates after single-stage reconstruction for MLKIs in a cohort containing a large proportion of competitive athletes over a 20-year period. Study Design Case series; Level of evidence, 4. Methods We identified all patients at our institution who underwent surgical reconstruction for an anterior cruciate ligament (ACL) or bicruciate (ACL-posterior cruciate ligament) MLKI between 2001 and 2020 and had ≥2 years of postoperative outcome data. Patient-reported outcomes were evaluated using the International Knee Documentation Committee (IKDC) form, a surgical satisfaction survey, and questions about subsequent knee surgery and RTS administered via telephone. Summary statistics for all outcomes data were calculated, and predictors of IKDC scores at follow-up were examined using univariable linear regression. Results Out of 151 patients eligible for this study, outcomes data were collected in 119 patients (79%). The mean follow-up time was 8.3 ± 4.4 years, and the mean IKDC score at follow-up was 79 ± 17. A total of 83 competitive athletes were included; 62 of these athletes attempted to return to preinjury sport. Among the 62 who attempted RTS, 50 (81%) were successful, and 12 were unable to return due to limitations from their surgery. At follow-up, 112 of the overall cohort of 119 patients (94%) were either satisfied or very satisfied with their surgical outcome, and 91% stated the surgery met or exceeded their expectations. In addition, 24% had subsequent ipsilateral knee operations after their index multiligament knee reconstruction. Older age at surgery and female sex were associated with worse IKDC scores at follow-up. Conclusion Despite the severity of the injuries in our cohort, we found high levels of patient-reported function and a high rate of successful RTS in the competitive athletes. Older age and female sex were associated with worse patient-reported knee function at follow-up.
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Affiliation(s)
- Eric A Mussell
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama, USA
- The American Sports Medicine Institute, Birmingham, Alabama, USA
| | - Anna E Crawford
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama, USA
- The American Sports Medicine Institute, Birmingham, Alabama, USA
| | - Matthew P Ithurburn
- The American Sports Medicine Institute, Birmingham, Alabama, USA
- Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Branum O Layton
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama, USA
- The American Sports Medicine Institute, Birmingham, Alabama, USA
| | - Glenn S Fleisig
- The American Sports Medicine Institute, Birmingham, Alabama, USA
| | - Marcus A Rothermich
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama, USA
- The American Sports Medicine Institute, Birmingham, Alabama, USA
| | - Benton A Emblom
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama, USA
- The American Sports Medicine Institute, Birmingham, Alabama, USA
| | - Michael K Ryan
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama, USA
- The American Sports Medicine Institute, Birmingham, Alabama, USA
- Prevea Health Orthopaedics and Sports Medicine, Green Bay, Wisconsin, USA
| | - Jeffrey R Dugas
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama, USA
- The American Sports Medicine Institute, Birmingham, Alabama, USA
| | - James R Andrews
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama, USA
- The American Sports Medicine Institute, Birmingham, Alabama, USA
| | - E Lyle Cain
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama, USA
- The American Sports Medicine Institute, Birmingham, Alabama, USA
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Bashaireh KM, Yabroudi MA, Logerstedt D, Snyder-Mackler L, Nawasreh ZH. Reasons for Not Returning to Pre-injury Sport Level After ACL-Reconstruction. Int J Sports Med 2024; 45:698-704. [PMID: 38718825 DOI: 10.1055/a-2270-3306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
The study aimed to identify athlete-reported reasons for not returning to pre-injury sports level after anterior cruciate ligament reconstruction (ACLR) and to identify the factors associated with these reasons. Ninety-one athletes with 2 years post-ACLR indicated whether or not they had returned to their pre-injury sport level (same frequency, duration, and intensity). Athletes who did not return were asked to provide the reasons. Athletes' characteristics and injury-related factors were used to determine factors associated with the reasons for not returning. Only nine athletes (10%) returned to pre-injury sport level after ACLR. The most common reasons for not returning were lack of confidence or concerns about re-injury (48.8%), followed by continued post-surgical impairments in the reconstructed knee (39%). Having episodes of the knee giving way after ACLR was the only significant predictor of post-surgical impairments (48.8%; OR=8.3, 95%CI=2.48-27.42, p=0.001). Lack of confidence, concerns about re-injury, or post-surgical impairments in the reconstructed knee were the most frequently reported reasons for not returning to pre-injury sports level with 2 years post-ACLR. Reported dynamic knee instability was the only factor associated with ongoing post-surgical knee impairments after ACLR. Rehabilitation programs should address athletes' psychological responses and resolve knee impairments to optimize return to pre-injury sport level after ACLR.
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Affiliation(s)
- Khaldoon M Bashaireh
- Department of Special Surgery, Jordan University of Science and Technology, Irbid central post o, Jordan
| | - Mohammad A Yabroudi
- Division of physical therapy, Dept. of Rehabilitation Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - David Logerstedt
- Physical Therapy, Saint Joseph's University, Philadelphia, United States
| | | | - Zakariya H Nawasreh
- Division of physical therapy, Dept. of Rehabilitation Sciences, Jordan University of Science and Technology, Irbid, Jordan
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Petit CB, Slone HS, Diekfuss JA, Barber Foss KD, Warren SM, Montalvo AM, Lamplot JD, Myer GD, Xerogeanes JW. Sex-Specific Outcomes After Anterior Cruciate Ligament Reconstruction Using an All-Soft Tissue Quadriceps Tendon Autograft in a Young Active Population. Am J Sports Med 2024; 52:2450-2455. [PMID: 39097771 DOI: 10.1177/03635465241262018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/05/2024]
Abstract
BACKGROUND The ideal graft for anterior cruciate ligament (ACL) reconstruction (ACLR) in young athletes has a high return-to-sport (RTS) rate and a low reinjury rate. Quadriceps tendon autografts are being used with increasing frequency for ACLR in this population, despite a paucity of evidence to support their use. PURPOSE To report the RTS rate, ipsilateral reinjury rate, and contralateral ACL injury rate in a young athletic population undergoing primary ACLR using an all-soft tissue quadriceps tendon (ASTQT) autograft. STUDY DESIGN Cases series; Level of evidence, 4. METHODS Patients aged 14 to 22 years who underwent primary ACLR using an ASTQT autograft by a single surgeon between January 1, 2005, and April 30, 2020, were identified via electronic medical records and contacted ≥24 months after ACLR to complete a survey regarding subsequent ipsilateral or contralateral ACL injuries and RTS. Patients who had undergone previous ACLR (ipsilateral or contralateral) were excluded. RESULTS A total of 656 patients (330 male, 326 female; mean age, 17.9 years) were identified, and 395 patients completed the survey (60.2%; 174 male, 221 female; mean age, 17.8 years) with a mean follow-up of 73 ± 29 months (range, 24-139 months). The RTS rate was high (male: 87.7%; female: 82.8%; P = .19). Male and female patients had similar rates of revision ACLR (male: 12.6%; female: 10.0%; P = .40) and contralateral ACL injuries (male: 13.8%; female: 11.3%; P = .46). CONCLUSION A high RTS rate and similar rates of ipsilateral and contralateral ACL injuries were found for male and female patients in a young athletic population undergoing primary ACLR using an ASTQT autograft. These results help one to better understand the utility of ASTQT grafts to support successful ACLR in young athletic populations, for which ASTQT grafts appear to yield favorable outcomes.
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Affiliation(s)
- Camryn B Petit
- Emory Sports Performance And Research Center, Flowery Branch, Georgia, USA
- Emory Sports Medicine Center, Atlanta, Georgia, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, USA
- Medical College of Georgia, Augusta, Georgia, USA
| | - Harris S Slone
- Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jed A Diekfuss
- Emory Sports Performance And Research Center, Flowery Branch, Georgia, USA
- Emory Sports Medicine Center, Atlanta, Georgia, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kim D Barber Foss
- Emory Sports Performance And Research Center, Flowery Branch, Georgia, USA
- Emory Sports Medicine Center, Atlanta, Georgia, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Shayla M Warren
- Emory Sports Performance And Research Center, Flowery Branch, Georgia, USA
- Emory Sports Medicine Center, Atlanta, Georgia, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Alicia M Montalvo
- Emory Sports Performance And Research Center, Flowery Branch, Georgia, USA
- College of Health Solutions, Arizona State University, Phoenix, Arizona, USA
| | - Joseph D Lamplot
- Emory Sports Performance And Research Center, Flowery Branch, Georgia, USA
- Campbell Clinic Orthopaedics, Germantown, Tennessee, USA
| | - Gregory D Myer
- Emory Sports Performance And Research Center, Flowery Branch, Georgia, USA
- Emory Sports Medicine Center, Atlanta, Georgia, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, USA
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA
- The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA
- Youth Physical Development Centre, Cardiff Metropolitan University, Cardiff, UK
| | - John W Xerogeanes
- Emory Sports Performance And Research Center, Flowery Branch, Georgia, USA
- Emory Sports Medicine Center, Atlanta, Georgia, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, USA
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Cain EL, Mussell EA, Crawford AE, Ithurburn MP, Layton BO, Fleisig GS, Rothermich MA, Emblom BA, Ryan MK, Dugas JR, Andrews JR. Long-term Outcomes of Multiligament Knee Injuries in American Football Players. Am J Sports Med 2024; 52:1918-1926. [PMID: 38822594 DOI: 10.1177/03635465241252440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2024]
Abstract
BACKGROUND Long-term outcomes for isolated anterior cruciate ligament (ACL) reconstructions in competitive American football athletes are well reported in the literature, but little data currently exist regarding multiligament knee injury (MLKI) reconstruction outcomes. PURPOSE To examine patient-reported and return-to-sport outcomes of competitive American football athletes who underwent primary, single-staged, multiligament knee reconstruction. STUDY DESIGN Case series; Level of evidence, 4. METHODS We identified patients from our institution's prospectively collected data repository between 2001 and 2020 who underwent single-staged surgical reconstruction of an MLKI sustained during competitive participation in American football. We assessed patient-reported outcomes at a minimum of 2 years after surgery using the International Knee Documentation Committee (IKDC) Subjective Knee Form and questions regarding surgical satisfaction and return to sport. Successful return to sport was defined as a return to preinjury level of competition. We summarized all outcome data and compared outcomes between 2-ligament and >2-ligament groups and between ACL-only MLKI injury and bicruciate MLKI injury groups using independent t test for IKDC scores and chi-square test for return to sport. Additionally, we evaluated predictors of postoperative IKDC scores using linear regression and predictors of return to sport using logistic regression. RESULTS Outcome data were successfully collected for 53 of 73 total eligible patients (73%; mean follow-up time, 7.7 ± 4.0 years; all male; mean age at surgery, 18.1 ± 2.7 years). The mean postoperative IKDC score was 84 ± 16. The most common level of preinjury competition was high school (n = 36; 68%), followed by college (n = 10; 19%). Seven patients did not return to sport competition at any level due to limitations from their knee surgery, and 82% of patients that attempted to return to preinjury level of sport were able to do so. A total of 50 patients (94%) were satisfied or very satisfied with their surgical outcome. The 2-ligament (n = 39) and >2-ligament (n = 14) groups did not significantly differ in IKDC scores (P = .96) or proportions with successful return to sport (P = .77). Similarly, the ACL-MLKI injury (n = 39) and bicruciate MLKI injury (n = 14) groups did not significantly differ in IKDC scores (P = .89) or proportions with successful return to sport (P = .77). Age and body mass index were not significantly associated with IKDC scores or successful return to sport at follow-up (all P > .05). CONCLUSION This study may represent the largest cohort of competitive American football athletes evaluated for longitudinal outcomes after multiligament knee reconstruction. Despite the severity of these injuries, we found good knee-related function and that the large majority of athletes who attempted to return to sport were successful. The majority of athletes (94%) were satisfied with their operative treatment.
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Affiliation(s)
- E Lyle Cain
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama, USA
- The American Sports Medicine Institute, Birmingham, Alabama, USA
| | - Eric A Mussell
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama, USA
- The American Sports Medicine Institute, Birmingham, Alabama, USA
| | - Anna E Crawford
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama, USA
- The American Sports Medicine Institute, Birmingham, Alabama, USA
| | - Matthew P Ithurburn
- The American Sports Medicine Institute, Birmingham, Alabama, USA
- Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Branum O Layton
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama, USA
- The American Sports Medicine Institute, Birmingham, Alabama, USA
| | - Glenn S Fleisig
- The American Sports Medicine Institute, Birmingham, Alabama, USA
| | - Marcus A Rothermich
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama, USA
- The American Sports Medicine Institute, Birmingham, Alabama, USA
| | - Benton A Emblom
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama, USA
- The American Sports Medicine Institute, Birmingham, Alabama, USA
| | - Michael K Ryan
- The American Sports Medicine Institute, Birmingham, Alabama, USA
- Prevea Health Orthopaedics & Sports Medicine, Green Bay, Wisconsin, USA
| | - Jeffrey R Dugas
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama, USA
- The American Sports Medicine Institute, Birmingham, Alabama, USA
| | - James R Andrews
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama, USA
- The American Sports Medicine Institute, Birmingham, Alabama, USA
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5
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Russell HC, Arendt EA, Wiese-Bjornstal DM. Psychological Responses During Latter Rehabilitation and Return to Sport After Anterior Cruciate Ligament Reconstruction Surgery. J Athl Train 2024; 59:627-632. [PMID: 38446462 PMCID: PMC11220769 DOI: 10.4085/1062-6050-0058.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
CONTEXT Despite positive physical outcomes of anterior cruciate ligament reconstruction (ACLR), many athletes do not return to sport afterward. OBJECTIVE To determine if there were differences between athletes who returned to play and those who did not return to sport after ACLR in patterns of psychological responses to injury over the latter course of rehabilitation and return to sport. DESIGN Case-control study. SETTING Comprehensive orthopedic medical center referrals. PATIENTS OR OTHER PARTICIPANTS Thirty-nine recreational and competitive athletes (13 to 58 years, 21 males) with a first ACL tear were observed over the course of the study. MAIN OUTCOME MEASURE(S) Return to sport. RESULTS Fifty-two percent of participants returned to play by 9 months post-ACLR. Those who returned showed a linear decrease in reinjury anxiety from 4 to 9 months post-ACLR, whereas those who did not return showed a linear decrease from 4 to 6 months post-ACLR and then a leveling off from 6 to 9 months. Those who returned showed linear and quadratic effects on perceived limitations of ability with a decrease from 4 to 9 months post-ACLR that accelerated over time, whereas nonreturners showed a linear decrease over time. No significant differences were found between returners and nonreturners in knee self-efficacy, perceived percent recovery, and psychological distress. CONCLUSIONS Our results suggest that reinjury anxiety and perceived limitations of ability are psychological constructs on which returners and nonreturners differ and therefore may be points of intervention to increase the likelihood of return to sport.
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Affiliation(s)
- Hayley C. Russell
- Department of Health and Exercise Science, Gustavus Adolphus College, Saint Peter, MN
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Sugimoto D, Milewski MD, Williams KA, Coene RP, Nunally KD, Kocher MS, Kramer DE, Micheli LJ, Yen YM, Christino MA. Effect of Age and Sex on Anterior Cruciate Ligament Functional Tests Approximately 6 Months After Anterior Cruciate Ligament Reconstruction. Arthrosc Sports Med Rehabil 2024; 6:100897. [PMID: 39006798 PMCID: PMC11240043 DOI: 10.1016/j.asmr.2024.100897] [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: 10/05/2023] [Accepted: 01/10/2024] [Indexed: 07/16/2024] Open
Abstract
Purpose To examine age- and sex-related differences in postoperative functional outcomes at approximately 6 months after anterior cruciate ligament reconstruction (ACLR). Methods In this study, patients who underwent primary ACLR performed a series of return-to-sport functional tests at 5 to 8 months after surgery. Functional tests included strength tests (knee extensors, knee flexors, hip abductors, and hip extensors), a balance test (Y-balance composite score), and hop tests (single, triple, crossover, and 6-m timed hop tests). Limb symmetry was calculated to compare the reconstructed limb with the uninvolved limb. A 2-way multivariate analysis of covariance was used, and effect size was calculated for data analysis. Results A total of 176 subjects were included in this study. There were no significant interaction between age and sex on return-to-sport functional tests after ACLR. Also, no main effects of age and sex on return-to-sport functional tests were found in our data. Conclusions Age and sex do not significantly affect functional test performance after ACLR 6 months postoperatively. Level of Evidence Level III, retrospective review of prospective cohort study.
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Affiliation(s)
- Dai Sugimoto
- Faculty of Sport Sciences, Waseda University, Tokyo, Japan
- The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, U.S.A
| | - Matthew D Milewski
- Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, Massachusetts, U.S.A
- Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Kathryn A Williams
- Biostatistics and Research Design Center, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Ryan P Coene
- Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Kianna D Nunally
- Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Mininder S Kocher
- Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, Massachusetts, U.S.A
- Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Dennis E Kramer
- Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, Massachusetts, U.S.A
- Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Lyle J Micheli
- The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, U.S.A
- Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, Massachusetts, U.S.A
- Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Yi-Meng Yen
- Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, Massachusetts, U.S.A
- Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Melissa A Christino
- Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, Massachusetts, U.S.A
- Harvard Medical School, Boston, Massachusetts, U.S.A
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Brinkman JC, Iturregui JM, Moore ML, Haglin J, Thompson A, Makovicka J, Economopoulos KJ. Arthroscopic Posterior Capsular Release Improves Range of Motion and Outcomes for Flexion Contracture After Anterior Cruciate Ligament Reconstruction in Athletes. Arthrosc Sports Med Rehabil 2024; 6:100914. [PMID: 39006795 PMCID: PMC11240015 DOI: 10.1016/j.asmr.2024.100914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 02/12/2024] [Indexed: 07/16/2024] Open
Abstract
Purpose To assess outcomes of arthroscopic posterior capsular release among athletes for loss of terminal extension following anterior cruciate ligament (ACL) reconstruction. Methods A retrospective review of prospectively collected data was performed for patients undergoing arthroscopic posterior capsular release for knee extension loss following ACL reconstruction between January 2014 and December 2019. Procedure indications included extension loss greater than 10° at least 3 months after ACL reconstruction that was refractory to physical therapy. Patients were included if they were involved in either high school or college athletics, had complete outcomes of interest, and had at least 2 years of follow-up. Prospectively collected outcomes included preoperative and postoperative measurement of knee extension, International Knee Documentation Committee score, Lysholm score, return to sport data, and complications. Results Eighteen athletes with minimum 2 years of follow-up who underwent posterior capsular release following ACL reconstruction performed by a single surgeon were included in the analysis. Patients underwent surgery at an average of 16 weeks after ACL reconstruction. Knee extension improved an average of 13.8° at 2 years' follow-up (prerelease mean extension deficit 15.1°, postrelease mean extension deficit 1.3°, P < .005). Improvements in the International Knee Documentation Committee score averaged 21.7 at 6 months and 35.0 at 24 months, both of which were statistically significant (P < .001). Similarly, differences in Lysholm included a significant improvement of 23.0 and 34.2 at 6 months and 2 years, respectively (P < .001). In total, 77.8% returned to sport at an average of 9.8 months from their primary ACL surgery and 6.5 months following posterior capsular release surgery. No infections or neurovascular complications were observed. One patient required secondary release to achieve adequate extension. Conclusions For athletes with persistent knee extension loss after ACL reconstruction, knee extension was significantly improved at 2 years following arthroscopic posterior capsular release. Substantial improvements in patient-reported outcomes also were seen. In addition, subjects demonstrated a high rate of return to sport and return to preinjury performance levels. Level of Evidence Level IV, therapeutic case series.
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Affiliation(s)
- Joseph C Brinkman
- Department of Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona, U.S.A
| | - Jose M Iturregui
- Department of Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona, U.S.A
| | - M Lane Moore
- Mayo Clinic Alix School of Medicine, Scottsdale, Arizona, U.S.A
| | - Jack Haglin
- Department of Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona, U.S.A
| | - Adam Thompson
- University of Vermont School of Medicine, Burlington, Vermont, U.S.A
| | - Justin Makovicka
- Department of Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona, U.S.A
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Alexander FJ, Mastroianni MA, Anderson MJ, Skaggs K, Swindell HW, Reynolds AW, Ahmad CS. Psychological Impact and Posttraumatic Stress Disorder Symptomatology After Ulnar Collateral Ligament Injuries in Baseball Players. Orthop J Sports Med 2024; 12:23259671241246061. [PMID: 38774386 PMCID: PMC11107329 DOI: 10.1177/23259671241246061] [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: 08/10/2023] [Accepted: 10/11/2023] [Indexed: 05/24/2024] Open
Abstract
Background Significant psychological impact and prevalence of posttraumatic stress disorder (PTSD) have been well documented in patients sustaining anterior cruciate ligament injury. Purpose To examine PTSD symptomatology in baseball players after sustaining elbow ulnar collateral ligament (UCL) injury. Study Design Cross-sectional study; Level of evidence, 3. Methods Male baseball players of various competition levels (high school through Minor League Baseball [MiLB]) who underwent surgery for a UCL injury between April 2019 and June 2022 participated in the study. Before surgery, patients completed the Impact of Event Scale-Revised (IES-R) to assess PTSD symptomatology. Subgroup analysis was conducted according to level of play and player position. Results A total of 104 male baseball players with a mean age of 19.4 years (range, 15-29 years) were included in the study; 32 players (30.8%) were in high school, 65 (62.5%) were in college, and 7 (6.7%) were in MiLB. There were 64 (61.5%) pitchers, 18 (17.3%) position players, and 22 (21.2%) 2-way players (both pitching and playing on the field). A total of 30 (28.8%) patients scored high enough on the IES-R to support PTSD as a probable diagnosis, and another 22 patients (21.2%) scored high enough to support PTSD as a clinical concern. Nineteen patients (18.3%) had potentially severe PTSD. Only 4 players (3.8%) were completely asymptomatic. Subgroup analysis revealed college players as significantly more symptomatic than high school players (P = .02), and 2-way players were found to be significantly less susceptible to developing symptoms of PTSD compared with pitchers (P = .04). Conclusion Nearly 30% of baseball players who sustained a UCL injury qualified for a probable diagnosis of PTSD based on the IES-R. Pitchers and college athletes were at increased risk for PTSD after UCL injury compared with 2-way players and high school athletes, respectively.
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Affiliation(s)
- Frank J. Alexander
- Columbia University Irving Medical Center/NewYork Presbyterian Hospital, New York, New York, USA
| | - Michael A. Mastroianni
- Columbia University Irving Medical Center/NewYork Presbyterian Hospital, New York, New York, USA
| | - Matthew J.J. Anderson
- Columbia University Irving Medical Center/NewYork Presbyterian Hospital, New York, New York, USA
| | - Kira Skaggs
- Columbia University Irving Medical Center/NewYork Presbyterian Hospital, New York, New York, USA
| | - Hasani W. Swindell
- Columbia University Irving Medical Center/NewYork Presbyterian Hospital, New York, New York, USA
| | - Alan W. Reynolds
- Columbia University Irving Medical Center/NewYork Presbyterian Hospital, New York, New York, USA
| | - Christopher S. Ahmad
- Columbia University Irving Medical Center/NewYork Presbyterian Hospital, New York, New York, USA
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Caumeil B, Laboute E, Verhaeghe E, Pérez S, Décamps G. Reinjury Anxiety and Return to Sport After Anterior Cruciate Ligament Reconstruction: A Cluster Analysis and Prospective Study Among 162 Athletes. Am J Sports Med 2024; 52:1189-1198. [PMID: 38520139 DOI: 10.1177/03635465241234887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/25/2024]
Abstract
BACKGROUND Recent studies have investigated the effect of psychological factors on return to sport (RTS), but none has tested the existence of psychological profiles linked to reinjury anxiety and its links with RTS and reinjury. PURPOSE To assess the effect of different psychological profiles on RTS and reinjury. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS The study screened patients who were involved in all types of sports for anterior cruciate ligament (ACL) reconstruction (hamstring and patellar tendon autografts). All participants were included during the RTS phase (90-180 days after ACL reconstruction). Reinjury anxiety, fear of reinjury, kinesiophobia, perceived stress, anxiety, depression, knee confidence, self-esteem, optimism, coping, and pain were measured. Hierarchical cluster analysis (Ward method) and analysis of variance were performed. In the second year after surgery, patients were recontacted by telephone to follow-up. RTS and reinjury were compared by profile type. RESULTS A total of 162 athletes were initially included, of whom 123 responded regarding RTS and reinjury. Cluster analysis showed a 4-cluster solution (χ2[21] = 428.59; λ = .064; P < .001). Profile 1 (27.8%) was characterized by moderate reinjury anxiety and no depression. Profile 2 (22.8%) was characterized by moderate reinjury anxiety and minor anxious-depressive reaction. Profile 3 (30.9%) was characterized by no reinjury anxiety, no depression, and high confidence. Profile 4 (18.5%) was characterized by high anxiety, high depression, and low confidence. Profile 4 had the lowest self-esteem and optimism scores compared with profile 3 (P < .001). In addition, a higher percentage of men was found in profile 3 as opposed to profile 4 (χ2[3] = 11.35; P < .01). Profile 4 had the highest rate of non-RTS with 54.2% (profile 1: 14.3%, P = .001; profile 2: 25.0%, P = .031; profile 3: 22.2%, P = .011). Finally, patients with profile 3 had a higher risk of reinjury (13.9%) than those with profile 4 (0%) (P = .047), who had an extremely conservative RTS. CONCLUSION The different profiles will affect RTS, but also the risk of reinjury exclusively for profiles 3 and 4. Rehabilitation management will probably require all stakeholders to understand psychological profiles of athletes to develop an on-demand rehabilitation plan.
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Affiliation(s)
- Benjamin Caumeil
- Management Sport Cancer Laboratory (UR 20122035V), Faculty of Sport Sciences, Aix-Marseille University, Marseille, France
| | - Eric Laboute
- Centre Européen de Rééducation du Sportifs, CERS, Groupe Ramsay Santé, Capbreton, France
| | - Emmanuel Verhaeghe
- Centre Européen de Rééducation du Sportifs, CERS, Groupe Ramsay Santé, Capbreton, France
| | - Sébastien Pérez
- Centre Européen de Rééducation du Sportifs, CERS, Groupe Ramsay Santé, Capbreton, France
| | - Greg Décamps
- University of Bordeaux, Laboratory of Psychology EA4139, Bordeaux, France
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10
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Watanabe A, Kikuchi N, Ichihara T, Kumagai H, Taniguchi Y, Sato Y, Kinugasa T, Ikeda K, Yamazaki M. Use of Unidirectional Porous β-Tricalcium Phosphate in the Tibial Tunnel for Anterior Cruciate Ligament Reconstruction: A Case Series. Cureus 2024; 16:e58366. [PMID: 38756267 PMCID: PMC11097233 DOI: 10.7759/cureus.58366] [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] [Accepted: 04/12/2024] [Indexed: 05/18/2024] Open
Abstract
Bone defects in the tibial tunnel for anterior cruciate ligament (ACL) reconstruction can cause adverse events. The unidirectional porous tricalcium β-phosphate (UDPTCP) has the potential to be used as a filling substitute for bone defects. In this case series, we present the first nine cases in which UDPTCP was used as a bone substitute in the tibial tunnel during ACL reconstruction. The patients comprised six males and three females, with an average age of 32 years (range: 16-50 years). A cylindrical UDPTCP measuring 10 x 20 mm was molded to fit the tibial tunnel and then implanted. At the one-year postoperative follow-up, none of the patients demonstrated any complications, and bone remodeling was observed on radiographs. Therefore, UDPTCP may provide a safe and reliable filling substitute for the tibial tunnel in ACL reconstruction.
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Affiliation(s)
- Arata Watanabe
- Department of Orthopaedic Surgery, Ichihara Hospital, Tsukuba, JPN
| | - Naoya Kikuchi
- Department of Orthopaedic Surgery, Institute of Medicine, University of Tsukuba, Tsukuba, JPN
| | - Takumi Ichihara
- Department of Orthopaedic Surgery, Ichihara Hospital, Tsukuba, JPN
| | - Hiroshi Kumagai
- Department of Orthopaedic Surgery, Ichihara Hospital, Tsukuba, JPN
| | - Yu Taniguchi
- Department of Orthopaedic Surgery, Ichihara Hospital, Tsukuba, JPN
| | - Yuki Sato
- Department of Orthopaedic Surgery, Ichihara Hospital, Tsukuba, JPN
| | | | - Kotaro Ikeda
- Department of Orthopaedic Surgery, Ichihara Hospital, Tsukuba, JPN
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, JPN
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11
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Nyland J, Tomberlin C, Brey J, Carter S. Global knee function rating more strongly influences adolescent athletes that sustain a sports-related surgical ACL re-injury or contralateral ACL injury. Knee Surg Sports Traumatol Arthrosc 2024; 32:599-607. [PMID: 38419433 DOI: 10.1002/ksa.12072] [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: 11/14/2023] [Revised: 01/12/2024] [Accepted: 01/19/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE This study evaluated differences between adolescent athletes who sustained a surgical anterior cruciate ligament (ACL) re-injury, or contralateral ACL injury following return to sports bridge programme participation (Group 1) compared to those that did not (Group 2). METHODS At 19.9 ± 7 years of age, 198 athletes participated in this study. Groups were compared for time postsurgery, preprogramme and postprogramme Knee Outcome Survey Sports Activity Scale (KOS-SAS) and global rating of knee function (GRKF) during sports activities, postprogramme lower extremity physical function test performance and perceived sports performance compared to preinjury level. RESULTS By 6.0 ± 3.2 years postsurgery, 11 (5.6%) sustained another ACL injury. Group 1 was younger (17.3 ± 1.7 years vs. 20.1 ± 6.8 years, p < 0.001). Postprogramme re-evaluation revealed that Group 1 had a greater GRKF compared to their programme initiation GRKF than Group 2 (32.6 ± 38 vs. 20.0 ± 23, p = 0.04). Group 1 also had a greater mean preprogramme to postprogramme GRKF change than Group 2 (51.3 ± 31 vs. 35.5 ± 21, p = 0.02) (effect size = 0.73). More Group 1 subjects also had a GRKF difference that exceeded the overall mean than Group 2 (p = 0.04). Group 1 had moderately strong relationships between preprogramme and postprogramme GRKF score change and the postprogramme GRKF score (r = 0.65, p = 0.04) and between preprogramme and postprogramme KOS-SAS score change and postprogramme GRKF score (r = 0.60, p = 0.04). CONCLUSION Global rating scores had a stronger influence among adolescent athletes that sustained either surgical ACL re-injury or contralateral ACL injury. Since group physical function and neuromuscular control factors were similar, clinicians need to increase their awareness and understanding of other factors that may influence surgical ACL re-injury or contralateral ACL injury risk. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- John Nyland
- Norton Orthopaedic Institute, Norton Healthcare, Louisville, Kentucky, USA
- Department of Orthopaedic Surgery, University of Louisville, Louisville, Kentucky, USA
| | - Colson Tomberlin
- Norton Orthopaedic Institute, Norton Healthcare, Louisville, Kentucky, USA
| | - Jennifer Brey
- Norton Orthopaedic Institute, Norton Healthcare, Louisville, Kentucky, USA
- Department of Orthopaedic Surgery, University of Louisville, Louisville, Kentucky, USA
| | - Sam Carter
- Norton Orthopaedic Institute, Norton Healthcare, Louisville, Kentucky, USA
- Department of Orthopaedic Surgery, University of Louisville, Louisville, Kentucky, USA
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12
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Sheean AJ, DeFoor MT, Spindler KP, Arner JW, Athiviraham A, Bedi A, DeFroda S, Ernat JJ, Frangiamore SJ, Nuelle CW, Sheean AJ, Spindler KP, Bedi A. The Psychology of ACL Injury, Treatment, and Recovery: Current Concepts and Future Directions. Sports Health 2024:19417381241226896. [PMID: 38374636 DOI: 10.1177/19417381241226896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024] Open
Abstract
CONTEXT Interest in the relationship between psychology and the outcomes of anterior cruciate ligament (ACL) reconstruction (ACLR) continues to grow as variable rates of return to preinjury level of activity continue to be observed. EVIDENCE ACQUISITION Articles were collected from peer-reviewed sources available on PubMed using a combination of search terms, including psychology, resilience, mental health, recovery, and anterior cruciate ligament reconstruction. Further evaluation of the included bibliographies were used to expand the evidence. STUDY DESIGN Clinical review. LEVEL OF EVIDENCE Level 4. RESULTS General mental health and wellbeing, in addition to a host of unique psychological traits (self-efficacy, resilience, psychological readiness and distress, pain catastrophizing, locus of control, and kinesiophobia) have been demonstrated convincingly to affect treatment outcomes. Moreover, compelling evidence suggests that a number of these traits may be modifiable. Although the effect of resilience on outcomes of orthopaedic surgical procedures has been studied extensively, there is very limited information linking this unique psychological trait to the outcomes of ACLR. Similarly, the available information related to other parameters, such as pain catastrophizing, is limited with respect to the existence of adequately sized cohorts capable of accommodating more rigorous and compelling analyses. A better understanding of the specific mechanisms through which psychological traits influence outcomes can inform future interventions intended to improve rates of return to preinjury level of activity after ACLR. CONCLUSION The impact of psychology on patients' responses to ACL injury and treatment represents a promising avenue for improving low rates of return to preinjury activity levels among certain cohorts. Future research into these areas should focus on specific effects of targeted interventions on known, modifiable risk factors that commonly contribute to suboptimal clinical outcomes. STRENGTH-OF-RECOMMENDATION TAXONOMY (SORT) B.
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Affiliation(s)
| | | | | | - Justin W Arner
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - Asheesh Bedi
- NorthShore University Health System, Skokie, Illinois
| | | | | | | | | | | | | | - Asheesh Bedi
- NorthShore University Health System, Skokie, Illinois
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13
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Gao H, Hu H, Sheng D, Sun L, Chen J, Chen T, Chen S. Risk Factors for Ipsilateral Versus Contralateral Reinjury After ACL Reconstruction in Athletes: A Systematic Review and Meta-analysis. Orthop J Sports Med 2023; 11:23259671231214298. [PMID: 38145217 PMCID: PMC10748928 DOI: 10.1177/23259671231214298] [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: 06/01/2023] [Accepted: 06/07/2023] [Indexed: 12/26/2023] Open
Abstract
Background Anterior cruciate ligament (ACL) reinjury after ACL reconstruction (ACLR) can occur on the ipsilateral or contralateral side. Limited evidence exists regarding the difference between the incidence of reinjury to either knee, which is important in developing interventions to prevent ACL reinjury. Purpose To compare the reinjury rate of the ACL on the ipsilateral side versus the contralateral side in athletes after ACLR and investigate the risk factors that may cause different reinjury rates between the sides. Study Design Systematic review; Level of evidence, 4. Methods A systematic review was performed based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies that involved ACL reinjury in athletes after ACLR were reviewed. Considering several risk factors, including age and sex, a comparison of ACL reinjury incidence on the ipsilateral and contralateral sides was performed using a meta-analysis. Results Of the 17 selected studies, 3 were found to be at high risk of bias, and thus, 14 (n = 3424 participants) studies were included in the meta-analysis. In this athletic population, the contralateral ACL had a significantly higher rupture rate than the ipsilateral graft (risk ratio [RR], 1.41; P < .0001). Female athletes were found to have a greater risk of ACL reinjury on the contralateral versus the ipsilateral side (RR, 1.65; P = .0005), but different results were found in male athletes. (RR, 0.81; P = .21). There was no statistical difference in the incidence rate of ACL reinjury to either side in adolescent athletes (RR, 1.15; P = .28). Conclusion The contralateral ACL was more vulnerable to reinjury than the ipsilateral side in athletes after ACLR. Female athletes were more likely to reinjure their contralateral native ACL, while the same trend was not found in their male counterparts. The reinjury rate was comparable in both knees in adolescent athletes.
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Affiliation(s)
- Han Gao
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
- H.G., H.H., and D.S. contributed equally to this study
| | - Haichen Hu
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
- H.G., H.H., and D.S. contributed equally to this study
| | - Dandan Sheng
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
- H.G., H.H., and D.S. contributed equally to this study
| | - Luyi Sun
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Jun Chen
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Tianwu Chen
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Shiyi Chen
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
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14
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Chen J, Wu T, Guo Y. Nordic hamstring exercises in functional knee rehabilitation after anterior cruciate ligament reconstruction: a prospective, randomised, controlled study. Sci Rep 2023; 13:19039. [PMID: 37923738 PMCID: PMC10624851 DOI: 10.1038/s41598-023-45817-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 10/24/2023] [Indexed: 11/06/2023] Open
Abstract
To study the effect of using Nordic hamstring exercise method on muscle strength and knee joint stability of patients after ACL reconstruction. 60 patients admitted to our hospital for ACL reconstruction were randomly divided into a test group (n = 30, applying Nordic hamstring exercise) and a control group (n = 30, applying conventional rehabilitation training methods), and the difference in the circumference of the thighs of the patients in the two groups was analysed after training, and the peak torque (PT), total torque (PT), and flexion and extension strength were measured by using the Biodex system3 Multi-joint Isokinetic Testing System at knee joints with an angular velocity of 60°/s and 120°/s. The peak torque (PT), total work (TW), and average peak torque (AVG PT) were measured by extension and flexion strength at angular velocity, and the Lysholm Knee Score was used to assess the knee function of 60 patients. There was no difference in the difference in thigh circumference between the two groups before surgery (P > 0.05); the difference in thigh circumference between the patients in the test group at 12 and 24 weeks after surgery was (- 0.35 ± 0.22) cm and (0.12 ± 0.03) cm, respectively, which were higher than those in the control group, (- 0.51 ± 0.15) cm and (- 0.41 ± 0.34) cm (P < 0.05). At the 12th and 24th postoperative weeks, the popliteal muscle strength of both groups was improved compared with that before surgery; among them, by comparing the popliteal peak moments with different angular velocities, the ratio of popliteal peak moment on the affected side/peak moment on the healthy side of the popliteal muscle of the experimental group was significantly higher than that of the control group, and the difference was significant (P < 0.05), but there was still a gap compared with that of the healthy side. The Lachmen test and the anterior drawer test were negative in the test and control groups at the 24th postoperative week of review, and the anterior tibial shift was < 5 mm in the KT-1000 test, and the difference in the anterior shift was < 3 mm compared with the healthy side, and there was no significant difference between the two groups. By Nordic hamstring exercise can make patients after knee ACL reconstruction reduce patient pain, accelerate the recovery of knee function, improve the swelling of the lower limb, reach the level of flexor strength of the healthy side within 24 weeks, and can increase the stability of the knee joint.
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Affiliation(s)
- JiaWei Chen
- Hunan Mechanical Electrical Polytechnic, Changsha, 410000, Hunan, China
| | - TianYu Wu
- Beijing Sport University, Beijing, 100010, China.
- The People's Liberation Army Joint Logistic Support Force Sanya Rehabilitation and Recuperation Center, Sanya, 572000, Hainan, China.
| | - Ying Guo
- Qiongzhong People's Hospital of Li and Miao Autonomous Country, Qiongzhong County, 572923, Hainan, China
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15
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Lee OT, Williams MA, Shaw CD, Delextrat A. The Role of Strength-Related Factors on Psychological Readiness for Return to Sport Following Anterior Cruciate Ligament (ACL) Reconstruction. Healthcare (Basel) 2023; 11:2787. [PMID: 37893861 PMCID: PMC10606503 DOI: 10.3390/healthcare11202787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/27/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023] Open
Abstract
Psychological readiness following anterior cruciate ligament reconstruction (ACLR) correlates with different return to sport outcomes. However, the relationship between strength and power and psychological readiness remains unexplored. The aim of this study was to investigate the relationship between anterior cruciate ligament return to sport after injury (ACL-RSI) scores and various hamstrings and quadriceps strength and power variables. Twelve participants (20.7 ± 2.5 years old; 174.2 ± 7.5 cm; 70.2 ± 8.5 kg; 18.2 ± 8.3% of body fat) who had an ACLR nine months or more before the study completed the ACL-RSI questionnaire and isokinetic strength testing of the hamstrings and quadriceps (60°·s-1 and 180°·s-1). Based on ACL-RSI scores, they were divided into "cases" and "controls", deemed not psychologically ready and psychologically ready to return to previous sport performance (PILOS), respectively. The main findings are that quadriceps' and hamstrings' rate of torque development (RTD) and time since surgery were determinants of psychological readiness following ACLR. Furthermore, compared to controls, cases showed significantly lower quadriceps torque at angles close to full knee extension (40 deg and 30 deg from extension). They also showed lower RTD than controls, but no difference in peak torque. These results suggest that physiotherapists should facilitate athletes' return to sport (RTS) by focusing on the restoration of RTD and strength at angles close to full knee extension.
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Affiliation(s)
| | | | | | - Anne Delextrat
- Department of Sport and Health Sciences and Social Work, Oxford Brookes University, Oxford OX3 0BP, UK (M.A.W.); (C.D.S.)
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16
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Lin KM, Atzmon R, Pierre KJ, Vel MS, Brinson K, Sherman SL. Common Soft Tissue Injuries About the Knee in American Football. HSS J 2023; 19:330-338. [PMID: 37435123 PMCID: PMC10331270 DOI: 10.1177/15563316231165298] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 02/01/2023] [Indexed: 07/13/2023]
Affiliation(s)
- Kenneth M Lin
- Division of Sports Medicine, Department of Orthopedic Surgery, Stanford University, Redwood City, CA, USA
| | - Ran Atzmon
- Division of Sports Medicine, Department of Orthopedic Surgery, Stanford University, Redwood City, CA, USA
| | - Kinsley J Pierre
- Division of Sports Medicine, Department of Orthopedic Surgery, Stanford University, Redwood City, CA, USA
| | - Monica S Vel
- Division of Sports Medicine, Department of Orthopedic Surgery, Stanford University, Redwood City, CA, USA
| | - Kenneth Brinson
- Division of Sports Medicine, Department of Orthopedic Surgery, Stanford University, Redwood City, CA, USA
| | - Seth L Sherman
- Division of Sports Medicine, Department of Orthopedic Surgery, Stanford University, Redwood City, CA, USA
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17
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Sheean AJ, Jin Y, Huston LJ, Brophy RH, Cox CL, Flanigan DC, Jones MH, Kaeding CC, Magnussen RA, Marx RG, Matava MJ, McCarty EC, Parker RD, Wolcott ML, Wolf BR, Wright RW, Spindler KP. Predictors of Return to Activity at 2 Years After Anterior Cruciate Ligament Reconstruction Among Patients With High Preinjury Marx Activity Scores: A MOON Prospective Cohort Study. Am J Sports Med 2023; 51:2313-2323. [PMID: 37724692 DOI: 10.1177/03635465231172769] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
BACKGROUND Predictors of return to activity after anterior cruciate ligament reconstruction (ACLR) among patients with relatively high preinjury activity levels remain poorly understood. PURPOSE/HYPOTHESIS The purpose of this study was to identify predictors of return to preinjury levels of activity after ACLR, defined as achieving a Marx activity score within 2 points of the preinjury value, among patients with Marx activity scores of 12 to 16 who had been prospectively enrolled in the Multicenter Orthopaedic Outcomes Network (MOON) cohort. We hypothesized that age, sex, preinjury activity level, meniscal injuries and/or procedures, and concurrent articular cartilage injuries would predict return to preinjury activity levels at 2 years after ACLR. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS All unilateral ACLR procedures from 2002 to 2008 performed in patients enrolled in the MOON, with preinjury Marx activity scores ranging from 12 to 16, were evaluated with a specific focus on return to preinjury activity levels at 2 years postoperatively. Return to activity was defined as a Marx activity score within 2 points of the preinjury value. The proportion of patients able to return to preinjury activity levels was calculated, and multivariable modeling was performed to identify risk factors for patients' inability to return to preinjury activity levels. RESULTS A total of 1188 patients were included in the final analysis. The median preinjury Marx activity score was 16 (interquartile range, 12-16). Overall, 466 patients (39.2%) were able to return to preinjury levels of activity, and 722 patients (60.8%) were not able to return to preinjury levels of activity. Female sex, smoking at the time of ACLR, fewer years of education, lower 36-Item Short Form Health Survey Mental Component Summary scores, and higher preinjury Marx activity scores were predictive of patients' inability to return to preinjury activity levels. Graft type, revision ACLR, the presence of medial and/or lateral meniscal injuries, a history of meniscal surgery, the presence of articular cartilage injuries, a history of articular cartilage treatment, and the presence of high-grade knee laxity were not predictive of a patient's ability to return to preinjury activity level. CONCLUSION At 2 years after ACLR, most patients with high preinjury Marx activity scores did not return to their preinjury level of activity. The higher the preinjury Marx activity score that a patient reported at the time of enrollment, the less likely he/she was able to return to preinjury activity level. Smoking and lower mental health at the time of ACLR were the only modifiable risk factors in this cohort that predicted an inability to return to preinjury activity levels. Continued effort and investigation are required to maximize functional recovery after ACLR in patients with high preinjury levels of activity.
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Affiliation(s)
- Andrew J Sheean
- San Antonio Military Medical Center, San Antonio, Texas, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA, and Cleveland Clinic, Cleveland, Ohio, USA
| | - Yuxuan Jin
- Cleveland Clinic, Cleveland, Ohio, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA, and Cleveland Clinic, Cleveland, Ohio, USA
| | - Laura J Huston
- Vanderbilt University, Nashville, Tennessee, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA, and Cleveland Clinic, Cleveland, Ohio, USA
| | - Robert H Brophy
- Washington University in St Louis, St Louis, Missouri, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA, and Cleveland Clinic, Cleveland, Ohio, USA
| | - Charles L Cox
- Vanderbilt University, Nashville, Tennessee, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA, and Cleveland Clinic, Cleveland, Ohio, USA
| | - David C Flanigan
- The Ohio State University, Columbus, Ohio, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA, and Cleveland Clinic, Cleveland, Ohio, USA
| | - Morgan H Jones
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA, and Cleveland Clinic, Cleveland, Ohio, USA
| | - Christopher C Kaeding
- The Ohio State University, Columbus, Ohio, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA, and Cleveland Clinic, Cleveland, Ohio, USA
| | - Robert A Magnussen
- The Ohio State University, Columbus, Ohio, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA, and Cleveland Clinic, Cleveland, Ohio, USA
| | - Robert G Marx
- Hospital for Special Surgery, New York, New York, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA, and Cleveland Clinic, Cleveland, Ohio, USA
| | - Matthew J Matava
- Washington University in St Louis, St Louis, Missouri, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA, and Cleveland Clinic, Cleveland, Ohio, USA
| | - Eric C McCarty
- University of Colorado, Denver, Colorado, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA, and Cleveland Clinic, Cleveland, Ohio, USA
| | - Richard D Parker
- Cleveland Clinic, Cleveland, Ohio, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA, and Cleveland Clinic, Cleveland, Ohio, USA
| | - Michelle L Wolcott
- University of Colorado, Denver, Colorado, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA, and Cleveland Clinic, Cleveland, Ohio, USA
| | - Brian R Wolf
- University of Iowa, Iowa City, Iowa, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA, and Cleveland Clinic, Cleveland, Ohio, USA
| | - Rick W Wright
- Vanderbilt University, Nashville, Tennessee, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA, and Cleveland Clinic, Cleveland, Ohio, USA
| | - Kurt P Spindler
- Cleveland Clinic, Cleveland, Ohio, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA, and Cleveland Clinic, Cleveland, Ohio, USA
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18
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Fine R, Curtis W, Stevens K, Imada AO, Stein ER, Treme G, Schenck RC, Richter DL. Return to Sport After Multiligament Knee Injury in Young Athletes. Orthop J Sports Med 2023; 11:23259671231179109. [PMID: 37667679 PMCID: PMC10475233 DOI: 10.1177/23259671231179109] [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: 02/02/2023] [Accepted: 03/09/2023] [Indexed: 09/06/2023] Open
Abstract
Background While return to sport (RTS) in young athletes after anterior cruciate ligament (ACL) reconstruction has been well studied, little is known regarding their rate of RTS after multiligament knee injury (MLKI). Purpose To assess the level of and factors associated with RTS after MLKI in young athletes. Study Design Case series; Level of evidence, 4. Methods We retrospectively identified 116 patients aged ≤23 years who had sustained an injury to ≥2 knee ligaments and undergone operative reconstruction or repair of ≥1 ligament. Our primary outcome was self-reported RTS at the preinjury level or higher. We estimated the likelihood of RTS using binomial logistic regression. Secondary variables included the 2000 International Knee Documentation Committee Subjective Knee Form (IKDC-SF), ACL-Return to Sport after Injury (ACL-RSI), and 12-Item Short Form Health Survey (SF-12) physical and mental health summaries. Results A total of 30 (25.9%) patients (24 men, 6 women; mean age, 18.1 ± 2.5 years) completed patient-reported outcome surveys at a mean follow-up of 7.8 years (median, 6.6 years [range, 1.1-19.5 years]). A total of 28 patients underwent surgical treatment of ≥2 ligaments. RTS was achieved by 90% of patients, and 43.3% returned to their preinjury level or higher. Patients who had played sports at a higher level before injury were more likely to RTS at their preinjury level or higher (odds ratio [OR], 3.516 [95% CI, 1.034-11.955]; P = .044), while those who played cutting sports were less likely to do so (OR, 0.013 [95% CI, 0.000-0.461; P = .017). Patients who achieved RTS at their preinjury level or higher had significantly higher IKDC-SF and ACL-RSI scores versus patients who did not (P = .001 and P = .002, respectively). The number of ligaments injured, age, mental health diagnosis, and SF-12 scores were not associated with the ability to RTS at the preinjury or higher levels. Conclusion Most young athletes who sustained MLKI were able to return to play at some level, but a minority returned to their preinjury level. Patients who did return at preinjury or higher levels had higher IKDC-SF and ACL-RSI scores than those who did not. Performance in cutting and/or pivoting sports was negatively associated with RTS.
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Affiliation(s)
- River Fine
- University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - William Curtis
- University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Kaleb Stevens
- University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Allicia O. Imada
- University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Elena R. Stein
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Gehron Treme
- University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Robert C. Schenck
- University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Dustin L. Richter
- University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
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Desai SS, Dent CS, El-Najjar DB, Swindell HW, Popkin CA. Musculoskeletal Injury in American Football: A Bibliometric Analysis of the Most Cited Articles. Orthop J Sports Med 2023; 11:23259671231168875. [PMID: 37359978 PMCID: PMC10286201 DOI: 10.1177/23259671231168875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 01/24/2023] [Indexed: 06/28/2023] Open
Abstract
Background Textbook knowledge and clinical dogma are often insufficient for effective evidence-based decision making when treating musculoskeletal injuries in American football players, given the variability in presentation and outcomes across different sports and different levels of competition. Key evidence can be drawn directly from high-quality published articles to make the appropriate decisions and recommendations for each athlete's unique situation. Purpose To identify and analyze the 50 most cited articles related to football-related musculoskeletal injury to provide an efficient tool in the arsenal of trainees, researchers, and evidence-based practitioners alike. Study Design Cross-sectional study. Methods The ISI Web of Science and SCOPUS databases were queried for articles pertaining to musculoskeletal injury in American football. For each of the top 50 most cited articles, bibliometric elements were evaluated: citation count and density, decade of publication, journal, country, multiple publications by the same first author or senior author, article content (topic, injury area), and level of evidence (LOE). Results The mean ± SD number of citations was 102.76 ± 37.11; the most cited article, with 227 citations, was "Syndesmotic Ankle Sprains" published in 1991 by Boytim et al. Several authors served as a first or senior author on >1 publication, including J.S. Torg (n = 6), J.P. Bradley (n = 4), and J.W. Powell (n = 4). The American Journal of Sports Medicine published the majority of the 50 most cited articles (n = 31). A total of 29 articles discussed lower extremity injuries, while only 4 discussed upper extremity injuries. The majority of the articles (n = 28) had an LOE of 4, with only 1 article having an LOE of 1. The articles with an LOE of 3 had the highest mean citation number (133.67 ± 55.23; F = 4.02; P = .05). Conclusion The results of this study highlight the need for more prospective research surrounding the management of football-related injury. The low overall number of articles on upper extremity injury (n = 4) also highlights an area for further research.
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Affiliation(s)
- Sohil S. Desai
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, New York, USA
| | - Craig S. Dent
- College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - Dany B. El-Najjar
- Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Hasani W. Swindell
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, New York, USA
| | - Charles A. Popkin
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, New York, USA
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Milewski MD, Traver JL, Coene RP, Williams K, Sugimoto D, Kramer DE, Kocher MS, Micheli LJ, Yen YM, Christino MA. Effect of Age and Sex on Psychological Readiness and Patient-Reported Outcomes 6 Months After Primary ACL Reconstruction. Orthop J Sports Med 2023; 11:23259671231166012. [PMID: 37332533 PMCID: PMC10273787 DOI: 10.1177/23259671231166012] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 01/25/2023] [Indexed: 06/20/2023] Open
Abstract
Background Successful return to sport after anterior cruciate ligament (ACL) reconstruction (ACLR) can be affected by a patient's physical and psychological state throughout the rehabilitation process. Purpose To prospectively compare differences in patients at 6 months after primary ACLR with the ACL-Return to Sport after Injury (ACL-RSI), International Knee Documentation Committee (IKDC) or pediatric (Pedi)-IKDC, Hospital for Special Surgery Pediatric Functional Activity Brief Scale (Pedi-FABS), and Patient-Reported Outcomes Measurement Information System-Psychological Stress Experiences (PROMIS-PSE) scores. Study Design Prospective cohort study; Level of evidence, 2. Methods Patients enrolled were 8 to 35 years old who underwent primary ACLR and had their 6-month follow-up appointments between December 2018 and March 2020. Patients were divided into 3 age groups as follows: (1) preadolescents (10-14 years); (2) adolescents (15-18 years); and (3) adults (>18 years). Outcomes on the ACL-RSI, IKDC/Pedi-IKDC, Pedi-FABS, and PROMIS-PSE were compared according to age group, graft type (hamstring, patellar tendon, quadriceps, or iliotibial band autograft), and sex. Results A total of 176 patients (69 male, 107 female), with a mean age of 17.1 ± 3.1 years were included in the study. The mean ACL-RSI scores were significantly different among age groups (preadolescents, 75 ± 18.9; adolescents, 61.5 ± 20.4; and adults, 52.5 ± 19.8 [P < .001]) and graft types (P = .024). The IKDC and PROMIS-PSE scores were also significantly different among age groups (P < .001 and P = .044, respectively) and graft types (P = .034 and P < .001, respectively), with the iliotibial graft and the younger age group performing the best. There was no significant difference in the Pedi-FABS either by age group (P = .127) or graft type (P = .198). Female patients had lower ACL-RSI scores and higher (worse) scores on PROMIS-PSE than their male counterparts (P = .019 and P < .001, respectively), with no sex-based differences on IKDC or Pedi-FABS scores. The ACL-RSI and IKDC were positively correlated (Spearman r = 0.57; P < .001), while the ACL-RSI and PROMIS-PSE were negatively correlated (Pearson r = -0.34; P < .001). Conclusion This study suggests that psychological profiles and subjective perceptions of knee function 6 months after ACLR may vary in patients of different ages and between the sexes. Preadolescent patients had better scores on a majority of patient-reported outcomes compared with adolescent and adult patients.
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Affiliation(s)
- Matthew D. Milewski
- Division of Sports Medicine, Department of Orthopedic Surgery, Boston Children’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Jessica L. Traver
- Department of Orthopedic Surgery, University of Texas, McGovern Medical School at UTHealth, Houston, Texas, USA
| | - Ryan P. Coene
- Division of Sports Medicine, Department of Orthopedic Surgery, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Kathryn Williams
- Division of Sports Medicine, Department of Orthopedic Surgery, Boston Children’s Hospital, Boston, Massachusetts, USA
- Biostatistics and Research Design Center, ICCTR, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Dai Sugimoto
- Division of Sports Medicine, Department of Orthopedic Surgery, Boston Children’s Hospital, Boston, Massachusetts, USA
- The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA
- Faculty of Sport Sciences, Waseda University, Tokyo, Japan
| | - Dennis E. Kramer
- Division of Sports Medicine, Department of Orthopedic Surgery, Boston Children’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Mininder S. Kocher
- Division of Sports Medicine, Department of Orthopedic Surgery, Boston Children’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Lyle J. Micheli
- Division of Sports Medicine, Department of Orthopedic Surgery, Boston Children’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Yi-Meng Yen
- Division of Sports Medicine, Department of Orthopedic Surgery, Boston Children’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Melissa A. Christino
- Division of Sports Medicine, Department of Orthopedic Surgery, Boston Children’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Song Y, Li L, Jensen MA, Dai B. Jump-landing kinetic asymmetries persisted despite symmetric squat kinetics in collegiate athletes following anterior cruciate ligament reconstruction. Sports Biomech 2023:1-14. [PMID: 37144626 PMCID: PMC10625647 DOI: 10.1080/14763141.2023.2207552] [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: 09/02/2022] [Accepted: 04/21/2023] [Indexed: 05/06/2023]
Abstract
The purpose was to determine the differences/correlations in anterior cruciate ligament (ACL) loading variables and bilateral asymmetries between injured/uninjured legs and among ascending/descending phases of double-leg squats and jumping/landing phases of countermovement jumps (CMJ) in the collegiate athletes following ACL reconstruction (ACLR). Fourteen collegiate athletes performed squats and CMJ 6-14 months following ACLR. The bilateral knee/hip flexion angles, peak vertical ground reaction force (VGRF) and knee extension moments (KEM), and kinetic asymmetries were calculated. Squats showed the greatest knee/hip flexion angles, while the landing phase of CMJ showed the least (P<0.001). The uninjured leg demonstrated greater VGRF (P≤0.010) and KEM (P≤0.008) than the injured leg in CMJ. Kinetic asymmetries were less than 10% for squats but were greater for the jumping (P≤0.014, 12%-25%) and landing (P≤0.047, 16%-27%) phases of CMJ. Significant correlations were found for KEM asymmetries between phases of CMJ (P=0.050) and squats (P<0.001). Kinetic asymmetries persisted in CMJ, while kinetic symmetries were achieved in squats in collegiate athletes 6-14 months following ACLR. Therefore, the CMJ appears to be a more sensitive assessment to monitor the bilateral kinetic asymmetries compared to squats. It is suggested to assess and screen kinetic asymmetries in different phases and tasks.
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Affiliation(s)
- Yu Song
- Division of Kinesiology and Health, University of Wyoming, Laramie, WY, USA
| | - Ling Li
- Division of Kinesiology and Health, University of Wyoming, Laramie, WY, USA
| | - Megan A. Jensen
- Department of Sports Medicine, University of Wyoming, Laramie, WY, USA
| | - Boyi Dai
- Division of Kinesiology and Health, University of Wyoming, Laramie, WY, USA
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22
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Song Y, Li L, Jensen MA, Dai B. Using trunk kinematics to predict kinetic asymmetries during double-leg jump-landings in collegiate athletes following anterior cruciate ligament reconstruction. Gait Posture 2023; 102:80-85. [PMID: 36934474 PMCID: PMC10148905 DOI: 10.1016/j.gaitpost.2023.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 02/10/2023] [Accepted: 03/08/2023] [Indexed: 03/21/2023]
Abstract
BACKGROUND Bilateral vertical ground reaction force (VGRF) and knee extension moment asymmetries are commonly observed during jumping and landing tasks following anterior cruciate ligament (ACL) reconstructions (ACLR) in collegiate athletes. Kinetic asymmetries during landings are associated with increased ACL re-injury risk. Efforts have been made to predict bilateral kinetic asymmetries using trunk kinematics during squats but not during jump-landings. RESEARCH QUESTION To determine the correlations between trunk kinematics (medial-lateral shoulder positions, medial-lateral hip positions, and lateral trunk bending angles) and bilateral kinetic asymmetries (VGRF and knee extension moments) during double-leg jump-landings in collegiate athletes following ACLR. METHODS Fifteen National Collegiate Athletic Association Division I athletes who had ACLR in the past 24 months participated. Eleven of them performed two assessments over the study period for a total of 26 assessments for data analyses. Athletes performed three double-leg countermovement jumps. Kinematics and kinetics data were collected. Medial-lateral shoulder and hip positions relative to ankle positions, lateral trunk bending angles, and kinetic asymmetries were calculated during the jumping (the lowest hip position until takeoff) and landing (the first 100 ms after initial contact) phases. RESULTS Medial-lateral shoulder positions correlated with VGRF (r = 0.63, p < 0.001) and knee moment asymmetries (r = 0.53, p = 0.006) in the jumping phase. Medial-lateral hip positions correlated with VGRF (r = 0.61, p < 0.001; r = 0.52, p = 0.006) and knee moment asymmetries (r = 0.55, p = 0.004; r = 0.61, p < 0.001) in both jumping and landing phases. SIGNIFICANCE Medial-lateral hip positions correlated with kinetic asymmetries during double-leg jump-landings in collegiate athletes following ACLR. A 2D assessment using a standard video camera might be used as a low-cost and clinically applicable tool to assess bilateral kinetic asymmetries by quantifying medial-lateral hip positions during jump-landings following ACLR.
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Affiliation(s)
- Yu Song
- Division of Kinesiology and Health, University of Wyoming, Laramie, WY, USA
| | - Ling Li
- Division of Kinesiology and Health, University of Wyoming, Laramie, WY, USA
| | - Megan A Jensen
- Department of Sports Medicine, University of Wyoming, Laramie, USA
| | - Boyi Dai
- Division of Kinesiology and Health, University of Wyoming, Laramie, WY, USA.
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Inclan PM, Brophy RH. Revision anterior cruciate ligament reconstruction. Bone Joint J 2023; 105-B:474-480. [PMID: 37121594 DOI: 10.1302/0301-620x.105b5.bjj-2022-1064.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Anterior cruciate ligament (ACL) graft failure from rupture, attenuation, or malposition may cause recurrent subjective instability and objective laxity, and occurs in 3% to 22% of ACL reconstruction (ACLr) procedures. Revision ACLr is often indicated to restore knee stability, improve knee function, and facilitate return to cutting and pivoting activities. Prior to reconstruction, a thorough clinical and diagnostic evaluation is required to identify factors that may have predisposed an individual to recurrent ACL injury, appreciate concurrent intra-articular pathology, and select the optimal graft for revision reconstruction. Single-stage revision can be successful, although a staged approach may be used when optimal tunnel placement is not possible due to the position and/or widening of previous tunnels. Revision ACLr often involves concomitant procedures such as meniscal/chondral treatment, lateral extra-articular augmentation, and/or osteotomy. Although revision ACLr reliably restores knee stability and function, clinical outcomes and reoperation rates are worse than for primary ACLr.
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Affiliation(s)
- Paul M Inclan
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Robert H Brophy
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
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Devitt BM, Neri T, Fritsch BA. Combined anterolateral complex and anterior cruciate ligament injury: Anatomy, biomechanics, and management-State-of-the-art. J ISAKOS 2023; 8:37-46. [PMID: 36368633 DOI: 10.1016/j.jisako.2022.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 10/06/2022] [Accepted: 10/25/2022] [Indexed: 11/11/2022]
Abstract
Anterior cruciate ligament (ACL) rupture typically occurs because of sudden axial loading of the knee in conjunction with a coupled valgus and rotational moment about the tibia. However, the ACL is not the only structure damaged during this mechanism of injury, and studies have shown that the anterolateral complex (ALC) of the knee is also commonly involved. Biomechanical studies have established that the ALC plays an important role as a secondary stabiliser to control anterolateral rotatory laxity (ALRL). Indeed, it has been suggested that failure to address injury to the ALC at the time of ACL reconstruction (ACLR) may increase the risk of graft failure owing to persistent ALRL. The concept of combining a lateral extra-articular procedure to augment ACLR for the treatment of ACL injury emerged with a view to decrease the failure rate of either procedure in isolation. This state-of-the-art review discusses the history of the anatomy of the ALC, the biomechanics of a variety of lateral extra-articular augmentation procedures, and provides clinical guidelines for their use in primary ACLR.
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Affiliation(s)
- Brian M Devitt
- Dublin City University, School of Health and Human Performance & Sports Surgery Clinic, Dublin, D09 C523, Ireland.
| | - Thomas Neri
- Department of Orthopaedic Surgery, University Hospital of Saint-Etienne, University of Lyon - Jean Monnet, 42000, France
| | - Brett A Fritsch
- Sydney Orthopaedic Research Institute, Level 1, The Gallery, 445 Victoria Avenue, Chatswood, NSW 2067, Australia
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Legnani C, Del Re M, Viganò M, Peretti GM, Borgo E, Ventura A. Relationships between Jumping Performance and Psychological Readiness to Return to Sport 6 Months Following Anterior Cruciate Ligament Reconstruction: A Cross-Sectional Study. J Clin Med 2023; 12:jcm12020626. [PMID: 36675557 PMCID: PMC9866224 DOI: 10.3390/jcm12020626] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/04/2023] [Accepted: 01/06/2023] [Indexed: 01/15/2023] Open
Abstract
Background: Investigating the relationship between functional capacity and psychological readiness is of paramount importance when planning sport resumption following knee surgery. The aim of this study was to prospectively assess clinical and functional outcomes in athletes 6 months after primary anterior cruciate ligament (ACL) reconstruction and to evaluate whether jumping ability is related to psychological readiness to return to sport following ACL surgery. Methods: Patients who underwent ACL reconstruction were prospectively enrolled and evaluated pre-operatively and 6 months after surgery. Assessment included Lysholm score, International Knee Documentation Committee (IKDC) Subjective Knee Form, Tegner activity level, and the ACL−Return to Sport after Injury (ACL-RSI) scale. Jumping ability was instrumentally assessed by an infrared optical acquisition system using a test battery including mono- and bipodalic vertical jump and a side hop test. Patients were dichotomized by ACL-RSI into two groups: group A (ACL-RSI > 60), and group B (ACL-RSI < 60). Results: Overall, 29 males and two females from the original study group of 37 patients (84%) were available for clinical evaluation. Mean age at surgery was 34.2 years (SD 11.3). Mean body mass index (BMI) was 25.4 (SD 3.7). Mean overall Lysholm, IKDC, and ACL-RSI scores increased from pre-operatively (p < 0.001). No differences in Tegner score were reported (p = 0.161). Similarly, improvement in most variables regarding jumping ability were observed at follow-up (p < 0.05). According to ACL-RSI, 20 subjects were allocated in group A (ACL-RSI > 60), while 11 were allocated in group B (ACL-RSI < 60). A statistically significant difference in favor of patients in group A was recorded for the post-operative Lysholm and Tegner score, as well as Side Hop test LSI level (p < 0.05), while a trend for IKDC was observed without statistical significance (p = 0.065). Conclusions: Patients with higher values of ACL-RSI scores showed better functional and clinical outcomes as well as improved performance 6 months after ACL reconstruction
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Affiliation(s)
- Claudio Legnani
- Sport Traumatology and Minimally Invasive Surgery Center, IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy
- Correspondence:
| | - Matteo Del Re
- Department of Orthopedics and Traumatology, University of Milan, 20133 Milan, Italy
| | - Marco Viganò
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy
| | - Giuseppe M. Peretti
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy
| | - Enrico Borgo
- Sport Traumatology and Minimally Invasive Surgery Center, IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy
| | - Alberto Ventura
- Sport Traumatology and Minimally Invasive Surgery Center, IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy
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Gabr A, Haddad FS. A comparison of preoperative scores prior to anterior cruciate ligament reconstruction with optimal preinjury scores and final scores at two-year follow up. Bone Jt Open 2023; 4:46-52. [PMID: 36692122 PMCID: PMC9887339 DOI: 10.1302/2633-1462.41.bjo-2022-0090] [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] [Indexed: 01/25/2023] Open
Abstract
AIMS The aim of this study was to compare the preinjury functional scores with the postinjury preoperative score and postoperative outcome scores following anterior cruciate ligament (ACL) reconstruction surgery (ACLR). METHODS We performed a prospective study on patients who underwent primary ACLR by a single surgeon at a single centre between October 2010 and January 2018. Preoperative preinjury scores were collected at time of first assessment after the index injury. Preoperative (pre- and post-injury), one-year, and two-year postoperative functional outcomes were assessed by using the Knee injury and Osteoarthritis Outcome Score (KOOS), Lysholm Knee Score, and Tegner Activity Scale. RESULTS We enrolled 308 males and 263 females of mean age 27 years (19 to 46). The mean preinjury and preoperative post-injury Lysholm Knee Scores were 94 (73 to 100) and 63 (25 to 85), respectively, while the respective mean scores at one and two years postoperatively were 84 (71 to 100) and 89 (71 to 100; p < 0.001). The mean Tegner preinjury and preoperative post-injury scores were 7 (3 to 9) and 3 (0 to 6), respectively, while the respective mean scores at one and two years postoperatively were 6 (1 to 8) and 6 (1 to 9) (p < 0.001). The mean KOOS scores at preinjury versus two years postoperatively were: symptoms (96 vs 84); pain (94 vs 87); activities of daily living (97 vs 91), sports and recreation function (84 vs 71), and quality of life (82 vs 69), respectively (p < 0.001). CONCLUSION Functional scores improved following ACLR surgery at two years in comparison to preoperative post-injury scores. However, at two-year follow-up, the majority of patients failed to achieve their preinjury scores. The evaluation of ACLR outcomes needs to consider the preinjury scores rather than the immediate preoperative score that is usually collected.Cite this article: Bone Jt Open 2023;4(1):46-52.
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Affiliation(s)
- Ayman Gabr
- The University College of London Hospitals NHS Trust, London, UK,Correspondence should be sent to Ayman Gabr. E-mail:
| | - Fares S. Haddad
- The University College of London Hospitals NHS Trust, London, UK,The Bone & Joint Journal, London, UK
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Aslani H, Bonakdar S, Gorji M, Gholipour M. Comparison of the Effectiveness of Two Management Strategies in the Pandemic COVID-19 Period in Patient Visits (Face-to-Face Visits vs. a Smartphone) in follow-up the Range of Motion of the Knee in Patients with Anterior Cruciate Ligament Reconstruction. Adv Biomed Res 2022; 11:102. [PMID: 36660760 PMCID: PMC9843597 DOI: 10.4103/abr.abr_82_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 07/07/2021] [Accepted: 08/31/2021] [Indexed: 01/21/2023] Open
Abstract
Background As the prevalence of the coronavirus increases, there is now more emphasis on reducing "face-to-face" patient visits. Therefore, the use of smartphones and their special medical applications can play an important role in following up patients. The aim of this study was to evaluate the use of smartphone in evaluating clinical outcomes and range of motion (ROM) of patients after anterior cruciate ligament reconstruction (ACLR). Materials and Methods From January to December 2020, 112 patients between 20 and 50 years old were randomly selected at our orthopedic sports center. All patients were visited online through smartphone by a knee fellowship surgeon in the morning (case group) and again all of them were visited online through smartphone in the evening by another knee fellowship surgeon (control group). Both visits were done at regular intervals in the 2nd, 6th, and 12th week after surgery. Patients were evaluated for function outcomes and joint ROM. Results The two groups were similar in terms of mean International Knee Documentation Committee score, Lysholm knee score, and Tegner Knee Score and did not show statistically significant difference (P < 0.05) There was no significant difference in knee ROM measurements between the two groups (face-to-face visits and online through smartphone visits) during the follow-ups (P > 0.05). Conclusion Smartphone apps are highly effective in assessing postoperative condition of knee ROM after ACLR, especially in the short time. However, this ability has been reduced in evaluating the long term. Hence, evaluation is still necessary through direct examination in the presence visit.
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Affiliation(s)
- Hamidreza Aslani
- Sport Medicine and Knee Research Center, Milad Hospital, Tehran, Iran
| | - Sona Bonakdar
- Skin Research Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mona Gorji
- Skin Research Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Morteza Gholipour
- Clinical Research Development Unit of Akhtar Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran,Address for correspondence: Dr. Morteza Gholipour, Clinical Research Development Unit, Akhtar Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. E-mail:
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Patankar AG, Christino MA, Milewski MD. Psychological Aspects of Adolescent Knee Injuries. Clin Sports Med 2022; 41:595-609. [DOI: 10.1016/j.csm.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
PURPOSE OF REVIEW The purpose of this review is to discuss treatment options, rehabilitation protocols, return-to-play criteria, and expected outcomes after non-operative and operative treatment of anterior cruciate ligament (ACL) tears among an athletic population. RECENT FINDINGS Non-operative treatment may be a viable option for some athletes with an ACL tears but can be difficult to predict "copers," and those that resume to sports return at lower performance level and/or less intense activities. Most studies assessing function after ACL reconstruction demonstrate favorable outcomes using patient-reported outcome studies. However, return-to-play and graft re-rupture rates vary substantially based on patient characteristics and level and type of athletic activity. Grafts used to reconstruct ACL produce similar objective outcomes and favorable patient-reported outcomes but have variable re-rupture rates depending on study and differ largely on morbidity associated with graft harvest. Various treatment methods including non-operative and operative techniques have been demonstrated to be efficacious in returning athletes to athletic activity depending on patient age and level of activity. Adherence to fundamental rehabilitation principles and accepted return-to-play guidelines can optimize outcomes and limit re-injury to the injured or contralateral limb.
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Jenkins AS, Pollock JR, Moore ML, Makovicka JL, Brinkman JC, Chhabra A. The 100 Most-Cited and Influential Articles in Collegiate Athletics. Orthop J Sports Med 2022; 10:23259671221108401. [PMID: 35837444 PMCID: PMC9274432 DOI: 10.1177/23259671221108401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/11/2022] [Indexed: 12/26/2022] Open
Abstract
Background Bibliometric citation analyses have been widely used in medicine to help researchers gain foundational knowledge about a topic and identify subtopics of popular interest for further investigations. There is a lack of similar research in collegiate athletics. Purpose To identify the 100 most-cited research publications related to collegiate athletics. Study Design Cross-sectional study. Methods The Clarivate Analytics Web of Knowledge database was used to generate a list of articles relating to collegiate athletics on January 24, 2022. Articles were filtered by the total number of citations, and the 100 most-cited articles were selected. For each article, we identified and analyzed the following: author name, publication year, country of origin, journal name, article type, main research topic area, competitive level, sex of study population, and level of evidence. Results Of the top 100 most-cited articles, 63 were related to medicine. In total, 96% of articles were published in the United States, and 80% were published in the year 2000 or later. Of the top 100 articles, 85 were observational; only 5 were experimental. The sport most represented was soccer, followed by football, baseball, and basketball. Of the top 100 articles, 21 were published in a single journal, the American Journal of Sports Medicine. Ten authors published ≥5 of the top 100 most-cited studies. Conclusion The majority of top 100 articles were published in the United States after 1999 and primarily focused on medicine-related topics. Soccer was studied by more articles than football, baseball, and basketball. An author's prestige may have influenced the likelihood of citation. The top 100 most-cited studies provide researchers, medical students, residents, and fellows with a foundational list of the most important and influential academic contributions to the literature on collegiate athletics.
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Affiliation(s)
- Anna S Jenkins
- Alix School of Medicine, Mayo Clinic, Scottsdale, Arizona, USA
| | | | - M Lane Moore
- Alix School of Medicine, Mayo Clinic, Scottsdale, Arizona, USA
| | | | - Joseph C Brinkman
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Anikar Chhabra
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona, USA
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Lee DW, Lee DR, Kim MA, Cho SI, Lee JK, Kim JG. Patients with advanced lateral osteoarthritis can return to sports and work after distraction arthroplasty plus lateral meniscal allograft transplantation combined with cartilage repair. Knee Surg Sports Traumatol Arthrosc 2022; 30:1990-2002. [PMID: 35165755 DOI: 10.1007/s00167-022-06864-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 01/01/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE This study aimed to report return to sports (RTS) and return to work (RTW) outcomes after distraction arthroplasty (DA) plus lateral meniscal allograft transplantation (MAT) combined with cartilage repair in active patients with advanced osteoarthritis. It was hypothesised that DA combined with lateral MAT would improve clinical and radiological outcomes and enable RTS and RTW for most patients. METHODS In total, 21 patients with advanced osteoarthritis (moderate to severe joint space narrowing at lateral edge on Rosenberg view and large cartilage defect of lateral femoral condyle) who underwent concomitant DA and MAT were retrospectively reviewed. Clinical outcomes were assessed using subjective knee scores [Lysholm score, International Knee Documentation Committee (IKDC) subjective knee score, and Tegner activity scale (TAS)] and functional tests (isokinetic extensor muscle strength test, single-leg vertical jump test, and single-leg hop for distance test). The rates of RTS, RTW, and satisfaction were evaluated. Radiological outcomes were assessed using magnetic resonance imaging (MRI) and X-ray (Rosenberg view). RESULTS The mean age at surgery and mean follow-up duration were 37.2 ± 5.9 years and 37.1 ± 5.4 months, respectively. All improvements in subjective scores were statistically significant (p < 0.001). The Lysholm score improved from 58.3 ± 8.1 to 84.3 ± 8.2, the IKDC subjective score from 53.9 ± 10.4 to 78.0 ± 7.7, and the TAS from 4.0 ± 0.5 to 5.1 ± 0.8. The limb symmetry index (LSI) (%) of the extensor peak torque at an angular velocity of 60°/s improved from 67.3 ± 19.2 to 88.4 ± 20.3% (p = 0.001). The LSI of the single-leg vertical jump test and single-leg hop for distance test improved from 62.8 ± 21.3 to 87.7 ± 19.5% and from 63.9 ± 20.8 to 85.5 ± 18.1%, respectively (all, p < 0.001). All patients were able to return to any sports activity and work. However, 67% and 90.5% returned to their defined or desired level of sports activity and occupation intensity, respectively. Further, 76.2% were very satisfied or somewhat satisfied with the outcome at the last follow-up. The JSW increased by 0.8 ± 0.4 to 2.3 ± 0.6 mm (p = 0.005). In more than 90% of patients, > 50% of cartilage lesion was covered. The mean graft extrusion was 2.6 ± 1.0 mm. CONCLUSION All patients who underwent distraction arthroplasty plus lateral MAT combined with cartilage repair returned to any sports and work at the last follow-up. Significant improvements in clinical outcomes and the radiographic joint space width were observed. However, the activity ability was somewhat reduced compared with the best preoperative level. This one-stage joint salvage treatment is a promising option for young and active patients with advanced OA who wish to return to high levels of sports activity and occupation intensity (≥ Tegner activity scale 4). LEVEL OF EVIDENCE III.
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Affiliation(s)
- Dhong Won Lee
- Department of Orthopaedic Surgery, KonKuk University Medical Center, Konkuk University College of Medicine, Seoul, Korea
| | - Dong Ryun Lee
- Department of Orthopaedic Surgery, KonKuk University Medical Center, Konkuk University College of Medicine, Seoul, Korea
| | - Min Ah Kim
- Sports Medical Center, HanYang University Myongji Hospital, Goyang-si, Gyeonggi-do, Korea
| | - Seung Ik Cho
- Sports Medical Center, KonKuk University Medical Center, Seoul, Korea
| | - Joon Kyu Lee
- Department of Orthopaedic Surgery, KonKuk University Medical Center, Konkuk University College of Medicine, Seoul, Korea
| | - Jin Goo Kim
- Department of Orthopaedic Surgery, HanYang University Myongji Hospital, 55, Hwasu-ro 14 beon-gil, Deogyang-gu, Goyang-si, Gyeonggi-do, 10475, Republic of Korea.
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Bley JA, Master H, Huston LJ, Block S, Pennings JS, Coronado RA, Cox CL, Sullivan JP, Dale KM, Saluan PM, Spindler KP, Archer KR. Return to Sports After Anterior Cruciate Ligament Reconstruction: Validity and Reliability of the SPORTS Score at 6 and 12 Months. Orthop J Sports Med 2022; 10:23259671221098436. [PMID: 35693459 PMCID: PMC9185013 DOI: 10.1177/23259671221098436] [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: 01/11/2022] [Accepted: 02/23/2022] [Indexed: 11/30/2022] Open
Abstract
Background: The Subjective Patient Outcome for Return to Sports (SPORTS) score is a
single-item scale that measures athletes' ability to return to their
preinjury sport based on effort and performance. Purpose/Hypothesis: The purpose of this study was to examine the psychometric properties of the
SPORTS score and a modified score within the first year after anterior
cruciate ligament reconstruction (ACLR). The modified version replaced “same
sport” with “any sport” in the answer choices. It was hypothesized that both
versions of the SPORTS score would have acceptable floor and ceiling effects
and internal responsiveness, moderate convergent validity, and excellent
test-retest reliability. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Patients were recruited preoperatively from 2 academic medical centers. The
authors collected responses to the 1-item SPORTS scores at 6 and 12 months
after ACLR and the Tegner activity scale, Lysholm knee score, Knee injury
and Osteoarthritis Outcome Score (KOOS)–sport/recreation subscale, and Marx
activity rating scale preoperatively and 6 and 12 months after ACLR. Ceiling
and floor effects and responsiveness were assessed using descriptive
statistics and cross-tabulations, respectively, at both follow-up time
points. Spearman correlations and intraclass correlation coefficients were
used to examine convergent validity and test-retest reliability,
respectively. Results: Follow-up rates at 6 and 12 months were 100% and 99%, respectively.
Test-retest follow-up was 77%. Floor effects for the SPORTS scores were not
observed, while ceiling effects at 12 months ranged from 38% to 40%.
Cross-tabulation of the SPORTS scores showed that 64% to 66% of patients
reported a change in their score from 6 to 12 months, with significant
differences noted between the proportions that improved versus worsened for
return to any sport. Convergent validity was observed at 6 and 12 months via
moderate correlations with the Tegner, Lysholm, KOOS–sport/recreation, and
Marx scores (r = 0.31 to 0.47). Fair to good test-retest
reliability (intraclass correlation coefficient, 0.58 and 0.60) was found at
12 months after ACLR. Conclusion: The SPORTS score appears to be a reliable, responsive, and valid 1-item scale
that can be used during the first year after ACLR. No differences in
psychometric properties were found between the SPORTS score and the modified
version.
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Affiliation(s)
- Jordan A Bley
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Hiral Master
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Vanderbilt Institute of Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Laura J Huston
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Shannon Block
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jacquelyn S Pennings
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Rogelio A Coronado
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Charles L Cox
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jaron P Sullivan
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kevin M Dale
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Paul M Saluan
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kurt P Spindler
- Department of Orthopaedic Surgery, Cleveland Clinic Florida Region, Weston, Florida, USA
| | - Kristin R Archer
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Koca F, Fältström A, Cristiani R, Stålman A. Comparison of Knee Function and Activity Level Between Bilateral and Unilateral ACL Reconstruction: A Matched-Group Analysis With Minimum 5-Year Follow-up. Orthop J Sports Med 2022; 10:23259671221083576. [PMID: 35494496 PMCID: PMC9047869 DOI: 10.1177/23259671221083576] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/24/2021] [Indexed: 11/21/2022] Open
Abstract
Background: There is a lack of knowledge regarding knee function and activity level after
bilateral anterior cruciate ligament reconstruction (ACLR) at midterm
follow-up. Purpose: To compare activity level, patient-reported knee function, and quality of
life in patients with bilateral ACLR and matched controls with unilateral
ACLR at a minimum 5-year follow-up. Study Design: Cohort study; Level of evidence, 3. Methods: Patients with bilateral ACLR who were aged ≤40 years and had a second ACLR
performed between 2010 and 2015 were identified in the authors’ local
database. Surgical data and preoperative Knee injury and Osteoarthritis
Outcome Score (KOOS) were extracted. The patients were sent a letter with
questionnaires including the KOOS, EuroQol 5-Dimensions (EQ-5D), and EuroQol
visual analog scale (EQ-VAS) and were asked study-specific questions by
telephone regarding activity level and knee function at a minimum 5-year
follow-up. For every patient with bilateral ACLR, a control matched for age
±2 years, sex, year ACLR was performed, and preinjury activity level or
sport at the time of injury were identified in the database. Results: A total of 98 patients (mean age ± SD, 33.3 ± 7.3 years) with bilateral ACLR
and 98 patients with unilateral ACLR (mean age ± SD, 33.1 ± 7.7 years) were
included. The mean postoperative follow-up was 7.6 ± 1.8 years (from the
second ACLR) for patients with bilateral ACLR and 7.8 ± 1.7 years for
patients with unilateral ACLR. Patients with bilateral ACLR reported lower
scores on all KOOS subscales, the EQ-5D, and the EQ-VAS at follow-up
(P < .05). There was no difference in activity level
between the groups at follow-up, but patients with bilateral ACLR were less
satisfied with their activity level and knee function (P
< .05). Conclusion: Patient-reported knee function and health-related quality of life were
inferior in patients with bilateral ACLR compared with patients with
unilateral ACLR. Patients with bilateral ACLR cannot expect the same knee
function and quality of life as patients with unilateral ACLR.
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Affiliation(s)
- Firathan Koca
- Capio Artro Clinic, Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden
| | - Anne Fältström
- Region Jönköping County, Rehabilitation Centre, Ryhov County Hospital, Jönköping, Sweden
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Riccardo Cristiani
- Capio Artro Clinic, Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden
| | - Anders Stålman
- Capio Artro Clinic, Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden
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Jenkins SM, Guzman A, Gardner BB, Bryant SA, Del Sol SR, McGahan P, Chen J. Rehabilitation After Anterior Cruciate Ligament Injury: Review of Current Literature and Recommendations. Curr Rev Musculoskelet Med 2022; 15:170-179. [PMID: 35381974 DOI: 10.1007/s12178-022-09752-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/09/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Anterior cruciate ligament reconstruction (ACLR) is a common surgical procedure with an estimated 120,000 cases performed in the USA each year. Physical therapy plays a critical role in the successful recovery of both surgically and non-surgically managed patients. Interestingly, ACL rehabilitation protocols vary greatly with little consensus among practitioners. Nonetheless, there has been agreement over the last decade to shift from conservative, standardized length protocols to more accelerated, individualized protocols that vary in length and modalities based on patient-specific findings and preferences. This review summarizes the most recent trends, opinions, and modalities in ACL rehabilitation research, with a specific focus on novel methods to treat the specific psychosocial needs of ACL deficient patients. RECENT FINDINGS We found that new protocols emphasize early weight bearing, open kinetic chain (OKC) exercises, and other alternative modalities such as neuromuscular electrical stimulation and blood flow restriction. We also found a recent trend toward the use of clinical milestones to determine when a patient is ready for the next phase of a "step-up" rehabilitation program. One particularly nascent topic of research is the inclusion of methods to treat the psychosocial impacts of ACL injury, recovery, and the anxiety around return to sport. Rehabilitation strategy has become increasingly patient-dependent, and the new modalities being utilized are accelerating patient recovery. Return to sport is a particularly important factor for many ACLR patients, and recovery has an important psychological component that has only recently been addressed in the literature, with positive preliminary findings.
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Affiliation(s)
- Sarah M Jenkins
- Advanced Orthopaedics and Sports Medicine, 450 Sutter St, San Francisco, CA, 94108, USA.
| | - Alvarho Guzman
- Advanced Orthopaedics and Sports Medicine, 450 Sutter St, San Francisco, CA, 94108, USA
| | - Brandon B Gardner
- Advanced Orthopaedics and Sports Medicine, 450 Sutter St, San Francisco, CA, 94108, USA
| | - Stewart A Bryant
- University of Hawaii Orthopaedic Surgery Residency, Honolulu, HI, USA
| | - Shane Rayos Del Sol
- Advanced Orthopaedics and Sports Medicine, 450 Sutter St, San Francisco, CA, 94108, USA
| | - Patrick McGahan
- Advanced Orthopaedics and Sports Medicine, 450 Sutter St, San Francisco, CA, 94108, USA
| | - James Chen
- Advanced Orthopaedics and Sports Medicine, 450 Sutter St, San Francisco, CA, 94108, USA
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Webster KE, Klemm HJ, Feller JA. Rates and Determinants of Returning to Australian Rules Football in Male Nonprofessional Athletes After Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2022; 10:23259671221074999. [PMID: 35178464 PMCID: PMC8844735 DOI: 10.1177/23259671221074999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 11/12/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Return to sport is a goal for most patients who undergo anterior cruciate ligament (ACL) reconstruction. However, at a nonelite level, there are limited sport-specific data regarding rates or factors associated with return to play. Purpose: To report rates and determinants of returning to play Australian Rules football after ACL reconstruction in male nonprofessional athletes. Study Design: Case-series; Level of evidence, 4. Methods: A total of 354 male nonprofessional Australian Rules football players who had undergone primary ACL reconstruction were asked to complete detailed sports activity questions at 12 months and 2 to 5 years (mean, 3 years) after surgery. Rates of return to play were calculated for both timepoints, along with preoperative patient expectations and postoperative sport performance. The following predictors of return to play were examined: age at surgery; height; weight; frequency of weekly football participation; sport participation level; psychological readiness to return to sport; and knee-related quality of life. Further ACL injuries were also documented. Descriptive statistics were used to summarize return-to-play data and contingency analysis for predictors of return to sport. Results: The rate of return to any level of play was 35% (95% CI, 30%-41%; n = 284) at the 12-month follow-up and 78% (95% CI, 72%-83%; n = 233) at the 2- to 5-year follow-up. Overall, 64% (95% CI, 57%-70%) of the patients were able to return to their same or higher level of play. Before surgery, 92% of the patients expected to return to their same preinjury level of Australian Rules football participation. At the 2- to 5-year follow-up, 61% who returned to play felt that they could perform as well as they could before their ACL injury. A greater psychological readiness to return to sport preoperatively and higher level of sport participation were significant predictors of a return at 2 to 5 years. Further ACL injuries were sustained by 21% of the cohort (15% graft rupture; 6% contralateral ACL injury). Conclusion: Most male athletes who participate in Australian Rules football returned to some level of play after ACL reconstruction; however, only 64% returned to preinjury levels. Preoperative expectations were not met, and high reinjury rates are a cause for concern.
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Affiliation(s)
- Kate E. Webster
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Haydn J. Klemm
- OrthoSport Victoria, Epworth HealthCare, Melbourne, Australia
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Hartnett DA, Milner JD, Bodendorfer BM, DeFroda SF. Lower extremity injuries in the baseball athlete. SAGE Open Med 2022; 10:20503121221076369. [PMID: 35154741 PMCID: PMC8832566 DOI: 10.1177/20503121221076369] [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: 09/12/2021] [Accepted: 01/10/2022] [Indexed: 01/02/2023] Open
Abstract
Baseball is unique in its multiple facets: pitching, hitting, base rounding, and fielding are distinct activities that require different athletic skills to perform at a high level. Likewise, these different aspects of the game can contribute to a multitude of varying injuries. While high-velocity overhead throwing, along with batting, can produce a plethora of upper extremity injuries that often garner attention, injuries to the lower extremity can severely impact a player’s performance and ability to compete. The rigors of the short, explosive sprinting required for base running, as well as the dynamic movement required for fielding, create ample opportunity for lower limb injury, and even subtle pathology can affect a pitcher’s ability to perform or increase their long-term risk of injury. Chronic injury from conditions such as femoroacetabular impingement and hip labral tears can also occur. The purpose of the present review is to summarize the relevant epidemiology, pathophysiology, and treatment of lower extremity injuries in baseball athletes, with reference to current research into the prevention and management of such injuries.
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Affiliation(s)
- Davis A Hartnett
- Department of Orthopaedic Surgery, The Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - John D Milner
- Department of Orthopaedic Surgery, The Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Blake M Bodendorfer
- Miller Orthopedic Specialists, Council Bluffs, IA, USA
- Miller Orthopedic Specialists, Omaha, NE, USA
| | - Steven F DeFroda
- Department of Orthopaedic Surgery, Missouri Orthopaedic Institute, University of Missouri, Columbia, MO, USA
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Spindler KP, Imrey PB, Yalcin S, Beck GJ, Calbrese G, Cox CL, Fadale PD, Farrow L, Fitch R, Flanigan D, Fleming BC, Hulstyn MJ, Jones MH, Kaeding C, Katz JN, Kriz P, Magnussen R, McErlean E, Melgaard C, Owens BD, Saluan P, Strnad G, Winalski CS, Wright R. Design Features and Rationale of the BEAR-MOON (Bridge-Enhanced ACL Restoration Multicenter Orthopaedic Outcomes Network) Randomized Clinical Trial. Orthop J Sports Med 2022; 10:23259671211065447. [PMID: 35097143 PMCID: PMC8793429 DOI: 10.1177/23259671211065447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/24/2021] [Indexed: 11/17/2022] Open
Abstract
Background: BEAR (bridge-enhanced anterior cruciate ligament [ACL] restoration), a paradigm-shifting technology to heal midsubstance ACL tears, has been demonstrated to be effective in a single-center 2:1 randomized controlled trial (RCT) versus hamstring ACL reconstruction. Widespread dissemination of BEAR into clinical practice should also be informed by a multicenter RCT to demonstrate exportability and compare efficacy with bone--patellar tendon–bone (BPTB) ACL reconstruction, another clinically standard treatment. Purpose: To present the design and initial preparation of a multicenter RCT of BEAR versus BPTB ACL reconstruction (the BEAR: Multicenter Orthopaedic Outcomes Network [BEAR-MOON] trial). Design and analytic issues in planning the complex BEAR-MOON trial, involving the US National Institute of Arthritis and Musculoskeletal and Skin Diseases, the US Food and Drug Administration, the BEAR implant manufacturer, a data and safety monitoring board, and institutional review boards, can usefully inform both clinicians on the trial’s strengths and limitations and future investigators on planning of complex orthopaedic studies. Study Design: Clinical trial. Methods: We describe the distinctive clinical, methodological, and operational challenges of comparing the innovative BEAR procedure with the well-established BPTB operation, and we outline the clinical motivation, experimental setting, study design, surgical challenges, rehabilitation, outcome measures, and planned analysis of the BEAR-MOON trial. Results: BEAR-MOON is a 6-center, 12-surgeon, 200-patient randomized, partially blinded, noninferiority RCT comparing BEAR with BPTB ACL reconstruction for treating first-time midsubstance ACL tears. Noninferiority of BEAR relative to BPTB will be claimed if the total score on the International Knee Documentation Committee (IKDC) subjective knee evaluation form and the knee arthrometer 30-lb (13.61-kg) side-to-side laxity difference are both within respective margins of 16 points for the IKDC and 2.5 mm for knee laxity. Conclusion: Major issues include patient selection, need for intraoperative randomization and treatment-specific postoperative physical therapy regimens (because of fundamental differences in surgical technique, initial stability construct, and healing), and choice of noninferiority margins for short-term efficacy outcomes of a novel intervention with evident short-term advantages and theoretical, but unverified, long-term benefits on other dimensions.
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Affiliation(s)
| | - Kurt P. Spindler
- BEAR-MOON Design Group: All authors are listed in the Authors section at the end of this article
| | - Peter B. Imrey
- BEAR-MOON Design Group: All authors are listed in the Authors section at the end of this article
| | - Sercan Yalcin
- BEAR-MOON Design Group: All authors are listed in the Authors section at the end of this article
| | - Gerald J. Beck
- BEAR-MOON Design Group: All authors are listed in the Authors section at the end of this article
| | - Gary Calbrese
- BEAR-MOON Design Group: All authors are listed in the Authors section at the end of this article
| | - Charles L. Cox
- BEAR-MOON Design Group: All authors are listed in the Authors section at the end of this article
| | - Paul D. Fadale
- BEAR-MOON Design Group: All authors are listed in the Authors section at the end of this article
| | - Lutul Farrow
- BEAR-MOON Design Group: All authors are listed in the Authors section at the end of this article
| | - Robert Fitch
- BEAR-MOON Design Group: All authors are listed in the Authors section at the end of this article
| | - David Flanigan
- BEAR-MOON Design Group: All authors are listed in the Authors section at the end of this article
| | - Braden C. Fleming
- BEAR-MOON Design Group: All authors are listed in the Authors section at the end of this article
| | - Michael J. Hulstyn
- BEAR-MOON Design Group: All authors are listed in the Authors section at the end of this article
| | - Morgan H. Jones
- BEAR-MOON Design Group: All authors are listed in the Authors section at the end of this article
| | - Christopher Kaeding
- BEAR-MOON Design Group: All authors are listed in the Authors section at the end of this article
| | - Jeffrey N. Katz
- BEAR-MOON Design Group: All authors are listed in the Authors section at the end of this article
| | - Peter Kriz
- BEAR-MOON Design Group: All authors are listed in the Authors section at the end of this article
| | - Robert Magnussen
- BEAR-MOON Design Group: All authors are listed in the Authors section at the end of this article
| | - Ellen McErlean
- BEAR-MOON Design Group: All authors are listed in the Authors section at the end of this article
| | - Carrie Melgaard
- BEAR-MOON Design Group: All authors are listed in the Authors section at the end of this article
| | - Brett D. Owens
- BEAR-MOON Design Group: All authors are listed in the Authors section at the end of this article
| | - Paul Saluan
- BEAR-MOON Design Group: All authors are listed in the Authors section at the end of this article
| | - Greg Strnad
- BEAR-MOON Design Group: All authors are listed in the Authors section at the end of this article
| | - Carl S. Winalski
- BEAR-MOON Design Group: All authors are listed in the Authors section at the end of this article
| | - Rick Wright
- BEAR-MOON Design Group: All authors are listed in the Authors section at the end of this article
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Maletis GB, Funahashi TT, Inacio MCS, Paxton LW. Optimizing anterior cruciate ligament reconstruction: Individualizing the decision-making process using data from the Kaiser Permanente ACLR Registry: 2018 OREF award paper. J Orthop Res 2022; 40:29-42. [PMID: 33751638 DOI: 10.1002/jor.25020] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/09/2021] [Accepted: 03/02/2021] [Indexed: 02/04/2023]
Abstract
Despite years of study, controversy remains regarding the optimal graft for anterior cruciate ligament reconstruction (ACLR), suggesting that a single graft type is not ideal for all patients. A large community based ACLR Registry that collects prospective data is a powerful tool that captures information and can be analyzed to optimize surgery for individual patients. The studies highlighted in this paper were designed to optimize and individualize ACLR surgery and have led to changes in surgeon behavior and improvements in patient outcomes. Kaiser Permanente (KP) is an integrated health care system with 10.6 million members and more than 50 hospitals. Every KP member who undergoes an ACLR is entered into the Registry, and prospectively monitored. The Registry uses a variety of feedback mechanisms to disseminate Registry findings to the ACLRR surgeons and appropriately influence clinical practices and enhance quality of care. Allografts were found to have a 3.0 times higher risk of revision than bone-patellar tendon-bone (BPTB) autografts. Allograft irradiation >1.8 Mrad, chemical graft processing, younger patients, BPTB allograft, and male patients were all associated with a higher risk of revision surgery. By providing feedback to surgeons, overall allograft use has decreased by 27% and allograft use in high-risk patients ≤21 years of age decreased 68%. We have identified factors that influence the outcomes of ACLR. Statement of Clinical Significance: We found that information derived from an ACLR Registry and shared with the participating surgeons directly decreased the use of specific procedures and implants associated with poor outcomes.
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Affiliation(s)
- Gregory B Maletis
- Department of Orthopedics, Kaiser Permanente Baldwin Park, Baldwin Park, California, USA
| | - Tadashi T Funahashi
- Department of Orthopedics, Kaiser Permanente Sand Canyon, Irvine, California, USA
| | - Maria C S Inacio
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Liz W Paxton
- Surgical Outcomes and Analysis, Kaiser Permanente, San Diego, California, USA
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Matsuzaki Y, Chipman DE, Hidalgo Perea S, Green DW. Unique Considerations for the Pediatric Athlete During Rehabilitation and Return to Sport After Anterior Cruciate Ligament Reconstruction. Arthrosc Sports Med Rehabil 2022; 4:e221-e230. [PMID: 35141555 PMCID: PMC8811511 DOI: 10.1016/j.asmr.2021.09.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 09/27/2021] [Indexed: 11/03/2022] Open
Abstract
Anterior cruciate ligament (ACL) injuries and surgical intervention in the pediatric population have increased in the recent years. Although surgical techniques have advanced, evidence-based rehabilitation guidelines that consider all aspects of the youth athlete are currently lacking. The purpose of this commentary is to review the current evidence on unique considerations for the pediatric and adolescent population during rehabilitation and return to sport after ACL reconstruction (ACLR), with a focus on children under 18 years of age. This review revealed that returning a youth athlete to sport after ACLR requires knowledge and appreciation of various aspects of the growing athlete different from adults. In addition to postoperative precautions that contribute to a slow rehabilitation process, young athletes need additional time for strength gains. Address risk of reinjury and for contralateral injury by using neuromuscular training and rigorous return-to-sport training programs. Consider return to sport after 9 months because the reinjury rate is high in this population. A combination of time and objective measures, both quantitative and qualitative criteria, and psychological readiness should be used to assess readiness to return to sport and decrease risk of future injury. Healthcare providers should be aware of the psychosocial impact of injury on the youth athletes and refer to sport psychology when necessary. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
- Yukiko Matsuzaki
- Department of Pediatric Rehabilitation, Department of Sports Rehabilitation and Performance, Hospital for Special Surgery, New York, New York, U.S.A
| | - Danielle E. Chipman
- Department of Pediatric Orthopedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Sofia Hidalgo Perea
- Department of Pediatric Orthopedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Daniel W. Green
- Department of Pediatric Orthopedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
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40
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High Return to Play and Low Reinjury Rates in National Collegiate Athletic Association Division I Football Players Following Anterior Cruciate Ligament Reconstruction Using Quadrupled Hamstring Autograft. Arthroscopy 2022; 38:99-106. [PMID: 33957214 DOI: 10.1016/j.arthro.2021.04.057] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 04/18/2021] [Accepted: 04/24/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to examine the outcomes of anterior cruciate ligament (ACL) reconstruction using quadrupled hamstring (QH) autograft in a cohort of National Collegiate Athletic Association (NCAA) Division I football players. METHODS A retrospective analysis was performed on NCAA Division I football players at a single institution who had transtibial ACL reconstruction using QH autograft between 2001 and 2016. Primary outcomes were ACL reinjury and return to play (RTP). Secondary outcomes were position, percent of eligibility used after surgery, graft diameter, Tegner-Lysholm scores, concomitant injuries/surgeries, and postcollegiate professional play. RESULTS Between 2001 and 2016, 34 players had QH autograft ACL reconstruction, and 29 players achieved RTP. Of the 29, 2 (6.9%) sustained ACL reinjuries. The average RTP was 318 days (range 115-628) after surgery. Players used 79.5% of their remaining collegiate eligibility after surgery. Nine players sustained multiligamentous knee injuries. This did not have a significant effect on RTP (P = 0.709; mean 306±24 days for isolated ACL, mean of 353±51 for 2 ligaments, mean of 324±114 for 3 + ligaments) and none sustained reinjury. Associated meniscal injuries were sustained by 28, and 8 sustained chondral injuries. The mean postoperative Tegner-Lysholm score was 90.7 of 100, with mean follow-up of 102 months. Of these players, 18 went on to play professionally, with 17 joining National Football League rosters and 1 an arena team roster. CONCLUSION QH demonstrated an ACL reinjury and RTP rates similar to those in previously published, predominantly bone-patella tendon-bone ACL reinjury data in elite athletes. This study demonstrates that QH autograft may be a viable option in elite athletes. LEVEL OF EVIDENCE IV, case series.
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Matava MJ, Koscso J, Melara L, Bogunovic L. Suture Tape Augmentation Improves the Biomechanical Performance of Bone-Patellar Tendon-Bone Grafts Used for Anterior Cruciate Ligament Reconstruction. Arthroscopy 2021; 37:3335-3343. [PMID: 33964381 DOI: 10.1016/j.arthro.2021.04.053] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/14/2021] [Accepted: 04/22/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to investigate the time-zero biomechanical properties (stiffness, displacement, and load at failure) of bone-patellar tendon-bone (BTB) grafts used for anterior cruciate ligament (ACL) reconstruction with and without suture tape augmentation as a means to determine the potential clinical benefit of this technique. METHODS Eight juvenile porcine knees underwent ACL reconstruction with a human cadaveric BTB graft (control). These were compared to 8 juvenile porcine knees that underwent ACL reconstruction with a BTB graft augmented with suture tape. All knees underwent biomechanical testing utilizing a dynamic tensile testing machine. Cyclic loading between 50-250N was performed for 500 cycles at 1 Hz to simulate in vivo ACL loads during the early rehabilitation phase. The grafts were displaced during load-at-failure tensile testing at 20 mm/min. Differences in graft displacement, stiffness, and load at failure for the control and suture tape augmented groups were compared with the Student t-test with a significance level of P < .05. RESULTS There was no difference in graft displacement between the 2 groups. A 104% higher postcyclic stiffness was noted in the augmented group compared to the controls (augmentation: 261 ± 76 N/mm versus control 128 ± 28 N/mm, P = .002). The mean ultimate load at failure was 57% higher in the augmented group compared to controls (744 ± 219 N vs postcyclic 473 ± 169 N, respectively [P = .015]). There was no difference in mode of failure between the control knees and those augmented with suture tape, with approximately half failing from pull off of the tendon from the bone plug and half with pull out of the bone plug from the tunnel. CONCLUSION Independent suture tape augmentation of a BTB ACL reconstruction grafts was associated with a 104% increase in graft stiffness and a 57% increase in load at failure compared to nonaugmented BTB grafts. CLINICAL RELEVANCE In vivo suture tape augmentation of a BTB ACL reconstruction increases graft construct strength and stiffness, which may reduce graft failure in the clinical setting.
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Affiliation(s)
- Matthew J Matava
- Washington University Department of Orthopedic Surgery, St. Louis, Missouri.
| | - Jonathan Koscso
- Washington University Department of Orthopedic Surgery, St. Louis, Missouri
| | - Lucia Melara
- Arthrex Department of Orthopedic Research, Naples, Florida, U.S.A
| | - Ljiljana Bogunovic
- Washington University Department of Orthopedic Surgery, St. Louis, Missouri
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Anterior Cruciate Ligament Reconstruction Does Not Impact Career Earnings After Return to Play in National Basketball Association Athletes. Arthrosc Sports Med Rehabil 2021; 3:e1491-e1497. [PMID: 34712986 PMCID: PMC8527322 DOI: 10.1016/j.asmr.2021.07.010] [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: 03/17/2021] [Accepted: 07/05/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose To quantify the financial impact of an anterior cruciate ligament (ACL) injury on the remaining career earnings of National Basketball Association (NBA) players. Methods We performed a retrospective review of all NBA players who had an ACL rupture between 2000 and 2019. Players were matched to healthy controls by age, position, body mass index, and player efficiency rating at the time of injury (index year). Player information collected included demographic information, position, team role, draft pick, date of injury, contract length, and earnings during the 3 years before and 7 years after the index year, as well as new contract length and earnings after injury. Results A total of 12 players (22%) did not return to play (RTP). No statistically significant difference in annual earnings was present at any time point between cohorts. When we examined the mean difference in earnings between the first 3 post-index seasons and the 3 pre-index seasons, both the ACL and control cohorts showed increased salaries as players’ careers progressed, without a significant difference in earnings. When comparing cohorts, we found no significant difference in the length and earnings of contracts during the index year. Furthermore, there was no significant difference in the length or earnings of the first new contract signed after the index year between cohorts. Additionally, NBA players who were able to RTP after ACL reconstruction were more likely to experience increased earnings if they had greater experience and performance prior to their injury (P < .01). Conclusions Our study found that NBA players did not experience diminished earnings after RTP from an ACL reconstruction when compared with matched controls. Furthermore, no differences were seen in lengths of new contracts or in contract earnings between cohorts. Players with greater experience and performance prior to injury were more likely to have increased earnings after ACL reconstruction. Level of Evidence Level III, retrospective case-control study.
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Beletsky A, Naami E, Lu Y, Polce EM, Chahla J, Okoroha KR, Bush-Joseph C, Bach B, Yanke A, Forsythe B, Cole BJ, Verma NN. The Minimally Clinically Important Difference and Substantial Clinical Benefit in Anterior Cruciate Ligament Reconstruction: A Time-to-Achievement Analysis. Orthopedics 2021; 44:299-305. [PMID: 34590953 DOI: 10.3928/01477447-20210819-03] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This study examined the time-dependent course of the minimally clinically important difference (MCID) and the substantial clinical benefit (SCB) achievement for International Knee Documentation Committee (IKDC) and Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales following anterior cruciate ligament reconstruction (ACLR). A prospective institutional registry was queried for patients receiving ACLR. The patient-reported outcome measures (PROMs) of interest included the IKDC score and KOOS sub-scales. One hundred forty-three patients (mean±SD age, 30.86±12.78 years; mean±SD body mass index, 25.51±4.64 kg/m2) were included in the analysis. Threshold values for the MCID/SCB were 18.9 of 29.6 on IKDC score, 15.7 of 25.3 on KOOS Symptom, 11.9 of 15.5 on KOOS Pain, 13.3 of 20.0 on KOOS ADL, 25.9 of 35.8 on KOOS Quality of Life (QoL), and 27.0 of 43.0 on KOOS Sport (area under the curve, 0.74-0.91). Overall, MCID achievement rates increased from 28.0% to 42.7% at 6 months to 41.9% to 70.8% at 12 months. Achievement rates of SCB increased from 16.1% to 30.4% at 6 months to 29.3% to 51.8% at 12 months. Statistically significant increases in MCID achievement (chi-square=47.95-79.36, all P<.001) and SCB achievement (chi-square=26.02-53.24, all P<.001) occurred from preoperative to 6-month time points across PROMs. From 6-month to 12-month time points, increases in MCID achievement occurred on IKDC score and KOOS QoL (chi-square=5.53-15.11, P<.001-.009). Statistically significant increases in MCID and SCB achievement occurred from preoperative to 6-month time points across IKDC score and KOOS subscales; however, statistically significant increases in achievement rates from 6 months to 1 year occurred on IKDC score, KOOS QoL, and KOOS Sport. This study underlines the importance of considering psychological factors and rehabilitative milestones when examining the achievement MCID and SCB after ACLR. [Orthopedics. 2021;44(5):299-305.].
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44
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Ogborn D. Optimizing Exercise Selection for the Asymmetric Athlete After Anterior Cruciate Ligament Reconstruction. Strength Cond J 2021. [DOI: 10.1519/ssc.0000000000000605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Faleide AGH, Magnussen LH, Bogen BE, Strand T, Mo IF, Vervaat W, Inderhaug E. Association Between Psychological Readiness and Knee Laxity and Their Predictive Value for Return to Sport in Patients With Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2021; 49:2599-2606. [PMID: 34251870 DOI: 10.1177/03635465211021831] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Deciding when patients are ready to return to sport (RTS) after an anterior cruciate ligament (ACL) reconstruction (ACLR) is challenging. The understanding of which factors affect readiness and how they may be related is limited. Therefore, despite widespread use of RTS testing, there is a lack of knowledge about which tests are informative on the ability to resume sports. PURPOSE To examine whether there is an association between knee laxity and psychological readiness to RTS after ACLR and to evaluate the predictive value of these measures on sports resumption. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Patients aged ≥16 years engaged in physical activity/sports before injury were recruited at routine clinical assessment 9-12 months after ACLR. Exclusion criteria were concomitant ligament surgery at ACLR and/or previous ACL injury in the contralateral knee. At baseline, a project-specific activity questionnaire and the ACL-Return to Sport After Injury (ACL-RSI) scale were completed. Knee laxity was assessed by use of the Lachman test, KT-1000 arthrometer, and pivot-shift test. Two years after surgery, knee reinjuries and RTS status (the project-specific questionnaire) were registered. Associations between psychological readiness and knee laxity were evaluated with the Spearman rho test, and predictive ability of the ACL-RSI and knee laxity tests were examined using regression analyses. RESULTS Of 171 patients screened for eligibility, 132 were included in the study. There were small but significant associations between the ACL-RSI score and the Lachman test (rho = -0.18; P = .046) and KT-1000 arthrometer measurement (rho = -0.18; P = .040) but no association between the ACL-RSI and the pivot-shift test at the time of recruitment. Of the total patients, 36% returned to preinjury sport level by 2 years after surgery. Higher age, better psychological readiness, and less anterior tibial displacement (KT-1000 arthrometer measurement) were significant predictors of 2-year RTS (explained variance, 33%). CONCLUSION Small but significant associations were found between measurements of psychological readiness and anterior tibial displacement, indicating that patients with less knee laxity after ACLR feel more ready to RTS. ACL-RSI and KT-1000 arthrometer measurements were independent predictors of 2-year RTS and should be considered in RTS assessments after ACLR.
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Affiliation(s)
- Anne Gro Heyn Faleide
- Haraldsplass Deaconess Hospital, Bergen, Norway.,University of Bergen, Bergen, Norway
| | | | - Bård Erik Bogen
- Haraldsplass Deaconess Hospital, Bergen, Norway.,Western Norway University of Applied Science, Bergen, Norway
| | | | | | | | - Eivind Inderhaug
- University of Bergen, Bergen, Norway.,Haukeland University Hospital, Bergen, Norway
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Davis-Wilson HC, Thoma LM, Longobardi L, Franz JR, Blackburn JT, Hackney AC, Pietrosimone B. Quality of Life Associates With Moderate to Vigorous Physical Activity Following Anterior Cruciate Ligament Reconstruction. J Athl Train 2021; 57:532-539. [PMID: 34329413 DOI: 10.4085/1062-6050-0670.20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Higher knee function is linked to psychological readiness to return to sport following anterior cruciate ligament reconstruction (ACLR). Individuals with ACLR participate in less physical activity compared to matched uninjured controls, yet the association between knee function and physical activity following ACLR remains unclear. OBJECTIVE To determine the association between patient-reported knee function measured with the Knee Injury and Osteoarthritis Outcomes Score Quality of Life (KOOS-QOL), daily steps, and minutes spent in moderate to vigorous physical activity (MVPA) in individuals with ACLR. Secondarily, we determined associations between KOOS-QOL, daily steps, and MVPA in individuals with ACLR who presented with (symptomatic) and without (asymptomatic) clinically meaningful knee related symptoms. DESIGN Cross-sectional study. SETTING Laboratory, Free-living conditions. PATIENTS OR OTHER PARTICIPANTS Sixty-six individuals with primary unilateral ACLR (55% female, 22±4 years, 28±33 months post-ACLR, BMI: 24.2±2.9 kg/m2). OUTCOME MEASURE(S) We collected KOOS and retrospectively stratified participants into those with (symptomatic [n=30]) or without (asymptomatic [n=36]) clinically meaningful knee related symptoms based on previously defined KOOS cutoffs. We assessed daily steps and MVPA from ActiGraph GT9X Link accelerometers which each participant wore on the right hip for 7 days. We conducted linear regressions to determine associations between KOOS-QOL, daily steps, and MVPA. RESULTS No significant associations existed in the entire sample between KOOS-QOL and daily steps (ΔR2=0.01, P=0.50) or MVPA (ΔR2=0.01, P=0.36). In symptomatic individuals, greater KOOS-QOL associated with greater MVPA (ΔR2=0.12, P=0.05,). No significant associations existed between KOOS-QOL, daily steps, and MVPA in the asymptomatic group. CONCLUSIONS Symptomatic individuals with ACLR who spent more time in MVPA reported higher quality of life.
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Affiliation(s)
- Hope C Davis-Wilson
- 1Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Louise M Thoma
- 2Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,3Division of Physical Therapy, Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lara Longobardi
- 4Department of Medicine, Division of Rheumatology, Allergy, and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jason R Franz
- 5Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC, USA
| | - J Troy Blackburn
- 2Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,6MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,7Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - A C Hackney
- 2Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,8Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Brian Pietrosimone
- 2Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,6MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,7Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Yin J, Yang K, Zheng D, Xu N. Anatomic reconstruction of the anterior cruciate ligament of the knee with or without reconstruction of the anterolateral ligament: A meta-analysis. J Orthop Surg (Hong Kong) 2021; 29:2309499020985195. [PMID: 33410381 DOI: 10.1177/2309499020985195] [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] [Indexed: 01/11/2023] Open
Abstract
PURPOSE To systematically analyze the effectiveness between combined anterior cruciate ligament and anterolateral ligament reconstruction (ACL+ALLR) and isolated anterior cruciate ligament reconstruction (ACLR) for treatment of patients with injured ACL. METHODS We performed a systematic search in MEDLINE, EMBASE, PubMed, Web of Science, Cochrane databases, Chinese Biomedical Literature Database, CNKI, and Wanfang Data for all relevant studies. All statistical analysis was performed using Review Manager version 5.3. RESULTS A total of six articles with 460 study subjects were included, with 193 patients in ACL+ALL reconstruction group and 267 patients in ACL reconstruction group. The results of the meta-analysis showed that the ACL+ALL reconstruction group had significantly lower KT measured value (P < 0.00001), Lachman test positive-rate (P = 0.02), Pivot-shift test positive-rate (P < 0.00001) and graft rupture rate (P = 0.02) compared with the ACL reconstruction group. Higher IKDC score (P < 0.00001) and Lysholm score (P < 0.00001) were measured in ACL+ALL reconstruction group, while infection rate (P = 0.86) and other complications rate (P = 0.29) showed no significant differences between the two groups. CONCLUSIONS Anatomic reconstruction of the ACL of the knee with reconstruction of the ALL indicates better postoperative knee function and clinical outcomes compared with isolated ACL reconstruction. The infection rate and other complications rate showed no significant difference between two groups.
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Affiliation(s)
- Jianjian Yin
- Department of Orthopedics, The Affiliated Changzhou No.2 People's Hospital with Nanjing Medical University, Changzhou, China
| | - Kaiyuan Yang
- Department of Orthopedics, The Affiliated Changzhou No.2 People's Hospital with Nanjing Medical University, Changzhou, China
| | - Dong Zheng
- Department of Orthopedics, The Affiliated Changzhou No.2 People's Hospital with Nanjing Medical University, Changzhou, China
| | - Nanwei Xu
- Department of Orthopedics, The Affiliated Changzhou No.2 People's Hospital with Nanjing Medical University, Changzhou, China
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Berthold DP, Willinger L, LeVasseur MR, Marrero DE, Bell R, Muench LN, Kane Z, Imhoff AB, Herbst E, Cote MP, Arciero RA, Edgar CM. High Rate of Initially Overlooked Kaplan Fiber Complex Injuries in Patients With Isolated Anterior Cruciate Ligament Injury. Am J Sports Med 2021; 49:2117-2124. [PMID: 34086492 PMCID: PMC8246408 DOI: 10.1177/03635465211015682] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Injuries to the Kaplan fiber complex (KFC) are not routinely assessed for in the anterior cruciate ligament (ACL)-deficient knee during preoperative magnetic resonance imaging (MRI). As injuries to the KFC lead to anterolateral rotatory instability (ALRI) in the ACL-deficient knee, preoperative detection of these injuries on MRI scans may help surgeons to individualize treatment and improve outcomes, as well as to reduce failure rates. PURPOSE To retrospectively determine the rate of initially overlooked KFC injuries on routine MRI in knees with isolated primary ACL deficiency. STUDY DESIGN Case series; Level of evidence, 4. METHODS Patients who underwent isolated ACL reconstruction between August 2013 and December 2019 were identified. No patient had had Kaplan fiber (KF) injury identified on the initial reading of the MRI scan or at the time of surgery. Preoperative knee MRI scans (minimum 1.5 T) were reviewed and injuries to the proximal and distal KFs were recorded by 3 independent reviewers. KF length and distance to nearby anatomic landmarks (the lateral joint line and the lateral femoral epicondyle) were measured. Additional radiological findings, including bleeding, lateral femoral notch sign, and bone marrow edema (BME), were identified to detect correlations with KFC injury. RESULTS The intact KFC could reliably be identified by all 3 reviewers (85.9% agreement; Kappa, 0.716). Also, 53% to 56% of the patients with initially diagnosed isolated ACL ruptures showed initially overlooked injuries to the KFC. Injuries to the distal KFs were more frequent (48.1%, 53.8%, and 43.3% by the first, second, and third reviewers, respectively) than injuries to the proximal KFs (35.6%, 47.1%, and 45.2% by the first, second, and third reviewers, respectively). Bleeding in the lateral supracondylar region was associated with KFC injuries (P = .023). Additionally, there was a positive correlation between distal KF injuries and lateral tibial plateau BME (P = .035), but no associations were found with the lateral femoral notch sign or other patterns of BME, including pivot-shift BME. CONCLUSION KF integrity and injury can be reliably detected on routine knee MRI scans. Also, 53% to 56% of the patients presenting with initially diagnosed isolated ACL ruptures had concomitant injuries to the KFC. This is of clinical relevance, as ACL injuries diagnosed by current routine MRI examination protocols may come with a high number of occult or hidden KFC injuries. As injuries to the KFC contribute to persistent ALRI, which may influence ACL graft failure or reoperation rates, significant improvements in preoperative diagnostic imaging are required to determine the exact injury pattern and to assist in surgical decision making.
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Affiliation(s)
- Daniel P. Berthold
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA,Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany,Daniel P. Berthold, MD, Ismaninger Str. 22, 81675 Munich, Germany ()
| | - Lukas Willinger
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Matthew R. LeVasseur
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Daniel E. Marrero
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Ryan Bell
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Lukas N. Muench
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Zenon Kane
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Andreas B. Imhoff
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Elmar Herbst
- Department of Trauma, Hand and Reconstructive Surgery University Hospital, Münster, Germany
| | - Mark P. Cote
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Robert A. Arciero
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Cory M. Edgar
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
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Tramer JS, Khalil LS, Jildeh TR, Sattar M, Ziedas A, Abbas MJ, Kolowich PA, Okoroha KR. Association of Prior Anterior Cruciate Ligament Tear With Decreased Career Longevity in Women's National Basketball Association. Orthop J Sports Med 2021; 9:23259671211009248. [PMID: 34250170 PMCID: PMC8239980 DOI: 10.1177/23259671211009248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 12/21/2021] [Indexed: 11/16/2022] Open
Abstract
Background The incidence of anterior cruciate ligament (ACL) injuries in women's basketball exceeds that of men. There is a paucity of data regarding career performance in Women's National Basketball Association (WNBA) athletes with a history of ACL reconstruction. Purpose To determine whether WNBA athletes with a history of ACL injury prior to professional play have reduced career game utilization, defined as games played and started and minutes per game (MPG), as well as statistical performance, defined by player efficiency rating (PER). Study Design Cohort study; Level of evidence, 3. Methods Included were 42 WNBA players from 1997 to 2018 who had a history of ACL reconstruction before entering professional leagues. Body mass index (BMI), age, and position were collected for each player. Career data and performance statistics were likewise collected for each player's entire WNBA career. A control group of WNBA players with no history of ACL injury were matched by position, BMI, and age at the time of WNBA debut. Statistics compared game utilization and performance to assess the impact of ACL reconstruction. Results Athletes who sustained an ACL tear before entering the league played in fewer games per season in their first 3 professional seasons compared with healthy controls (24.2 ± 8.4 vs 28.2 ± 6.1; P = .02). Among athletes with a history of ACL reconstruction, 11 (26.2%) played only a single WNBA season, while no control athletes played in just 1 season. Additionally, athletes who had a previous ACL tear started significantly fewer games per season (9.0 ± 9.4 vs 14.0 ± 9.0; P < .01) and played fewer MPG (15.5 ± 7.2 vs 20.7 ± 5.5; P < .01) during their WNBA career. Athletes with a history of ACL tear had significantly shorter WNBA careers (4.8 ± 4.1 vs 8.1 ± 3.3 seasons; P < .001). Total professional play duration (WNBA + overseas) was significantly reduced in players with an ACL tear compared with controls (P < .05). PER was not significantly different between cohorts at any time point. Conclusion WNBA athletes with a history of an ACL tear before professional play had decreased career game utilization and workload throughout their career despite having similar PER compared with healthy controls.
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Affiliation(s)
- Joseph S Tramer
- Department of Orthopedic Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Lafi S Khalil
- Department of Orthopedic Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Toufic R Jildeh
- Department of Orthopedic Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Mohammad Sattar
- Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Alexander Ziedas
- Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Muhammad J Abbas
- Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Patricia A Kolowich
- Department of Orthopedic Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Kelechi R Okoroha
- Department of Orthopedic Surgery, Henry Ford Hospital, Detroit, Michigan, USA
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50
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Rauck RC, Apostolakos JM, Nwachukwu BU, Schneider BL, Williams RJ, Dines JS, Altchek DW, Pearle A, Allen A, Stein BS, Dines D, Ranawat A, Kelly A, Kelly B, Rose H, Maynard M, Strickland S, Coleman S, Hannafin J, MacGillivray J, Marx R, Warren R, Rodeo S, Fealy S, O'Brien S, Wickiewicz T. Return to Sport After Bone-Patellar Tendon-Bone Autograft ACL Reconstruction in High School-Aged Athletes. Orthop J Sports Med 2021; 9:23259671211011510. [PMID: 34250173 PMCID: PMC8239981 DOI: 10.1177/23259671211011510] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 01/12/2021] [Indexed: 11/30/2022] Open
Abstract
Background: Anterior cruciate ligament (ACL) injuries are occurring with increasing frequency in the adolescent population. Outcomes after ACL reconstruction (ACLR) are inconsistently reported in homogeneous patient populations. Purpose/Hypothesis: To evaluate outcomes after bone–patellar tendon–bone (BTB) autograft ACLR in competitive high school–aged athletes by examining return to sport (RTS), patient satisfaction, and reinjury rates. Our hypothesis was that RTS rates and satisfaction will be high and reinjury rates will be low. Study Design: Case series; Level of evidence, 4. Methods: An institutional ACL registry was utilized to identify competitive high school–aged athletes (14-18 years old) who underwent primary ACLR using BTB autograft with a minimum 2-year follow-up. A postoperative questionnaire was administered to determine rates and types of RTS, quality of sports performance, reinjury, and satisfaction. Uni- and multivariable analyses were used to identify demographic, sport-specific, and clinical factors related to RTS. Results: A total of 53 patients were included (mean ± SD age at the time of surgery, 16.6 ± 1.34 years). Mean follow-up was 3.78 ± 0.70 years (range, 2.60-4.94 years). The overall ipsilateral ACL retear rate was 7.5% (n = 4). There were 10 subsequent ACL tears to the contralateral knee (19%). Forty-four (83%) patients successfully returned to at least their prior level of sport at a mean 10.5 ± 8.7 months (range, 3-48 months). Overall satisfaction was high, with 91% of patients very satisfied with the outcome. Higher confidence levels regarding performance of the reconstructed knee were associated with increased probability of RTS on multivariate analysis. Conclusion: BTB autograft ACLR results in high rates of RTS and satisfaction and low rates of subsequent ipsilateral ACL injuries in competitive high school–aged athletes. Patients with higher confidence in performance of the reconstructed knee are more likely to return to at least their prior level of sport.
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Affiliation(s)
- Ryan C Rauck
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - John M Apostolakos
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Benedict U Nwachukwu
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Brandon L Schneider
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Riley J Williams
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Joshua S Dines
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - David W Altchek
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | | | - Andrew Pearle
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA.,Investigation performed at Hospital for Special Surgery, New York, New York, USA
| | - Answorth Allen
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA.,Investigation performed at Hospital for Special Surgery, New York, New York, USA
| | - Beth Shubin Stein
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA.,Investigation performed at Hospital for Special Surgery, New York, New York, USA
| | - David Dines
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA.,Investigation performed at Hospital for Special Surgery, New York, New York, USA
| | - Anil Ranawat
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA.,Investigation performed at Hospital for Special Surgery, New York, New York, USA
| | - Anne Kelly
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA.,Investigation performed at Hospital for Special Surgery, New York, New York, USA
| | - Bryan Kelly
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA.,Investigation performed at Hospital for Special Surgery, New York, New York, USA
| | - Howard Rose
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA.,Investigation performed at Hospital for Special Surgery, New York, New York, USA
| | - Michael Maynard
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA.,Investigation performed at Hospital for Special Surgery, New York, New York, USA
| | - Sabrina Strickland
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA.,Investigation performed at Hospital for Special Surgery, New York, New York, USA
| | - Struan Coleman
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA.,Investigation performed at Hospital for Special Surgery, New York, New York, USA
| | - Jo Hannafin
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA.,Investigation performed at Hospital for Special Surgery, New York, New York, USA
| | - John MacGillivray
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA.,Investigation performed at Hospital for Special Surgery, New York, New York, USA
| | - Robert Marx
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA.,Investigation performed at Hospital for Special Surgery, New York, New York, USA
| | - Russell Warren
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA.,Investigation performed at Hospital for Special Surgery, New York, New York, USA
| | - Scott Rodeo
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA.,Investigation performed at Hospital for Special Surgery, New York, New York, USA
| | - Stephen Fealy
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA.,Investigation performed at Hospital for Special Surgery, New York, New York, USA
| | - Stephen O'Brien
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA.,Investigation performed at Hospital for Special Surgery, New York, New York, USA
| | - Thomas Wickiewicz
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA.,Investigation performed at Hospital for Special Surgery, New York, New York, USA
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