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Michaud A, Koskoletos C, Patterson BE, Crossley KM, Birmingham TB, Culvenor AG, Hart HF. Longitudinal changes in adiposity following anterior cruciate ligament reconstruction and associations with knee symptoms and function. OSTEOARTHRITIS AND CARTILAGE OPEN 2024; 6:100473. [PMID: 38737984 PMCID: PMC11088183 DOI: 10.1016/j.ocarto.2024.100473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 04/17/2024] [Accepted: 04/19/2024] [Indexed: 05/14/2024] Open
Abstract
Objective To evaluate adiposity after anterior cruciate ligament reconstruction (ACLR): i) cross-sectionally (1-year post-ACLR) compared to uninjured controls; ii) longitudinally up to 5 years post-ACLR; and iii) associations with patient-reported symptoms and physical performance. Methods In 107 individuals post-ACLR and 19 controls, we assessed global (BMI), peripheral (subcutaneous adipose tissue thickness on the posteromedial side of knee MRI), and central (waist circumference in ACLR group) adiposity. Patient-reported symptoms (Knee injury and Osteoarthritis Outcome Score) and physical performance (hop for distance) were evaluated at 1 and 5 years post-ACLR. Linear regression models evaluated adiposity between groups. Paired t-tests evaluated changes in adiposity from 1- to 5 years post-ACLR. Linear regression models analyzed adiposity's associations with patient-reported symptoms and physical performance at 1-year post-ACLR, changes in symptoms and performance over 4 years post-ACLR, and longitudinal changes in adiposity and symptoms and performance, controlling for age, sex, and activity level. Results Individuals 1-year post-ACLR were associated with higher average global (3 kg/m2) and peripheral adiposity (2.3 mm). From 1- to 5 years post-ACLR, higher average global (0.58 kg/m2) and central (5 cm) adiposity, and lower average peripheral adiposity (1.3 mm) were observed. In general, adiposity at one-year post-ACLR was negatively associated with patient-reported symptoms and physical performance, and changes from 1 to 5 years post-ACLR. Increases in adiposity were negatively associated with changes in patient-reported symptoms and physical performance over four years post-ACLR. Conclusion Greater global and central adiposity is a feature of young adults following ACLR and influences current and future patient-reported symptoms and physical performance.
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Affiliation(s)
- Amélie Michaud
- Action Sport Physio, Sherbrooke, Canada
- School of Physical Therapy, Western University, London, Canada
| | - Chris Koskoletos
- Rewind Physio, Embrun, Ontario, Canada
- School of Physical Therapy, Western University, London, Canada
| | - Brooke E. Patterson
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Kay M. Crossley
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | | | - Adam G. Culvenor
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Harvi F. Hart
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
- School of Physical Therapy, Western University, London, Canada
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Della Villa F, Di Paolo S, Crepaldi M, Santin P, Menditto I, Pirli Capitani L, Boldrini L, Ciampone L, Vassura G, Bortolami A, Bosi AN, Grassi A, Zaffagnini S. Kinematics of 90° change of direction in young football players: Insights for ACL injury prevention from the CUTtheACL study on 6008 trials. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38713875 DOI: 10.1002/ksa.12230] [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: 01/17/2024] [Revised: 03/20/2024] [Accepted: 03/26/2024] [Indexed: 05/09/2024]
Abstract
PURPOSE To investigate the 90° change of direction (COD) task in an extensive cohort of competitive healthy football players within the CUTtheACL study and to provide normative values and differences between males and females for full-body kinematics based on two-dimensional (2D) video analysis and scoring system. METHODS One-thousand-and-two competitive football (soccer) players (age 16.3 ± 2.8 years, 264 females) were prospectively enroled. Each player performed three preplanned 90° COD tasks per limb. The 2D evaluation was performed through objective measures (collected through three high-speed cameras) of frontal and sagittal plane joint kinematics at the cut initial foot contact (IC) and maximum knee flexion angle. A previously published scoring system was adopted to measure the movement quality of the COD task. The scoring system included five criteria (limb stability [LS], pelvis stability [PS], trunk stability [TS], shock absorption [SA], movement strategy [MS]) ranked from 0/2 (nonadequate) to 2/2 (adequate) with a maximum score of 10/10. Normative data were provided for all the variables; statistical differences between male and female players were investigated (p < 0.05). RESULTS A total of 6008 valid attempts were included. Frontal plane knee projection angle (FPKPA) at initial contact was 24.4 ± 9.8° (95th percentile: FPKPA > 40°). The total score was ≤4/10 in 71.2% of the trials, the lowest subscores were LS and PS. Female players showed different movement patterns with lower hip and trunk flexion both at IC and maximum knee flexion angle (p < 0.01, ES = 0.41-0.64). Female players also showed worse scores than males in SA, MS and total score (p < 0.01). CONCLUSION Female players seem more prone to stiffer lower limb strategy and greater pelvis-trunk frontal plane instability than males. Clinicians could adopt normative data and sex-specific differences in players' movement techniques to improve ACL injury risk mitigation protocols. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Francesco Della Villa
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Stefano Di Paolo
- 2nd Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Matteo Crepaldi
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Piefrancesco Santin
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Ilaria Menditto
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Luca Pirli Capitani
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Lorenzo Boldrini
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Luca Ciampone
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Gabriele Vassura
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Antonio Bortolami
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Andrea Nicolò Bosi
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Alberto Grassi
- 2nd Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Zaffagnini
- 2nd Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
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Adhitya IPGS, Kurniawati I, Sawa R, Wijaya TF, Dewi NPAC. The Risk Factors and Preventive Strategies of Poor Knee Functions and Osteoarthritis after Anterior Cruciate Ligament Reconstruction: A Narrative Review. Phys Ther Res 2023; 26:78-88. [PMID: 38125289 PMCID: PMC10730125 DOI: 10.1298/ptr.r0028] [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] [Accepted: 10/31/2023] [Indexed: 12/23/2023]
Abstract
Anterior cruciate ligament reconstruction (ACLR) is the standard surgical treatment for ACL injury, which typically uses a graft to replace the torn ligament in the knee that uses small incisions with minimally invasive surgery. The optimal knee functions following ACLR depend on rehabilitation processes before and after the surgery. Knee function is the ability of the knee to perform various types of functional movements like walking, squatting, running, jumping, and pivoting where patients expect to achieve maximum knee function or at least more than 80% of its initial condition before the injury to avoid being categorized as poor knee function after ACLR. Patients use patient-reported outcome measures to collect data on their health status and quality of life after ACLR. Post-traumatic osteoarthritis (PTOA) is a type of OA that manifests in local cartilage injury caused by chondrocyte death, and matrix dispersion occurs following a joint injury like ACL injury. Gender, time from injury to surgery, and graft type were considered as risk factors for poor knee function after ACLR, while overweight, meniscus tear, and cartilage defect as risk factors for PTOA. However, age is an internal risk factor for both poor knee function and PTOA following ACLR. This review suggests several strategies to prevent both conditions, including a pre-operative program, comprehensive rehabilitation, body weight control, and return to sport (RTS) consideration based on physical capacity, proper time, and psychological readiness.
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Affiliation(s)
| | - Ida Kurniawati
- Department of Histology, Faculty of Medicine and Health Sciences, Universitas Warmadewa, Indonesia
| | - Ryuichi Sawa
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Japan
| | - Tabita Febyola Wijaya
- Bachelor and Professional Program of Physical Therapy, College of Medicine, Universitas Udayana, Indonesia
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Huang SG, Wilson PL, Worrall HM, Ramo BA, Kapadia A, Ellis HB. Elective musculoskeletal surgery is associated with postoperative weight changes in pediatric and adolescent patients. J Child Orthop 2023; 17:489-496. [PMID: 37799309 PMCID: PMC10549699 DOI: 10.1177/18632521231198250] [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: 01/20/2023] [Accepted: 08/15/2023] [Indexed: 10/07/2023] Open
Abstract
Purpose Patients of elective orthopedic surgeries often reduce activity levels during postoperative recovery. It is unclear whether these extended periods of modified activities lead to weight changes. The purpose of this study was to evaluate changes in body mass index percentile in pediatric patients over 2.5 years following primary musculoskeletal surgeries. Methods Institutional records for utilized current procedural terminology codes were used to identify patients aged 21 years or younger who underwent elective surgery at a single pediatric orthopedic institution between October 2016 and December 2018. Non-primary surgeries and patients without preoperative body mass index measurements were excluded. Demographic characteristics, height, weight, and body mass index within 30 months of surgery were collected. Body mass index relative to age was calculated. Analysis of body mass index changes at follow-up intervals of 3-7, 9-18, and 24-30 months after surgery was performed for the overall sample, within surgical categories, and within preoperative weight classifications. Results A total of 1566 patients (53.1% female, average age 12.4 years) were included. Over one-third of patients were overweight or obese at presentation. The average change in body mass index percentile relative to baseline was increased at all follow-up intervals. Values reached significance at 9-18 months (p = .002) and 24-30 months (p = .001). While underweight and normal-weight patients had increased body mass index at all three timepoints, overweight or obese patients decreased. Conclusions Patients undergoing elective orthopedic procedures may experience significant changes in body mass index percentile postoperatively. At extremes of weight, patients experience improvement toward the mean, but most patients may undergo body mass index increases beyond what would be expected during normal growth. Level of evidence Retrospective level III.
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Affiliation(s)
- Sharon G Huang
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Philip L Wilson
- University of Texas Southwestern Medical Center, Dallas, TX, USA
- Scottish Rite for Children, Dallas, TX, USA
- Children’s Medical Center Dallas, Dallas, TX, USA
| | | | - Brandon A Ramo
- University of Texas Southwestern Medical Center, Dallas, TX, USA
- Scottish Rite for Children, Dallas, TX, USA
- Children’s Medical Center Dallas, Dallas, TX, USA
| | - Ami Kapadia
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Henry B Ellis
- University of Texas Southwestern Medical Center, Dallas, TX, USA
- Scottish Rite for Children, Dallas, TX, USA
- Children’s Medical Center Dallas, Dallas, TX, USA
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Johnson MA, Cirrincione PM, Zucker CP, Blanco JS, Widmann RF, Heyer JH. Changes in height, weight, and body mass index after posterior spinal fusion in juvenile and adolescent idiopathic scoliosis. J Child Orthop 2023; 17:354-359. [PMID: 37565004 PMCID: PMC10411370 DOI: 10.1177/18632521231177041] [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: 02/15/2023] [Accepted: 04/21/2023] [Indexed: 08/12/2023] Open
Abstract
Purpose Posterior spinal fusion for idiopathic scoliosis is known to increase spinal height, but the impacts on weight and resulting body mass index are unknown. This study assesses body mass index, weight, and height percentile changes over time after posterior spinal fusion for idiopathic scoliosis. Methods Body mass index, weight, and height age- and sex-adjusted percentiles for patients with idiopathic scoliosis undergoing posterior spinal fusion between January 2016 and August 2022 were calculated based on growth charts from the Centers for Disease Control for Disease Control and compared to preoperative values at 2 weeks, 3 months, 6 months, 1 year, and 2 years. The data were analyzed for normality with a Shapiro-Wilk test, and percentiles were compared with the Wilcoxon signed-rank tests. Results On average, 12.1 ± 2.3 levels were fused in 269 patients 14.4 ± 1.9 years, and percentiles for body mass index, weight, and height preoperatively were 55.5 ± 29.4%, 57.5 ± 28.9%, and 54.6 ± 30.4%, respectively. Body mass index and weight percentiles decreased at 2 weeks (-10.7%, p < 0.001; -4.6%, p < 0.001, respectively) and 3 months (-6.9%, p < 0.001; -3.2%, p < 0.001, respectively) postoperatively. Postoperative weight loss at 2 weeks averaged 2.25 ± 3.09% of body weight (0.98 ± 4.5 kg), normalizing by 3 months. Body mass index percentile normalized at 1 year, but height percentile was increased at 2 weeks (2.42 ± 1.72 cm, p < 0.001) and through 2 years. Conclusion Despite initial height increase due to deformity correction, acute postoperative weight and body mass index percentile decreases postoperatively normalize by 1-year body mass index percentile. Physicians may benefit from utilizing this information when discussing the postoperative course of posterior spinal fusion with idiopathic scoliosis. Level of evidence 4, Retrospective Case Series.
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Morgan K, Cowburn J, Farrow M, Carter J, Cazzola D, Walhin JP, McKay C. Understanding the role of physical activity on the pathway from intra-articular knee injury to post-traumatic osteoarthritis disease in young people: a scoping review protocol. BMJ Open 2023; 13:e067147. [PMID: 36868595 PMCID: PMC9990625 DOI: 10.1136/bmjopen-2022-067147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2023] Open
Abstract
INTRODUCTION The prevalence of intra-articular knee injuries and reparative surgeries is increasing in many countries. Alarmingly, there is a risk of developing post-traumatic osteoarthritis (PTOA) after sustaining a serious intra-articular knee injury. Although physical inactivity is suggested as a risk factor contributing to the high prevalence of the condition, there is a paucity of research characterising the association between physical activity and joint health. Consequently, the primary aim of this review will be to identify and present available empirical evidence regarding the association between physical activity and joint degeneration after intra-articular knee injury and summarise the evidence using an adapted Grading of Recommendations Assessment, Development and Evaluations. The secondary aim will be to identify potential mechanistic pathways through which physical activity could influence PTOA pathogenesis. The tertiary aim will be to highlight gaps in current understanding of the association between physical activity and joint degeneration following joint injury. METHODS A scoping review will be conducted using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews checklist and best-practice recommendations. The review will be guided by the following research question: what is the role of physical activity in the trajectory from intra-articular knee injury to PTOA in young men and women? We will identify primary research studies and grey literature by searching the electronic databases Scopus, Embase: Elsevier, PubMed, Web of Science: all databases, and Google Scholar. Reviewing pairs will screen abstracts, full texts and will extract data. Data will be presented descriptively using charts, graphs, plots and tables. ETHICS AND DISSEMINATION This research does not require ethical approval due to the data being published and publicly available. This review will be submitted for publication in a peer-reviewed sports medicine journal irrespective of discoveries and disseminated through scientific conference presentations and social media. TRIAL REGISTRATION NUMBER https://osf.io/84pnh/.
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Affiliation(s)
- Karl Morgan
- Department for Health, University of Bath, Bath, UK
- University of Bath, Centre for Health and Injury and Illness Prevention in Sport (CHI2PS), Bath, UK
- University of Bath, Centre for Nutrition and Exercise Metabolism (CNEM), Bath, UK
- Centre for Sport, Exercise and Osteoarthritis Versus Arthritis, University of Bath, Bath, UK
| | - James Cowburn
- Department for Health, University of Bath, Bath, UK
- University of Bath, Centre for Health and Injury and Illness Prevention in Sport (CHI2PS), Bath, UK
| | - Matthew Farrow
- Department for Health, University of Bath, Bath, UK
- University of Bath, Centre for Nutrition and Exercise Metabolism (CNEM), Bath, UK
| | - Josh Carter
- Department for Health, University of Bath, Bath, UK
- University of Bath, Centre for Health and Injury and Illness Prevention in Sport (CHI2PS), Bath, UK
| | - Dario Cazzola
- Department for Health, University of Bath, Bath, UK
- University of Bath, Centre for Health and Injury and Illness Prevention in Sport (CHI2PS), Bath, UK
- University of Bath, Centre for the Analysis of Motion, Entertainment Research and Applications (CAMERA), Bath, UK
| | - Jean-Philippe Walhin
- Department for Health, University of Bath, Bath, UK
- University of Bath, Centre for Nutrition and Exercise Metabolism (CNEM), Bath, UK
| | - Carly McKay
- Department for Health, University of Bath, Bath, UK
- University of Bath, Centre for Health and Injury and Illness Prevention in Sport (CHI2PS), Bath, UK
- Centre for Sport, Exercise and Osteoarthritis Versus Arthritis, University of Bath, Bath, UK
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Driban JB, Vincent HK, Trojian TH, Ambrose KR, Baez S, Beresic N, Berkoff DJ, Callahan LF, Cohen B, Franek M, Golightly YM, Harkey M, Kuenze CM, Minnig MC, Mobasheri A, Naylor A, Newman CB, Padua DA, Pietrosimone B, Pinto D, Root H, Salzler M, Schmitt L, Snyder-Mackler L, Taylor JB, Thoma LM, Vincent KR, Wellsandt E, Williams M. Evidence Review for Preventing Osteoarthritis After an Anterior Cruciate Ligament Injury: An Osteoarthritis Action Alliance Consensus Statement. J Athl Train 2023; 58:198-219. [PMID: 37130279 PMCID: PMC10176847 DOI: 10.4085/1062-6050-0504.22] [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: 05/04/2023]
Abstract
CONTEXT The Osteoarthritis Action Alliance formed a secondary prevention task group to develop a consensus on secondary prevention recommendations to reduce the risk of osteoarthritis after a knee injury. OBJECTIVE Our goal was to provide clinicians with secondary prevention recommendations that are intended to reduce the risk of osteoarthritis after a person has sustained an anterior cruciate ligament injury. Specifically, this manuscript describes our methods, literature reviews, and dissenting opinions to elaborate on the rationale for our recommendations and to identify critical gaps. DESIGN Consensus process. SETTING Virtual video conference calls and online voting. PATIENTS OR OTHER PARTICIPANTS The Secondary Prevention Task Group consisted of 29 members from various clinical backgrounds. MAIN OUTCOME MEASURE(S) The group initially convened online in August 2020 to discuss the target population, goals, and key topics. After a second call, the task group divided into 9 subgroups to draft the recommendations and supportive text for crucial content areas. Twenty-one members completed 2 rounds of voting and revising the recommendations and supportive text between February and April 2021. A virtual meeting was held to review the wording of the recommendations and obtain final votes. We defined consensus as >80% of voting members supporting a proposed recommendation. RESULTS The group achieved consensus on 15 of 16 recommendations. The recommendations address patient education, exercise and rehabilitation, psychological skills training, graded-exposure therapy, cognitive-behavioral counseling (lacked consensus), outcomes to monitor, secondary injury prevention, system-level social support, leveraging technology, and coordinated care models. CONCLUSIONS This consensus statement reflects information synthesized from an interdisciplinary group of experts based on the best available evidence from the literature or personal experience. We hope this document raises awareness among clinicians and researchers to take steps to mitigate the risk of osteoarthritis after an anterior cruciate ligament injury.
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Affiliation(s)
| | - Jeffrey B. Driban
- Division of Rheumatology, Allergy, and Immunology, Tufts Medical Center, Boston, MA
| | - Heather K. Vincent
- UF Health Sports Performance Center, Department of Physical Medicine and Rehabilitation, University of Florida, Gainesville
| | - Thomas H. Trojian
- UF Health Sports Performance Center, Department of Physical Medicine and Rehabilitation, University of Florida, Gainesville
| | | | - Shelby Baez
- Osteoarthritis Action Alliance, Thurston Arthritis Research Center, University of North Carolina at Chapel Hill
| | | | - David J. Berkoff
- Department of Kinesiology, Michigan State University, East Lansing
| | - Leigh F. Callahan
- Osteoarthritis Action Alliance, Thurston Arthritis Research Center, University of North Carolina at Chapel Hill
| | | | - Madison Franek
- University of North Carolina Therapy Services, UNC Wellness Center at Meadowmont, Chapel Hill
| | - Yvonne M. Golightly
- Department of Epidemiology, Thurston Arthritis Research Center, Injury Prevention Research Center, Osteoarthritis Action Alliance, University of North Carolina at Chapel Hill
| | - Matthew Harkey
- Department of Kinesiology, Michigan State University, East Lansing
| | | | - Mary Catherine Minnig
- Department of Epidemiology, Thurston Arthritis Research Center, Injury Prevention Research Center, Osteoarthritis Action Alliance, University of North Carolina at Chapel Hill
| | - Ali Mobasheri
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Finland; Department of Regenerative Medicine, State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania; Department of Joint Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; World Health Organization Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Liege, Belgium
| | | | - Connie B. Newman
- Department of Medicine, Division of Endocrinology, Diabetes & Metabolism, NYU Grossman School of Medicine, New York, NY
| | - Darin A. Padua
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - Brian Pietrosimone
- Department of Physical Therapy, Congdon School of Health Sciences, High Point University, NC
| | - Daniel Pinto
- Department of Physical Therapy, Marquette University, Milwaukee, WI
| | - Hayley Root
- Department of Physical Therapy, Marquette University, Milwaukee, WI
| | - Matthew Salzler
- Department of Physical Therapy and Athletic Training, Northern Arizona University, Flagstaff
| | - Laura Schmitt
- Division of Physical Therapy, School of Health and Rehabilitation Sciences, Ohio State University, Columbus
| | | | - Jeffrey B. Taylor
- Department of Physical Therapy, Congdon School of Health Sciences, High Point University, NC
| | - Louise M. Thoma
- Division of Physical Therapy, Department of Allied Health Sciences, University of North Carolina at Chapel Hill
| | - Kevin R. Vincent
- UF Health Sports Performance Center, Department of Physical Medicine and Rehabilitation, University of Florida, Gainesville
| | - Elizabeth Wellsandt
- Division of Physical Therapy Education, University of Nebraska Medical Center, Omaha
| | - Monette Williams
- Division of Physical Therapy Education, University of Nebraska Medical Center, Omaha
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Do Weightbearing Restrictions Cause Excess Weight Gain in Children With LEGG-Calvé-Perthes Disease? J Pediatr Orthop 2023; 43:31-36. [PMID: 36084623 DOI: 10.1097/bpo.0000000000002264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 08/11/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Restricted weight bearing is commonly prescribed in Legg-Calvé-Perthes Disease (LCPD), raising concerns of causing overweight or obesity. This study utilizes prospectively collected data to address the following questions: (1) does body mass index (BMI) Z-score increase over the course of LCPD follow-up; (2) is having a BMI category of normal, overweight, or obese at baseline associated with BMI Z-score changes over the course of follow-up; and (3) is the duration of weight bearing restrictions (no restrictions, <3, 3 to <6, 6 to 9, or >9 mo) associated with BMI Z-score changes. METHODS Data of 130 children aged 5 to 12 years with unilateral early-stage LCPD were extracted from an international database. Nation-specific BMI Z-scores and percentile-based weight categories were determined, and the duration of follow-up and weight bearing restrictions were calculated. Longitudinal changes in BMI Z-scores were evaluated for the 3 study questions using mixed effects linear regression models with surgery as a covariate. Sensitivity analyses were used to determine the influence of socio-cultural background (USA vs. India) for each study question. RESULTS During the 35.5±15.9 months of follow-up, no statistically significant increase in BMI Z-scores was observed across the entire cohort, or following stratification by baseline weight categories or the duration of the weight bearing restriction. Sensitivity analyses indicated that patients in the USA had no change in their BMI Z-score. When stratified by weight categories, the normal weight of US children had a small increase in their BMI Z-score (0.005 per mo, 95% confidence interval: 0.0002, 0.009), but this was not seen in other BMI categories. The cohort of Indian children had a small but significant decrease in their BMI Z-score (-0.005/mo, 95% CI: -0.009, -0.0002). After stratification by weight categories, a small decrease of the BMI Z-score was observed only in the Indian overweight children (-0.016 per mo, 95% CI: -0.027, -0.005) and no other BMI category. CONCLUSIONS Weightbearing restrictions over the course of follow-up for our cohort of children with early-stage LCPD were not associated with clinically meaningful increases of BMI Z-scores. Weight gain is multi-factorial and probably not caused by weight bearing restrictions alone. LEVEL OF EVIDENCE III Diagnostic Study.
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Edwards ER, Hazkani I, Stein E, Josefson JL, Samis JH, Miller JL, Rastatter J. Total Thyroidectomy and Subsequent Weight Gain in Pediatric Populations. Laryngoscope 2022; 133:1518-1523. [PMID: 36537365 DOI: 10.1002/lary.30532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/02/2022] [Accepted: 12/03/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To evaluate weight gain in children post-thyroidectomy and identify predictors. METHODS Charts from patients at a tertiary health care facility who underwent total thyroidectomy from 2014 to 2020 were reviewed for Body Mass Index z-scores (BMIz) at the time of thyroidectomy and at 1 and 2-year post-operation intervals. Patient demographic information, comorbidities, pre- and postoperative thyroid stimulating hormone, and postoperative free T4 levels were also extracted. Patients with other known endocrine abnormalities, chronic kidney disease, or without sufficient follow-up were excluded. RESULTS A total of 56 patients (ages 3-17 years old) met the inclusion criteria (n = 17 Graves' disease; n = 39 presumed cancer). Over the first year, average BMIz significantly increased in patients with Graves' disease (∆BMIz = 0.45 ± 0.77, p = 0.03), Hispanic ethnicity (∆BMIz = 0.43 ± 0.68, p = 0.004), Medicaid/no insurance coverage (∆BMIz = 0.33 ± 0.74, p = 0.038), age <13 years at thyroidectomy (∆BMIz = 0.35 ± 0.68, p = 0.016), and persistent postoperative hypothyroidism (∆BMIz = 0.41 ± 0.41, p = 0.012). These changes remained significant after the second year. Age at thyroidectomy correlated negatively with ∆BMIz only after the first year (r = -0.40, p = 0.002). Regression analysis, controlling for Graves' status, persistent postoperative hypothyroidism, and insurance coverage, identified age at thyroidectomy as a significant predictor of ∆BMIz after the first year (b = -0.06, p = 0.004) and Hispanic ethnicity as a significant predictor after the second year (b = 0.60, p = 0.003). CONCLUSION A small increase in BMIz post-thyroidectomy was observed across several patient subgroups. Younger age at thyroidectomy and Hispanic ethnicity were associated with increased BMIz in the first 2 years post-thyroidectomy. LEVEL OF EVIDENCE Level 4 - Historically controlled cohort Laryngoscope, 133:1518-1523, 2023.
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Affiliation(s)
- Evan R. Edwards
- Feinberg School of Medicine Northwestern University Chicago Illinois USA
| | - Inbal Hazkani
- Feinberg School of Medicine Northwestern University Chicago Illinois USA
- Division of Pediatric Otolaryngology‐Head and Neck Surgery Ann & Robert H. Lurie Children's Hospital of Chicago Chicago Illinois USA
| | - Eli Stein
- Feinberg School of Medicine Northwestern University Chicago Illinois USA
| | - Jami L. Josefson
- Feinberg School of Medicine Northwestern University Chicago Illinois USA
- Division of Pediatric Endocrinology Ann & Robert H. Lurie Children's Hospital of Chicago Chicago Illinois USA
| | - Jill H. Samis
- Feinberg School of Medicine Northwestern University Chicago Illinois USA
- Division of Pediatric Endocrinology Ann & Robert H. Lurie Children's Hospital of Chicago Chicago Illinois USA
| | - Jennifer L. Miller
- Feinberg School of Medicine Northwestern University Chicago Illinois USA
- Division of Pediatric Endocrinology Ann & Robert H. Lurie Children's Hospital of Chicago Chicago Illinois USA
| | - Jeffrey Rastatter
- Feinberg School of Medicine Northwestern University Chicago Illinois USA
- Division of Pediatric Otolaryngology‐Head and Neck Surgery Ann & Robert H. Lurie Children's Hospital of Chicago Chicago Illinois USA
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10
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Ang ACH, Wong D, Lui PPY. Increased Risk of Concomitant Meniscal Injuries in Adolescents With Elevated Body Mass Index After Anterior Cruciate Ligament Tear: A Systematic Review. Arthroscopy 2022; 38:3209-3221. [PMID: 35660518 DOI: 10.1016/j.arthro.2022.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 05/03/2022] [Accepted: 05/12/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate existing studies examining the association between body mass index (BMI) and outcomes of anterior cruciate ligament reconstruction (ACLR) in adolescent patients. METHODS A literature search was conducted on PubMed and Embase. Studies examining associations between BMI and outcomes after ACLR in adolescents were included. Quality assessment was performed. Data on patient age, sex, study design, time of follow-up, sample size, graft type, concomitant injuries (meniscal injury, surgical procedures), clinical outcomes (revision ACLR, postoperative weight gain, post-traumatic osteoarthritis [PTOA], range of motion [ROM]), and functional outcome (muscle strength) were extracted. RESULTS Eleven papers of Levels II-IV evidence were included. Five studies found positive correlations between BMI and risk of concomitant meniscal injuries. Two of them reported young patients with elevated BMI having 1.6 times greater odds of requiring meniscectomy (P < .01) and 1.031 times greater odds of requiring concomitant surgeries (P = .011). One study showed significant positive association of postoperative weight gain by time (r = 0.28, P < .01), with smaller increase in the overweight and obese groups compared with the normal-weight group. One study demonstrated greater cartilage breakdown in young patients with overweight and obesity postsurgery, contributing to PTOA (r = 0.42, P = .009). There was no clinically important difference in postoperative ROM and muscle strength. Four studies reviewed the association between BMI and revision ACLR risk, but results were heterogeneous and a firm conclusion cannot be drawn. CONCLUSIONS Adolescents with elevated BMI are more likely to have concomitant meniscal injuries and surgical procedures after ACL tear. There is some weak evidence of the association of elevated BMI with PTOA and slight postoperative weight gain post-ACLR. There may not be any clinically significant association of obesity with post-operative muscle strength and ROM, and current studies are inconclusive regarding the impact of BMI on revision ACLR risk. LEVEL OF EVIDENCE Level IV, systematic review of Level II-IV studies.
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Affiliation(s)
- Ashley Cheuk Hei Ang
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Doris Wong
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Pauline Po Yee Lui
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; Center for Neuromusculoskeletal Restorative Medicine, Hong Kong SAR, China.
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11
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Werner DM, Golightly YM, Tao M, Post A, Wellsandt E. Environmental Risk Factors for Osteoarthritis: The Impact on Individuals with Knee Joint Injury. Rheum Dis Clin North Am 2022; 48:907-930. [PMID: 36333003 DOI: 10.1016/j.rdc.2022.06.010] [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: 11/06/2022]
Abstract
Osteoarthritis is a debilitating chronic condition involving joint degeneration, impacting over 300 million people worldwide. This places a high social and economic burden on society. The knee is the most common joint impacted by osteoarthritis. A common cause of osteoarthritis is traumatic joint injury, specifically injury to the anterior cruciate ligament. The purpose of this review is to detail the non-modifiable and modifiable risk factors for osteoarthritis with particular focus on individuals after anterior cruciate ligament injury. After reading this, health care providers will better comprehend the wide variety of factors linked to osteoarthritis.
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Affiliation(s)
- David M Werner
- Office of Graduate Studies, Medical Sciences Interdepartmental Area, University of Nebraska Medical Center, 987815 Nebraska Medical Center, Omaha, NE 68198-7815, USA; Division of Physical Therapy Education, College of Allied Health Professions, University of Nebraska Medical Center, 984420 Nebraska Medical Center, Omaha, NE 68198-4420, USA.
| | - Yvonne M Golightly
- College of Allied Health Professions, University of Nebraska Medical Center, 984035 Nebraska Medical Center Omaha, NE 68198-4035, USA
| | - Matthew Tao
- Division of Physical Therapy Education, College of Allied Health Professions, University of Nebraska Medical Center, 984420 Nebraska Medical Center, Omaha, NE 68198-4420, USA; Department of Orthopedic Surgery and Rehabilitation, University of Nebraska Medical Center, 984420 Nebraska Medical Center, Omaha, NE 68198-4420, USA
| | - Austin Post
- College of Medicine, University of Nebraska Medical Center, 984420 Nebraska Medical Center, Omaha, NE 68198-4420, USA
| | - Elizabeth Wellsandt
- Division of Physical Therapy Education, College of Allied Health Professions, University of Nebraska Medical Center, 984420 Nebraska Medical Center, Omaha, NE 68198-4420, USA; Department of Orthopedic Surgery and Rehabilitation, University of Nebraska Medical Center, 984420 Nebraska Medical Center, Omaha, NE 68198-4420, USA
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12
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Tisano B, Anigian K, Kantorek N, Kenfack YJ, Johnson M, Brooks JT. The Insidious Effects of Childhood Obesity on Orthopedic Injuries and Deformities. Orthop Clin North Am 2022; 53:461-472. [PMID: 36208888 DOI: 10.1016/j.ocl.2022.06.008] [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: 02/02/2023]
Abstract
The current childhood obesity epidemic, affecting approximately 20% of American children and adolescents, is accompanied by unique orthopedic manifestations. The growing musculoskeletal system is susceptible to the endocrine effects of obesity, resulting in decreased bone mass and quality. As a result, obese children are at increased risk of musculoskeletal injury, fracture, and lower extremity deformities. The efficacy of nonoperative treatment such as casting or bracing may be limited by body habitus and surgical treatment is accompanied by increased risk of perioperative complications.
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Affiliation(s)
- Breann Tisano
- Department of Orthopaedic Surgery, UT-Southwestern, 1801 Inwood Road, Dallas, TX 75390, USA
| | - Kendall Anigian
- Department of Orthopaedic Surgery, UT-Southwestern, 1801 Inwood Road, Dallas, TX 75390, USA
| | - Nyssa Kantorek
- UT-Southwestern School of Medicine, 5323 Harry Hines Blvd, Dallas, TX 75390, USA
| | - Yves J Kenfack
- UT-Southwestern School of Medicine, 5323 Harry Hines Blvd, Dallas, TX 75390, USA
| | - Megan Johnson
- Department of Orthopaedic Surgery, Scottish Rite for Children/UT-Southwestern, 2222 Welborn Street, Dallas, TX 75219, USA
| | - Jaysson T Brooks
- Department of Orthopaedic Surgery, Scottish Rite for Children/UT-Southwestern, 2222 Welborn Street, Dallas, TX 75219, USA.
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13
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Hawkinson LE, Yates L, Minnig MC, Register-Mihalik JK, Golightly YM, Padua DA. Understanding Youth Sport Coaches' Perceptions of Evidence-Based Injury-Prevention Training Programs: A Systematic Literature Review. J Athl Train 2022; 57:877-893. [PMID: 36638345 PMCID: PMC9842123 DOI: 10.4085/1062-6050-0215.22] [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: 01/15/2023]
Abstract
OBJECTIVE To systematically review and summarize the knowledge, attitudes, beliefs, and contextual perceptions of youth sport coaches toward injury-prevention training programs by using the Theoretical Domains Framework to guide the organization of results. DATA SOURCES Systematic searches of PubMed and Google Scholar were undertaken in November 2021. STUDY SELECTION The Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol was followed. Results were limited to full-text articles that were published in peer-reviewed journals and printed in English. Additional studies were added after a citation search of included studies. Studies were eligible for inclusion if researchers evaluated youth sport coaches' knowledge, beliefs, contextual perceptions, or all 3 of anterior cruciate ligament injury-prevention training programs. DATA EXTRACTION Data charting was performed by 1 author and confirmed by a separate author. DATA SYNTHESIS Of the 1194 articles identified, 19 were included in the final sample. Among articles in which researchers assessed knowledge (n = 19), coaches' awareness of the existence and components of injury-prevention training programs was inconsistent. Among articles in which researchers assessed beliefs (n = 19), many coaches had positive attitudes toward injury-prevention training programs, but few believed youth athletes are at a high risk of injury. Among articles in which researchers assessed contextual perceptions (n = 13), many coaches did not feel they had access to information about injury-prevention training programs and cited a lack of time, space, support, and other resources as barriers to implementation. CONCLUSIONS Our findings support the need for programs, protocols, and policies to enhance knowledge of and support for youth sport coaches who wish to implement injury-prevention training programs. A gap exists in the research about addressing the needs of youth sport coaches in the United States high school sports setting. The use of multilevel implementation science frameworks (such as the Theoretical Domains Framework) will be beneficial for identifying constructs that affect implementation and developing train-the-trainer programming to meet the needs of individual youth sport coaches.
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Affiliation(s)
- Lauren E. Hawkinson
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill
| | - Lindsey Yates
- Department of Maternal and Child Health, University of North Carolina at Chapel Hill
| | - Mary Catherine Minnig
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Johna K. Register-Mihalik
- Matthew Gfeller Center and STAR Heel Performance Laboratory, Department of Exercise and Sport Science, Injury Prevention Research Center, University of North Carolina at Chapel Hill
| | - Yvonne M. Golightly
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill
- College of Allied Health Professions, University of Nebraska Medical Center, Omaha
| | - Darin A. Padua
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
- Department of Orthopaedics, Biomedical Engineering, Allied Health Sciences, University of North Carolina at Chapel Hill
- MOTION Science Institute, University of North Carolina at Chapel Hill
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14
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Zimmerer A, Schneider MM, Semann C, Schopf W, Sobau C, Ellermann A. 17-Year Results following Transepiphyseal Anterior Cruciate Ligament Reconstruction in Children and Adolescents. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2022; 160:393-399. [PMID: 33601463 DOI: 10.1055/a-1352-5541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Rupture of the anterior cruciate ligament (ACL) in childhood and adolescence is a serious injury. It is now known that conservative therapy of an unstable knee joint in childhood or adolescence under can lead to poor subjective and objective results. The aim of this study is to record long-term results after transepiphyseal ACL reconstruction using autologous hamstring tendons and extracortical fixation in childhood and adolescence with open physes - at least 15 years after surgery. METHODS Our internal registry was used to identify all patients who received surgical treatment of an acl tear during childhood and adolescence by transepiphyseal acl reconstruction more than 15 years previously. In these patients, the International Knee Documentation Committee for Subjective Knee Form (IKDCsubj.), Knee Injury and Osteoarthritis Outcome Score (KOOS), Tegner Activity Score (TAS) and Lysholm Score were collected, and clinical and magnetic resonance imaging (MRI) examinations were performed. RESULTS A total of 22 patients were identified, 5 of whom could not be contacted. The mean age at the time of surgery was 13.1 years, and the mean follow-up time was 17.4 years. In 3 patients, a traumatic tear was observed with subsequent reconstruction of the ACL. None of the included patients showed a growth disorder during the course of the study. The IKDCsubj. was 92.4 ± 14.7 (48 - 100), the Lysholm score was 87.9 ± 16.9 (34 - 100), the TAS was 5.7 ± 2.3 (3 - 9) and the pain level based on VAS was 3.5 ± 2.6 (1 - 8) points. The values showed subjective and objective deterioration compared to the 10-year results, with no statistical significance. The following subscores were reported for the KOOS: KOOSpain 90.9 ± 17.6 (28 - 100); KOOSsymptom 82.9 ± 22.6 (11 - 100); KOOOSADL 94.3 ± 13.7 (44 - 100); KOOSSport 80.3 ± 26.4 (15 - 100); KOOSQOL 80.9 ± 25.8 (0 - 100). 13 of the 17 patients could also be clinically and radiologically examined. In 92% of patients, an intact acl reconstruction was found without evidence of cartilage or meniscus damage. The mean lateral difference in the KT-1000 measurement was 1.5 mm. CONCLUSION ACL reconstruction in childhood and adolescence provides good functionality and stability of the knee joint over the long term. Secondary signs of osteoarthritis can only be detected in isolated cases by MRI. ACL reconstruction using the transepiphyseal technique can be considered the method of choice for open growth plate knee joints.
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Affiliation(s)
- Alexander Zimmerer
- Orthopaedic Clinic, ARCUS Clinic for Sports Medicine, Pforzheim, Germany.,Orthopaedic and Orthopaedic Surgery Clinic, University Medical Clinics Greifswald, Germany
| | - Marco M Schneider
- Orthopaedic Clinic, ARCUS Clinic for Sports Medicine, Pforzheim, Germany
| | - Carina Semann
- Orthopaedic Clinic, ARCUS Clinic for Sports Medicine, Pforzheim, Germany
| | - Wolfgang Schopf
- Orthopaedic Clinic, ARCUS Clinic for Sports Medicine, Pforzheim, Germany
| | - Christian Sobau
- Orthopaedic Clinic, ARCUS Clinic for Sports Medicine, Pforzheim, Germany
| | - Andree Ellermann
- Orthopaedic Clinic, ARCUS Clinic for Sports Medicine, Pforzheim, Germany
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15
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Walker A, Hing W, Gough S, Lorimer A. 'Such a massive part of rehab is between the ears'; barriers to and facilitators of anterior cruciate ligament reconstruction rehabilitation: a qualitative focus group analysis. BMC Sports Sci Med Rehabil 2022; 14:106. [PMID: 35701850 PMCID: PMC9199234 DOI: 10.1186/s13102-022-00499-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 05/30/2022] [Indexed: 12/05/2022]
Abstract
Background Current evidence demonstrates that few patients complete anterior cruciate ligament reconstruction rehabilitation according to evidence-based guidelines. It is important to investigate the viewpoints of our patients to identify patient-reported barriers and facilitators of anterior cruciate ligament reconstruction rehabilitation. Qualitative analysis can provide insight into potential methods for improving the delivery of rehabilitation services. Methods In this qualitative study, utilising a social constructionism orientation, viewed through the social phenomenological lens, three focus groups were conducted with individuals 1–20 years post anterior cruciate ligament reconstruction (n = 20, 9 males, 11 females, mean 6.5 years post-surgery, 19–51 years old). Utilising a semi-structured interview guide, participants were asked about their experiences during anterior cruciate ligament reconstruction rehabilitation. Focus groups were recorded, transcribed, and coded using an inductive semantic thematic analysis methodology. Results Five organising themes were identified (consisting of 19 sub-themes) to provide a framework to present the data: psychological, physiological, rehabilitation service, rehabilitation characteristics, and interaction with others. Each theme details aspects of rehabilitation, such as exercise delivery, informational support, frequency, and duration of care, kinesiophobia, weight management and interactions with teams and coaches, which present barriers or facilitators for patients to adhere to and participate in rehabilitation. Example quotes are provided for each theme to provide context and the patient’s voice. Conclusions This qualitative investigation identified key aspects of a patient's rehabilitation in which they encounter a variety of barriers and facilitators of ACL reconstruction rehabilitation. These aspects, such as the rehabilitation characteristics, service delivery, psychological and physiological factors, and interactions with others, were consistently identified by this cohort as factors which affected their rehabilitation. The themes may provide targets for clinicians to improve rehabilitation and deliver patient-centred care. However, the themes must be evaluated in future trials to assess whether interventions to remove barriers or enhance facilitators improves subsequent outcomes such as return to sport and re-injury rates. Supplementary Information The online version contains supplementary material available at 10.1186/s13102-022-00499-x.
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Affiliation(s)
- Adam Walker
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, 4226, Australia. .,Bond Institute of Health and Sport, Promethean Way, Robina, QLD, 4226, Australia.
| | - Wayne Hing
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, 4226, Australia
| | - Suzanne Gough
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, 4226, Australia
| | - Anna Lorimer
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, 4226, Australia
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16
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Ezzat AM, Brussoni M, Mâsse LC, Barton CJ, Emery CA. New or Recurrent Knee Injury, Physical Activity, and Osteoarthritis Beliefs in a Cohort of Female Athletes 2 to 3 Years After ACL Reconstruction and Matched Healthy Peers. Sports Health 2022; 14:842-848. [PMID: 35499092 PMCID: PMC9631034 DOI: 10.1177/19417381221091791] [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: 11/16/2022] Open
Abstract
BACKGROUND At 2 to 3 years after anterior cruciate ligament reconstruction (ACLR), the relationship between known modifiable osteoarthritis (OA) risk factors and recurrent knee injury is unknown. This study aimed to determine the odds of new or recurrent traumatic knee injury in a cohort of young female athletes with ACLR 2 to 3 years postsurgery compared with healthy control participants. Secondary objectives were to explore the relationships of moderate and vigorous physical activity (MVPA) and body mass index (BMI) with knee injury, and to document self-reported MVPA satisfaction and beliefs about OA. STUDY DESIGN Prospective cohort. LEVEL OF EVIDENCE Level 2. METHODS A total of 51 female athletes with unilateral ACLR 1 to 2 years previously and 51 age and sport-matched control participants underwent assessment of MVPA (GT3X accelerometers) and BMI. One year later, participants self-reported knee injuries. Bivariable conditional logistic regression explored the association between knee injury, MVPA, and BMI in each group (injury/control). RESULTS At 1-year follow-up (n = 101), 19.6% of the injured cohort and 6.0% of control participants sustained a new or recurrent knee injury. The odds of knee injury for the injury group increased 7-fold over controls [odds ratio (OR) = 7.00 (95% CI = 0.86, 56.90)], although this was not statistically significant. The OR for MVPA was 0.98 (95% CI = 0.93, 1.03) and BMI was OR = 1.24 (95% CI = 0.85, 1.82). Half (56.0%) of injury participants and 66% of controls were satisfied with their MVPA; 81.6% of injury participants believed they had increased knee OA risk compared with someone who had never had a knee injury. CONCLUSIONS In the 2 to 3 years after ACLR, 1 in 5 young female athletes had a new or recurrent knee injury. Based on the point estimate, injured participants were more likely to suffer a traumatic knee injury than matched control participants. MVPA and BMI were not associated with increased odds of knee injury. CLINICAL RELEVANCE Clinicians should be encouraged to have in-depth conversations with female athletes with previous ACLR regarding enjoyable and sustainable MVPA participation to promote long-term joint health.
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Affiliation(s)
- Allison M Ezzat
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Northcote, Australia.,Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Mariana Brussoni
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.,British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.,Human Early Learning Partnership, University of British Columbia, Vancouver, BC, Canada
| | - Louise C Mâsse
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.,British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Christian J Barton
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Northcote, Australia.,Department of Surgery, St Vincent's Hospital, The University of Melbourne, Australia
| | - Carolyn A Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Departments of Pediatrics and Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada.,The Alberta Children's Hospital Research Institute, O'Brien Institute of Public Health and McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada
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17
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Di Paolo SS, Nijmeijer E, Bragonzoni L, Dingshoff E, Gokeler A, Benjaminse A. Comparing lab and field agility kinematics in young talented female football players: implications for ACL injury prevention. Eur J Sport Sci 2022; 23:859-868. [PMID: 35400311 DOI: 10.1080/17461391.2022.2064771] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Modifiable (biomechanical and neuromuscular) anterior cruciate ligament (ACL) injury risk factors have been identified in laboratory settings. These risk factors were subsequently used in ACL injury prevention measures. Due to the lack of ecological validity, the use of on-field data in the ACL injury risk screening is increasingly advocated. Though, the kinematic differences between laboratory and on-field settings have never been investigated. The aim of the present study was to investigate the lower-limb kinematics of female footballers during agility movements performed both in laboratory and football field environments.Twenty-eight healthy young female talented football (soccer) players (14.9 ± 0.9 years) participated. Lower-limb joint kinematics was collected through wearable inertial sensors (Xsens Link) in three conditions: 1) laboratory setting during unanticipated sidestep cutting at 40-50°; on the football pitch 2) football-specific exercises (F-EX) and 3) football games (F-GAME). A hierarchical two-level random effect model in Statistical Parametric Mapping was used to compare joint kinematics among the conditions. Waveform consistency was investigated through Pearson's correlation coefficient and standardized z-score vector.In-lab kinematics differed from the on-field ones, while the latter were similar in overall shape and peaks. Lower sagittal plane range of motion, greater ankle eversion, and pelvic rotation were found for on-field kinematics (p<0.044). The largest differences were found during landing and weight acceptance.The biomechanical differences between lab and field settings suggest the application of context-related adaptations in female footballers and have implications in ACL injury prevention strategies.Highlights- Talented youth female football players showed kinematical differences between the lab condition and the on-field ones, thus adopting a context-related motor strategy.- Lower sagittal plane range of motion, greater ankle eversion, and pelvic rotation were found on the field. Such differences pertain to the ACL injury mechanism and prevention strategies.- Preventative training should support the adoption of non-linear motor learning to stimulate greater self-organization and adaptability- It is recommended to test football players in an ecological environment to improve subsequent primary ACL injury prevention programs.
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Affiliation(s)
- S Stefano Di Paolo
- Department for Life Quality Studies, University of Bologna, Via di Barbiano 1/10, Bologna, Italy
| | - Eline Nijmeijer
- Department of Human Movement Sciences, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands
| | - Laura Bragonzoni
- Department for Life Quality Studies, University of Bologna, Via di Barbiano 1/10, Bologna, Italy
| | - Evelien Dingshoff
- Department of Human Movement Sciences, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands
| | - Alli Gokeler
- Department Exercise & Health, Faculty of Science, Exercise and Neuroscience unit, Warburger Str 100, 33098 Paderborn, Germany.,Amsterdam Collaboration for Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, VU University Medical Center, Amsterdam, Netherlands.,OCON Centre for Orthopaedic Surgery and Sports Medicine Clinic, Hengelo, Netherlands
| | - Anne Benjaminse
- Department of Human Movement Sciences, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands.,School of Sport Studies, Hanze University Groningen, Groningen, The Netherlands
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18
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Implementing ACL Injury Prevention in Daily Sports Practice-It's Not Just the Program: Let's Build Together, Involve the Context, and Improve the Content. Sports Med 2021; 51:2461-2467. [PMID: 34533777 PMCID: PMC8589765 DOI: 10.1007/s40279-021-01560-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2021] [Indexed: 11/03/2022]
Abstract
Although the benefits of current anterior cruciate ligament (ACL) injury prevention programmes have been demonstrated in efficacy studies, they, unfortunately, have had limited public health impact to date. For example, the incidence of ACL injuries continues to rise in adolescent athletes. Raising awareness and educating coaches and athletes is not enough to facilitate the widespread, sustained use of these programmes in the real-world setting. Considering the profound burden of ACL injuries, it is necessary to continue to improve the current ACL injury prevention programmes through co-creation. First, the uptake of the programmes should be optimized by a better appreciation and understanding of the individual, socio-cultural and environmental context (i.e., community). Second, the content of the programmes should be optimized to better reflect the demands of the sport by creating more ownership and increasing motivation (incorporating challenging, sport-specific and fun elements) with the end-users. In addition, implicit motor learning, random practice and differential learning are concepts that should be integrated when practising to obtain the most optimal results when learning or finetuning skills.
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19
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Triplett AN, Kuenze CM. Characterizing body composition, cardiorespiratory fitness, and physical activity in women with anterior cruciate ligament reconstruction. Phys Ther Sport 2020; 48:54-59. [PMID: 33373903 DOI: 10.1016/j.ptsp.2020.12.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 12/14/2020] [Accepted: 12/16/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The purpose was to compare body composition, cardiorespiratory fitness, and physical activity (PA) engagement between women with ACLR and healthy controls. DESIGN Cross-sectional study. SETTING University laboratory. PARTICIPANTS Ten women with ACLR (time since surgery = 33.0 ± 18.3 months; age = 21.4 ± 3.8 years) and 10 healthy women (age = 21.9 ± 3.1 years) matched based on age (±2 years) and Tegner Activity Level (±2) participated. MAIN OUTCOME MEASURES Body fat percentage (%BF) was estimated using air displacement plethysmography, cardiorespiratory fitness was assessed via a graded cycle test, and PA was assessed using accelerometers worn for 7 days. Groups were compared using Mann-Whitney U tests. Time (minutes/week) spent in moderate-to-vigorous PA and step count (steps/day) were compared between groups using a one-way ANCOVA with 7-day total wear time as the only covariate. Statistical significance was established a priori as α ≤ 0.05. RESULTS Women with ACLR had significantly higher %BF than controls (ACLR = 32.7 ± 6.7%, healthy = 22.6 ± 4.9%; p < 0.01) and participated in less steps per day (ACLR = 6650 ± 3227 steps/day, healthy = 9361 ± 2626 steps/day; p = 0.02). CONCLUSIONS There may be persistent negative effects on body composition and PA engagement for women following ACLR. Low PA and high %BF have adverse consequences for premature mortality and morbidity; therefore, it is crucial to assess these characteristics and determine interventions to maintain PA and healthy body composition following ACLR.
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Affiliation(s)
- Ashley N Triplett
- Department of Kinesiology, Michigan State University, East Lansing, MI, USA.
| | - Christopher M Kuenze
- Department of Kinesiology, Michigan State University, East Lansing, MI, USA; Department of Orthopaedics, Michigan State University, East Lansing, MI, USA.
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