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Russo A, Costa GG, Musumeci MA, Giancani M, Di Naro C, Pegreffi F, Testa G, Sapienza M, Pavone V. Anterior Cruciate Ligament Reconstruction with Modified Transtibial Technique: Outcomes and Return to Sport in Athletes. Healthcare (Basel) 2025; 13:1056. [PMID: 40361834 PMCID: PMC12071300 DOI: 10.3390/healthcare13091056] [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: 03/19/2025] [Revised: 04/25/2025] [Accepted: 05/02/2025] [Indexed: 05/15/2025] Open
Abstract
BACKGROUND Anterior cruciate ligament (ACL) injuries are common among athletes and significantly impact their knee stability and performance. Surgical reconstruction is the standard treatment. The modified transtibial technique has emerged as a promising surgical approach for optimal graft positioning and complication reduction. METHODS A retrospective study of athletes who underwent primary ACL reconstruction with the modified transtibial technique was conducted. Clinical outcomes were evaluated using the Lysholm and International Knee Documentation Committee (IKDC) subjective scores and objective knee stability assessments. Return-to-sport rates and associated factors were analyzed. RESULTS Forty-four athletes were included (thirty-seven males, seven females; mean age 21.2 ± 5.0 years). At mean follow-up of 27.0 ± 12.2 months, significant improvements in the Lysholm and IKDC subjective scores were observed. Overall, 88.2% of athletes returned to sports, and 65.9% achieved their pre-injury levels. Return to pre-injury level was defined as regaining the same type, intensity, and frequency of sport participation as before the injury occurred. Professional athletes showed significantly higher return-to-pre-injury-sport rates (79.3%) than recreational athletes (40.0%, p = 0.0091). Concomitant meniscus injuries negatively impacted return-to-sport rates (92.9% versus 66.7%, p = 0.0397). The overall failure rate was 4.6% (2/44; 95% confidence level [CI]: 0.6-15.5%) with two cases of graft insufficiency or re-rupture. CONCLUSIONS ACL reconstruction with the modified transtibial technique provides favorable clinical outcomes, high return-to-sport rates, and low failure rates, particularly among professional athletes. Meniscus preservation is crucial for optimizing post-operative recovery. Future research should focus on long-term outcomes and comparative studies with other ACL reconstruction techniques.
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Affiliation(s)
- Arcangelo Russo
- Faculty of Medicine and Surgery, Kore University of Enna, 94100 Enna, Italy; (A.R.); (G.G.C.); (C.D.N.); (F.P.)
- Orthopaedic and Traumatologic Unit, Umberto I Hospital, Azienda Sanitaria Provinciale di Enna, 94100 Enna, Italy;
| | - Giuseppe Gianluca Costa
- Faculty of Medicine and Surgery, Kore University of Enna, 94100 Enna, Italy; (A.R.); (G.G.C.); (C.D.N.); (F.P.)
- Orthopaedic and Traumatologic Unit, Umberto I Hospital, Azienda Sanitaria Provinciale di Enna, 94100 Enna, Italy;
| | - Maria Agata Musumeci
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopedics and Traumatology, A.O.U. Policlinico Rodolico-San Marco, University of Catania, 95100 Catania, Italy; (M.A.M.); (G.T.); (V.P.)
| | - Michele Giancani
- Orthopaedic and Traumatologic Unit, Umberto I Hospital, Azienda Sanitaria Provinciale di Enna, 94100 Enna, Italy;
- Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, 90133 Palermo, Italy
| | - Calogero Di Naro
- Faculty of Medicine and Surgery, Kore University of Enna, 94100 Enna, Italy; (A.R.); (G.G.C.); (C.D.N.); (F.P.)
- Orthopaedic and Traumatologic Unit, Umberto I Hospital, Azienda Sanitaria Provinciale di Enna, 94100 Enna, Italy;
| | - Francesco Pegreffi
- Faculty of Medicine and Surgery, Kore University of Enna, 94100 Enna, Italy; (A.R.); (G.G.C.); (C.D.N.); (F.P.)
- Unit of Recovery and Functional Rehabilitation, Umberto I Hospital, Azienda Sanitaria Provinciale di Enna, 94100 Enna, Italy
| | - Gianluca Testa
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopedics and Traumatology, A.O.U. Policlinico Rodolico-San Marco, University of Catania, 95100 Catania, Italy; (M.A.M.); (G.T.); (V.P.)
| | - Marco Sapienza
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopedics and Traumatology, A.O.U. Policlinico Rodolico-San Marco, University of Catania, 95100 Catania, Italy; (M.A.M.); (G.T.); (V.P.)
| | - Vito Pavone
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopedics and Traumatology, A.O.U. Policlinico Rodolico-San Marco, University of Catania, 95100 Catania, Italy; (M.A.M.); (G.T.); (V.P.)
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Çakar B, Uzun E, Xıaokaıtı W, Canbaz SB, Güney A. Positive impact of patient participation in arthroscopic anterior cruciate ligament reconstruction surgery on clinical and functional outcomes, rehabilitation and patient satisfaction. BMC Musculoskelet Disord 2025; 26:252. [PMID: 40082881 PMCID: PMC11905494 DOI: 10.1186/s12891-025-08480-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2024] [Accepted: 02/28/2025] [Indexed: 03/16/2025] Open
Abstract
BACKGROUND This study aimed to evaluate the effect of patient participation on clinical and functional outcomes, satisfaction, and compliance with postoperative rehabilitation in patients undergoing surgery for anterior cruciate ligament (ACL) injury. METHODS Sixty-one patients who underwent isolated ACL reconstruction (ACLR) were included. Thirty patients in the participation group were shown the arthroscopy screen and allowed to communicate with the surgeon during surgery. For clinical and functional evaluation, knee joint range of motion (ROM), International Knee Documentation Committee Subjective Knee Form (IKDC), Knee Injury and Osteoarthritis Outcome Score (KOOS), Lysholm Knee Scoring Scale (LKSS), Short Form-36 (SF-36) score, and Tegner Activity Scale (TAS), were used. The Pain Quality Assessment Scale was used to assess pain. Additionally, the patient's satisfaction and exercise compliance were evaluated using a 5-point Likert scale and percentage of exercise participation, respectively. RESULTS At 3rd week, the ROM, SF-36, LKSS values, and pain scores were better in the participation group compared to the control group(p <.05). At 6th month, the IKDC, KOOS, SF-36 values and pain scores were also better in the participation group compared to the control group (p <.05). However, the ROM, LKSS, and TAS values were similar between groups at the 6th month(p >.05). Postop satisfaction at 3rd week and 6th month and exercise compliance postoperatively were significantly better in the participation group compared to the control group(p <.05). CONCLUSION Patient participation during ACLR surgery by communicating with the surgeon positively affects clinical and functional outcomes. It also contributes to patient satisfaction and compliance with the rehabilitation program postoperatively. CLINICAL TRIAL NUMBER Not Applicable.
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Affiliation(s)
- Burak Çakar
- Department of Orthopedics and Traumatology, Erciyes University, Kayseri, Turkey
| | - Erdal Uzun
- Department of Orthopedics and Traumatology, Erciyes University, Kayseri, Turkey.
| | - Wubulıkasımu Xıaokaıtı
- Department of Orthopedics and Traumatology, İstanbul Başakşehir Çam ve Sakura City Hospital, İstanbul, Turkey
| | - Sebati Başer Canbaz
- Department of Orthopedics and Traumatology, Kartal Dr. Lütfi Kırdar City Hospital, İstanbul, Turkey
| | - Ahmet Güney
- Private Kayseri Tekden Hospital, Kayseri, Turkey
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Nedder VJ, Raju AG, Moyal AJ, Calcei JG, Voos JE. Impact of Psychological Factors on Rehabilitation After Anterior Cruciate Ligament Reconstruction: A Systematic Review. Sports Health 2025; 17:291-298. [PMID: 39041333 PMCID: PMC11569572 DOI: 10.1177/19417381241256930] [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: 07/24/2024] Open
Abstract
CONTEXT Anterior cruciate ligament (ACL) tears are a common orthopaedic injury, and the incidence of ACL reconstruction (ACLR) continues to increase. Current clinical practice guidelines (CPGs) recognize the role of psychological factors in rehabilitation, but patient-reported outcome measures (PROs) and psychological readiness are rarely incorporated into rehabilitation. OBJECTIVE The purpose of this review was to highlight the importance of psychological health after ACL injury, understand the current metrics used to monitor psychological recovery, and outline how psychological recovery can be better incorporated in current CPGs. DATA SOURCES A systematic review was conducted using the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines (PRISMA); 63 studies were identified with a PubMed search using the term "ACL Injuries/psychology". STUDY SELECTION Exclusion criteria included lack of consideration of psychological effects or studies validating PROs after ACLR. Studies were reviewed by multiple reviewers, and a total of 38 studies were included after applying exclusion criteria. STUDY DESIGN Systematic review. LEVEL OF EVIDENCE Level 3b. DATA EXTRACTION Two independent reviewers analyzed the included articles to extract sample size, psychological readiness scale or other measures used, and key results. RESULTS Psychological outcomes, especially kinesiophobia and fear of reinjury, are seen commonly after ACLR. Psychological factors were shown to impede return to sport (RTS), alter measurable knee biomechanics, and potentially increase the risk for re-rupture. Targeted interventions such as kinesiotaping, knee bracing, and imagery training can help improve psychological and functional testing after ACLR. CONCLUSION ACLR is often complicated by psychological factors. Psychological readiness is a crucial yet often unincorporated part of rehabilitation. Patients with higher levels of kinesiophobia and lower psychological readiness to RTS specifically should be identified to allow for administration of interventions, such as imagery training, knee bracing, or kinesiotaping, that can mitigate the negative effects of psychological outcomes and improve recovery.
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Affiliation(s)
| | - Akash G. Raju
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Andrew J. Moyal
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Jacob G. Calcei
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - James E. Voos
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
- Case Western Reserve University School of Medicine, Cleveland, Ohio
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Kaur M, Chmielewski TL, Saliba S, Hart J. How Does Physical and Psychological Recovery Vary Among Competitive and Recreational Athletes After Anterior Cruciate Ligament Reconstruction? Sports Health 2025; 17:272-280. [PMID: 38736252 PMCID: PMC11569635 DOI: 10.1177/19417381241249413] [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: 05/14/2024] Open
Abstract
BACKGROUND The recovery and rehabilitation journey after anterior cruciate ligament reconstruction (ACLR) surgery can be different for competitive and recreational athletes as their motivation and goals toward sports are different. HYPOTHESIS Competitive athletes would present with better patient-reported outcomes and higher muscle strength compared with recreational athletes postsurgery. Second, competitive athletes would recover better (patient-reported outcome [PRO] measures and muscle strength) compared with recreational athletes at later stages. STUDY DESIGN Cross-sectional laboratory-based study. LEVEL OF EVIDENCE Level 2. METHODS A total of 245 patients with unilateral ACLR were categorized as competitive or recreational athletes and grouped into early (4-6.9 months) or late (7-10 months) stages of recovery. PRO were collected for psychological response (Tampa Scale Kinesiophobia; Anterior Cruciate Ligament-Return to Sport after Injury), perceived knee function (International Knee Documentation Committee subjective form [IKDC]), and quality of life (Knee injury and Osteoarthritis Outcome Score; Veteran Rand-12). Isokinetic, concentric knee extension strength was measured bilaterally with a multimodal dynamometer (System 4, Biodex Medical Systems) at a speed of 90° and 180°/s. RESULTS Competitive athletes had significantly higher scores for IKDC (P = 0.03), and quadriceps peak torque at 90°/s (P = 0.01) and 180°/s (P < 0.01) compared with recreational athletes. Competitive athletes had higher quadriceps strength at 90°/s (P < 0.01) and 180°/s (P = 0.02) in the late group. Recreational athletes displayed higher sports participation in the late group. CONCLUSION Outcomes of ACLR may differ based on preinjury athletic level. Whereas competitive athletes had higher knee and muscle function than recreational athletes, psychological measures were not different among groups. CLINICAL RELEVANCE There is a need for more individualized care for patients with ACLR since there is variability among patient goals postsurgery. This information might help set realistic expectations for competitive and recreational athletes after surgery.
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Affiliation(s)
- Mandeep Kaur
- School of Health Professions, Department of Physical Therapy and Rehabilitation Sciences, University of Texas Medical Branch, Galveston, Texas
| | | | - Susan Saliba
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia
| | - Joe Hart
- Department of Orthopaedic Surgery, University of North Carolina, Chapel Hill, North Carolina
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Högberg J, Fridh E, Piussi R, Hamrin Senorski R, Cristiani R, Samuelsson K, Thomeé R, Hamrin Senorski E. Delayed Anterior Cruciate Ligament Reconstruction Is Associated With Lower Odds of Returning to Preinjury Physical Activity Level at 12 Months Follow-Up. Arthroscopy 2025:S0749-8063(25)00132-X. [PMID: 39983801 DOI: 10.1016/j.arthro.2025.02.011] [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: 05/13/2024] [Revised: 01/26/2025] [Accepted: 02/05/2025] [Indexed: 02/23/2025]
Abstract
PURPOSE To examine the effects of timing of anterior cruciate ligament (ACL) reconstruction on the odds to recover muscle (quadriceps and hamstring) strength, return to preinjury physical activity level, and achieve rehabilitation goals at 12 months follow-up. METHODS Data were extracted from a local rehabilitation registry in Sweden in November 2023. Patients ≥16 years old who underwent primary ACL reconstruction with hamstring tendon autografts, who underwent isokinetic muscle strength assessment, and responded to patient-reported outcomes 12 months after surgery were included. A multivariable logistic regression analysis was used to analyze the association between timing of ACL reconstruction and the recovery of muscle strength, return to preinjury physical activity level, and achievement of rehabilitation goals. The results of the logistic regression analysis were expressed as odds ratios for every 1-unit increase in the predictor variable (months between ACL injury and reconstruction). RESULTS In total, 715 patients were included, of whom 53.4% (n = 383) were women. The mean age at ACL reconstruction was 28.3 ± 10.5 years, and the median time between ACL injury to reconstruction was 4.9 months (interquartile range [IQR] 2.9-9.4). Delayed ACL reconstruction significantly decreased the odds of returning to preinjury physical activity level at 12 months in patients with a Tegner score of 6-10 (odds ratio 0.97; 95% confidence interval 0.94-0.99, P = .009), regardless of age. Shorter median time in months from ACL injury to reconstruction was observed for patients who returned to preinjury physical activity level, especially in younger patients (16-30 years old) (3.9 [IQR 2.5, 6.5] vs 4.7 [IQR 2.9, 9.1], P = .007) and in patients who participated in pivoting activities (Tegner scale 6-10) preinjury (3.4 [IQR 2.3, 6.2] vs 5.0 [IQR 2.9, 9.7], P < .001). CONCLUSIONS Delayed ACL reconstruction reduces the odds of returning to preinjury physical activity level in patients active in pivoting activities preinjury (Tegner 6-10), regardless of age, 12 months after surgery. LEVEL OF EVIDENCE Level III, retrospective study.
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Affiliation(s)
- Johan Högberg
- Sportrehab Sports Medicine Clinic, Gothenburg, Sweden; Sahlgrenska Sports Medicine Center, Gothenburg, Sweden; Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Emily Fridh
- Sportrehab Sports Medicine Clinic, Gothenburg, Sweden
| | - Ramana Piussi
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden; Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Rebecca Hamrin Senorski
- Sportrehab Sports Medicine Clinic, Gothenburg, Sweden; Sahlgrenska Sports Medicine Center, Gothenburg, Sweden; Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Riccardo Cristiani
- Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institute, Stockholm, Sweden; Capio Artro Clinic, FIFA Medical Centre of Excellence, Sophiahemmet Hospital, Stockholm, Sweden
| | - Kristian Samuelsson
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden; Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Roland Thomeé
- Sportrehab Sports Medicine Clinic, Gothenburg, Sweden; Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eric Hamrin Senorski
- Sportrehab Sports Medicine Clinic, Gothenburg, Sweden; Sahlgrenska Sports Medicine Center, Gothenburg, Sweden; Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Murray M, Wekesser M, DeFreese JD, Kuenze C, Brinkman C, Gould D, Baez S. Patient Perceptions of Psychological and Rehabilitation Experiences After Anterior Cruciate Ligament Reconstruction: A Qualitative Study. J Sport Rehabil 2025; 34:77-83. [PMID: 39527947 DOI: 10.1123/jsr.2023-0385] [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] [Received: 11/09/2023] [Revised: 08/11/2024] [Accepted: 08/18/2024] [Indexed: 11/16/2024]
Abstract
CONTEXT Over 80% of patients anticipate fully returning to sport (RTS) within 1 year after anterior cruciate ligament reconstruction (ACLR), but only one quarter of patients succeed. Although several factors influence the RTS process, this study focused on how psychological responses to injury, such as injury-related fear and self-determined motivation, help to explain variation in rehabilitation experiences. There is limited information about how these meaningful psychological responses to injury are connected to responses such as athlete burnout or how patient perceptions of these responses relate to rehabilitation. The purpose of this qualitative study was to explore how patient perceptions of injury-related fear, self-determined motivation, and athlete burnout influence individual psychological and rehabilitation experiences at 4 to 6 months post-ACLR. DESIGN Qualitative study. METHODS Eight patients (female = 4, age = 16.3 ± 1.9) between 4 and 6 months post-ACLR who injured their knee playing or training for sports were included in the study. Patients completed the Sport Motivation Scale-6, Athlete Burnout Questionnaire, Perceived Stress Scale 4, and Tampa Scale of Kinesiophobia-11 to measure self-determined motivation, athlete burnout, stress, and injury fear. These questionnaires collected descriptive data used to guide audio- and video-recorded semistructured interviews. The interviews were transcribed and analyzed in a 6-stage process of thematic analysis. RESULTS Thematic analysis revealed 3 themes related to how participants perceived their rehabilitation experiences: (1) acknowledging recurring struggles during recovery, (2) finding motivation to RTS and normal life, and (3) successfully navigating the recovery process. In particular, participants described the impact of positive shifts in their psychological perceptions at 4 to 6 months post-ACLR. CONCLUSIONS Patients 4 to 6 months post-ACLR described how struggles during their recovery and rehabilitation experiences were improved by positive shifts in their psychological perceptions. Increasing positive psychological awareness within a supportive rehabilitation environment may improve rehabilitation experiences and RTS rates after ACLR.
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Affiliation(s)
- Megan Murray
- Department of Kinesiology, Michigan State University, East Lansing, MI, USA
| | - Meredith Wekesser
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA
| | - J D DeFreese
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, NC, USA
| | - Christopher Kuenze
- Department of Kinesiology, University of Virginia, Charlottesville, VA, USA
| | - Caitlin Brinkman
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, NC, USA
| | - Daniel Gould
- Department of Kinesiology, Michigan State University, East Lansing, MI, USA
| | - Shelby Baez
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, NC, USA
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Legnani C, Del Re M, Peretti GM, Macchi V, Borgo E, Ventura A. Return to sport at the pre-injury level following anterior cruciate ligament reconstruction is influenced by patients' perceived knee status and psychological readiness, and does not correlate with functional ability. J ISAKOS 2025; 10:100369. [PMID: 39622414 DOI: 10.1016/j.jisako.2024.100369] [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] [Received: 09/16/2023] [Revised: 11/20/2024] [Accepted: 11/21/2024] [Indexed: 01/16/2025]
Abstract
OBJECTIVES The purposes of this study were to (1) prospectively evaluate clinical and functional outcomes of athletes following anterior cruciate ligament (ACL) reconstruction up to 12 months after surgery, (2) to identify the correlations between functional and subjective tests, and (3) to determine which factors influence patients' capability to resume sports at pre-injury level. METHODS Patients who underwent ACL reconstruction using doubled autologous hamstring graft were prospectively assessed pre-operatively, 6, and 12 months after surgery using International Knee Documentation Committee (IKDC) Subjective Knee Form, Tegner activity level, and ACL-Return to Sport after Injury (ACL-RSI) scale. Jumping ability was instrumentally assessed using a test battery including bipodalic squat jump (SJ), bipodalic countermovement jump (CMJ), monopodalic CMJ, and monopodalic side-hop test. RESULTS Thirty-three patients were available for clinical evaluation at 12-months follow-up. Average age was 34.0 years (SD 11.5, range 19-50). Male/female ratio was 31:2. Mean overall IKDC, and ACL-RSI scores increased from 52.5 to 47.1 preoperatively, to 89.9 (SD: 12.2, range 36.8-100) and 81.3 (SD 21.7, range 10-98.3), respectively at last follow-up (p < 0.001). Monopodalic jump tests showed improvements at 12-month evaluation compared to 6-month follow-up (p < 0.01). No statistically significant correlation was reported for ACL-RSI and jump limb symmetry index (LSI) (p = 0.08 vs. CMJ; p = 0.07 vs. side-hop test). No differences were observed in terms of jump LSI between patients who returned to pre-injury activity level and those who did not (p = 0.11 for CMJ, p = 0.09 for side-hop test). A significantly higher IKDC score at 6 months was observed in patients who did not return to pre-injury levels (p = 0.009). Patients who did not return to pre-injury activity reported lower ACL-RSI scores at 12-months follow-up (p = 0.007). CONCLUSIONS One year after ACL reconstruction, an improvement in jumping ability was observed, while a persistence of lower limbs asymmetries when performing jump tests was noted at 6-months follow-up. The ability to perform vertical jumps was not influenced by psychological outcomes 12 months following surgery. Higher values of subjective knee score and psychological readiness weakly correlated to return to sport at preinjury level, while no correlation was reported concerning jumping performance.
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Affiliation(s)
| | | | - Giuseppe M Peretti
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy; Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | | | - Enrico Borgo
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
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Sandon A, Kvist J, Hedevik H, Forssblad M. Return to competition after ACL reconstruction: Factors influencing rates and timing in Swedish football players. Knee Surg Sports Traumatol Arthrosc 2025. [PMID: 39865456 DOI: 10.1002/ksa.12579] [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: 08/27/2024] [Revised: 12/25/2024] [Accepted: 12/27/2024] [Indexed: 01/28/2025]
Abstract
PURPOSE To investigate the rate and timing for return to football league games after anterior cruciate ligament reconstruction (ACLR) in Swedish players, examining associations with sex, age, level, graft and additional ACL surgery. METHOD Data from the Swedish National Knee Registry (SNKLR) and the Swedish Football Association's IT System (FOGIS) were used. The study cohort comprised 971 football players, 64% males, who underwent primary ACLR. Demographics, graft type and surgical information were extracted from the SNKLR and game participation from FOGIS. Follow-up for return to competition (RTC) was conducted for 36 months, while additional ACLR follow-up was 3-7 years. Statistical analyses, including Kaplan-Meier survival curves and relative risk calculations, were employed to assess factors influencing RTC rates and timing. RESULTS Out of 971 players analyzed, 53% RTC within 3 years with no difference between males and females, at a mean of 15 months (median 14 months) from surgery to the first game. Eleven (2%) players RTC < 6 months from ACLR, 62 (12%) 6-9 months, 125 (24%) 9-12 months and 331 (63%) >12 months. Patellar tendon (PT) grafts demonstrated superior performance, showing quicker returns and higher RTC rates (p = 0.005) compared to hamstring (hazard ratio [HR]: 0.63 [0.48-0.84]) and quadriceps tendon grafts (HR: 0.53 [0.30-0.93]). Players competing in higher divisions pre-injury experienced significantly swifter and higher RTC rates (p < 0.001). Ninety-five (10%) had a registered additional ACLR. Players who RTC did not exhibit a significantly higher rate of revision (35 [7%] vs. 25 [5%]). However, those who returned faced a heightened risk of contralateral ACLRs compared to those who did not RTC (32 [6%] vs. 4 [1%] RR 1.72 [1.59-1.96], p < 0.001). CONCLUSION The study reveals that 53% of football players RTC after ACLR, predominantly after more than 12 months. The RTC was higher and faster in high-level players and those receiving a PT graft. The slow RTC may contribute to the relatively low rate of additional ACLRs. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Alexander Sandon
- Department of Molecular Medicine & Surgery, Stockholm Sports Trauma Research Center, Karolinska Institute, Stockholm, Sweden
| | - Joanna Kvist
- Department of Molecular Medicine & Surgery, Stockholm Sports Trauma Research Center, Karolinska Institute, Stockholm, Sweden
- Division of Physiotherapy, Department of Health, Medicine and Caring Science, Linköping University, Linköping, Sweden
| | - Henrik Hedevik
- Division of Physiotherapy, Department of Health, Medicine and Caring Science, Linköping University, Linköping, Sweden
| | - Magnus Forssblad
- Department of Molecular Medicine & Surgery, Stockholm Sports Trauma Research Center, Karolinska Institute, Stockholm, Sweden
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Lin AP, Nguyen BTT, Tran SQ, Kuo YJ, Huang SW, Chen YP. Does septic arthritis after anterior cruciate ligament reconstruction lead to poor outcomes? A systematic review and meta-analysis of observational studies. Knee Surg Relat Res 2024; 36:45. [PMID: 39639400 PMCID: PMC11622541 DOI: 10.1186/s43019-024-00248-z] [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: 06/18/2024] [Accepted: 11/12/2024] [Indexed: 12/07/2024] Open
Abstract
BACKGROUND Septic arthritis is a rare but devastating complication after anterior cruciate ligament reconstruction (ACLR). While early treatment can prevent significant graft complications, outcomes are often inferior to those in uncomplicated ACLR. Furthermore, whether to retain or remove the graft after infection remains debatable. Therefore, we sought to compare the outcomes of septic arthritis post ACLR with uncomplicated ACLR and evaluate graft retention versus removal in infected patients. METHODS We conducted a systematic review and meta-analysis in which PubMed, Embase, and Cochrane Library databases were searched. Clinical studies were included if they compared patient-reported, clinician-reported, or radiographic outcomes (minimum follow-up of 12 months) between patients with post-ACLR septic arthritis and those with uncomplicated ACLR or that compared graft retention and removal in patients with post-ACLR septic arthritis. RESULTS Thirteen studies were retrieved. Patients with post-ACLR septic arthritis reported inferior Lysholm Knee Scoring Scale scores (mean difference (MD) 7.53; 95% confidence interval (CI) 3.20-11.86; P = 0.0006), Tegner Activity Scale scores (MD, 1.42; 95% CI 1.07-1.76; P < .00001), and return to sports rates (53% versus 76%, respectively) to those of patients with uncomplicated ACLR. Patients with post-ACLR septic arthritis and those with uncomplicated ACLR did not differ in terms of the pooled estimate of various clinician-reported outcomes, such as the objective International Knee Documentation Committee score, anterior-posterior laxity, pivot shift, and Lachman test results. Furthermore, no significant difference was noted between the aforementioned patient groups regarding osteoarthritis (detected radiographically). Graft retention led to better patient- and clinician-reported outcomes than graft removal. CONCLUSIONS Despite similar clinician-reported outcomes and osteoarthritis rates, patients with post-ACLR septic arthritis reported worse outcomes than those with uncomplicated ACLR. Graft retention leads to improved patient- and clinician-reported outcomes compared with the outcomes of graft removal. Our findings may help develop realistic expectations and management strategies for this rare complication.
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Affiliation(s)
- Ashleigh Peng Lin
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Bao Tu Thai Nguyen
- The International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Orthopedics, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Son Quang Tran
- Department of Orthopedics, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Yi-Jie Kuo
- Department of Orthopedics, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Shu-Wei Huang
- Department of Applied Science, National Taitung University, Taitung City, Taiwan
| | - Yu-Pin Chen
- Department of Orthopedics, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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Hållén I, Kvist J, Forssblad M, Sandon A. Return to Soccer After Anterior Cruciate Ligament Reconstruction: An Outcome or a Decision? Orthop J Sports Med 2024; 12:23259671241295834. [PMID: 39697607 PMCID: PMC11653463 DOI: 10.1177/23259671241295834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2024] [Accepted: 09/17/2024] [Indexed: 12/20/2024] Open
Abstract
Background The return-to-sports rate is often used as an outcome measure after anterior cruciate ligament (ACL) reconstruction (ACLR). Although most soccer players want to return to sports after their ACL injury, up to 40% do not believe they will return to soccer after their ACL injury. Purpose To investigate whether self-reported presurgical beliefs regarding return to soccer correspond to registered official match participation after ACLR. Study Design Cohort study; Level of evidence, 2. Methods Included were soccer players with a primary unilateral ACL injury who were ≥15 years at the time of ACLR and who had completed a presurgical question about their future sports participation beliefs. ACLR surgical data were extracted from the Swedish National Knee Ligament Registry, and game participation data were extracted from the Swedish Football Association's administrative data system. Results A total of 959 soccer players (617 [64%] male and 342 [36%] female) were included. The follow-up time after ACLR ranged from 18 months to 5.5 years. Of 720 soccer players (75%) who believed that they would return to play (RTP), 462 (64%) players actually did. Of the players who believed that they would not RTP, 181 (76%) did not. Presurgical beliefs predicted RTP (odds ratio [OR], 5.59; P < .001). Younger age at the time of ACLR favored RTP, where 61% of the players aged 15-20 years had RTP (OR, 3.85; P < .001). At the top competitive level, 84% of the players RTP compared to 14% at the recreational level. Players active at higher levels were more likely to believe that they would RTP, and they also actually did so (OR, 33.06; P < .001). Overall, 67% of players followed their presurgical intention to return to soccer. Conclusion The findings indicated that presurgical beliefs, age, and level of play helped to predict the actual RTP of soccer players after ACLR.
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Affiliation(s)
- Isabelle Hållén
- Aleris Sports Medicine and Ortopedi Sabbatsberg, Stockholm, Sweden
| | - Joanna Kvist
- Department of Health, Medicine and Caring Sciences, Division of Physiotherapy, Linköping University, Linköping, Sweden
- Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Forssblad
- Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden
| | - Alexander Sandon
- Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden
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11
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Barth T, Bond CW, MacFadden LN, Skelley NW, Combs J, Noonan BC. Effect of Time and Sex on Post-Anterior Cruciate Ligament Reconstruction Psychological Patient-Reported Outcome Measure Scores. J Athl Train 2024; 59:898-905. [PMID: 38014794 PMCID: PMC11440824 DOI: 10.4085/1062-6050-0189.23] [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] [Indexed: 11/29/2023]
Abstract
CONTEXT Low scores on psychological patient-reported outcomes measures, including the Anterior Cruciate Ligament-Return to Sport After Injury (ACL-RSI) and Injury-Psychological Readiness to Return to Sport (I-PRRS), after anterior cruciate ligament reconstruction (ACLR) have been associated with a maladaptive psychological response to injury and poor prognosis. OBJECTIVE To assess the effect of time post-ACLR and sex on ACL-RSI and I-PRRS scores and generate normative reference curves. DESIGN Case series. SETTING Outpatient sports medicine and orthopaedic clinic. PATIENTS OR OTHER PARTICIPANTS A total of 507 patients (age at ACLR, 17.9 ± 3.0 years) who had undergone primary ACLR and completed ACL-RSI or I-PRRS assessments ≥1 times (n = 796) between 0 and 1 year post-ACLR. MAIN OUTCOME MEASURE(S) An honest broker provided anonymous data from our institution's knee-injury clinical database. Generalized additive models for location, scale, and shape and generalized least-squares analyses were used to assess the effect of time post-ACLR and sex on ACL-RSI and I-PRRS scores. RESULTS The ACL-RSI and I-PRRS scores increased over time post-ACLR. Males had higher scores than females until approximately 5 months post-ACLR, with scores converging thereafter. CONCLUSIONS Males reported higher ACL-RSI and I-PRRS scores than females in the initial stages of rehabilitation, but scores converged between sexes at times associated with return to play post-ACLR. Normative reference curves can be used to objectively appraise ACL-RSI and I-PRRS scores at any time post-ACLR. This may lead to timely recognition of patients with a maladaptive psychological response to injury and a higher likelihood of a poor prognosis, optimizing ACLR outcomes.
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Affiliation(s)
- Tiffany Barth
- Sanford Orthopedics and Sports Medicine Research, Sanford Health, Fargo, ND
| | - Colin W Bond
- Sanford Orthopedics and Sports Medicine Research, Sanford Health, Fargo, ND
| | - Lisa N MacFadden
- Department of Biomedical Engineering
- Sanford School of Medicine, University of South Dakota, Sioux Falls
| | - Nathan W Skelley
- Sanford Orthopedics and Sports Medicine Research, Sanford Health, Sioux Falls, SD
| | - Josefine Combs
- Sanford Orthopedics and Sports Medicine Research, Sanford Health, Sioux Falls, SD
| | - Benjamin C Noonan
- Sanford Orthopedics and Sports Medicine Research, Sanford Health, Fargo, ND
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12
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Tagliero AJ, Miller MD. Anterior Cruciate Ligament Tears in Soccer Players. Sports Med Arthrosc Rev 2024; 32:138-145. [PMID: 39087703 DOI: 10.1097/jsa.0000000000000391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
Anterior cruciate ligament (ACL) injuries to soccer players present unique challenges in sports medicine, given the sport's global prevalence and intricate injury dynamics. These injuries, especially in the youth and female demographic, have become a substantial concern in sports medicine. This review explores the epidemiology, mechanism of injury, diagnostic procedures, treatment modalities, and rehabilitation strategies related to ACL tears within the soccer community. Progress in diagnostics, treatments, and rehabilitation underscores the importance of evidence-based approaches. As soccer continues its ascent in popularity, addressing the specific risks and nuances of ACL injuries in this context remains of paramount significance.
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Affiliation(s)
- Adam J Tagliero
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Mark D Miller
- Department of Orthopedic Surgery, University of Virginia Health System, Charlottesville, VA
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Gerfroit A, Marty-Diloy T, Laboudie P, Graveleau N, Bouguennec N. Correlation between Anterior Cruciate Ligament-Return to Sport after Injury Score at 6 Months after Anterior Cruciate Ligament Reconstruction and Mid-Term Functional Test Results: An Observational Study at 5-Year Follow-Up. J Clin Med 2024; 13:4498. [PMID: 39124766 PMCID: PMC11312896 DOI: 10.3390/jcm13154498] [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: 07/08/2024] [Revised: 07/25/2024] [Accepted: 07/31/2024] [Indexed: 08/12/2024] Open
Abstract
Background/Objectives: Evaluations allowing patients to return to sport (RTS) after anterior cruciate ligament reconstruction (ACLR) should be multimodal, including a psychological evaluation. The goal of this study was to determine if there is a correlation between the ACL-return to sport after injury (ACL-RSI) score at 6 months post-ACLR and mid-term functional results. Methods: A total of 498 patients were assessed 6 months after primary ACLR using a composite test including isokinetics, hops, and ACL-RSI. A minimum of 3 years of follow-up was necessary. At the last follow-up, each patient completed clinical and functional evaluations, including the subjective International Knee Documentation Committee (IKDC) score, Tegner Activity Scale, Self Knee Value (SKV), and ACL-RSI score. The results were compared overall and item by item. Results: At the last follow-up, the mean SKV, Tegner, IKDC, and ACL-RSI scores were 86.8 ± 14.3%, 6 ± 2.1, 77 ± 11.9%, and 68.8 ± 25.7%, respectively. A significant correlation existed between the 6-month ACL-RSI score and each functional test (respectively, ρ = 0.189 p < 0.001; ρ = 0.174 p < 0.001; ρ = 0.237 p < 0.001). The ACL-RSI score was significantly higher than at 6 months after surgery (p < 0.001). Over half (59.2%) of the cohort returned to an equal or greater level of activity, and there was a significant correlation between the 6-month ACL-RSI score and post-surgery level of activity. Conclusions: Patients with better ACL-RSI scores at 6 months post-ACLR have better functional results in the medium term and are more likely to RTS. Our results show a correlation between psychological factors at 6 months, measured through the ACL-RSI score, and activity level at mid-term follow-up. This study underlines the relationship between RTS and psychological effects, and the importance of ACLR rehabilitation to focus on decreasing apprehension and fear.
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Affiliation(s)
- Alexis Gerfroit
- Sports Clinic of Bordeaux-Mérignac, 33700 Mérignac, France
- Centre Hospitalo-Universitaire de Poitiers, 86000 Poitiers, France
| | - Thibault Marty-Diloy
- Sports Clinic of Bordeaux-Mérignac, 33700 Mérignac, France
- Centre Hospitalo-Universitaire de Poitiers, 86000 Poitiers, France
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Dean RS, Hafen TJ, Braithwaite CL, Farley KX, LaPrade RF, Guettler JH, Bicos J. Patient Perception of Allograft Versus Autograft in ACL Reconstruction Using a Validated Online Survey Marketplace. Orthop J Sports Med 2024; 12:23259671241263853. [PMID: 39165330 PMCID: PMC11334250 DOI: 10.1177/23259671241263853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/02/2024] [Indexed: 08/22/2024] Open
Abstract
Background Little is known regarding the opinions of the general population on anterior cruciate ligament (ACL) graft options. Purpose To evaluate the general population's perception of the use of allografts versus autografts in ACL reconstruction using a previously validated online marketplace platform. Methods A prospective 34-question survey was distributed via the online marketplace. After collecting baseline demographics, participant preferences for ACL reconstruction with an allograft or autograft were established. All respondents completed a preeducation survey, reviewed an evidence-based education sheet, and completed a posteducation survey to assess their understanding. Upon completion, participants were asked which graft they would prefer. Participants were then asked if they would be willing to change their preference based on surgeon recommendation. Finally, participants were asked to rank the factors from the education sheet that were most influential. Study Design Cross-sectional study. Results There were 491 participants that completed the survey (mean age, 39.9 years [range, 19-72 years]; 244 male, 241 female, and 6 nonbinary/third-gender participants). Before reading the education sheet, 276 (56%) reported no graft preferences, 146 (30%) preferred autograft, and 69 (14%) preferred allograft. After reading the provided sheet, 226 (46%) participants preferred autograft, 185 (38%) preferred allograft, and 80 (16%) had no preference. The mean score on the preeducation test was 45%, and the mean score on the posteducation test was significantly greater (61%; P < .01). Overall, 345 participants (83.9%) stated they would change their preference for autograft or allograft if their surgeon recommended it. Surgeon preference (n = 330; 67%), educational information provided (n = 117; 24%), and previous knowledge (n = 44; 9%) were the most important factors for making graft selections. The mean ages of the participants selecting each graft type before and after education were as follows: allograft (37.8 ± 10.1 vs 40.6 ± 11.8 years; P = .05), autograft (38 ± 11.5 vs 39.5 ± 10.1 years; P = .21), and no preference (41.5 ± 11.2 vs 39.4 ± 11.8 years; P = .16). Conclusion Education resulted in a greater number of individuals' reporting a preference in graft type (either allograft or autograft) compared with preinformation questioning. In addition, 83.9% of the participants were willing to switch their graft choice if recommended by their surgeon.
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Affiliation(s)
- Robert S. Dean
- Department of Orthopaedics, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan, USA
| | - Tanner J. Hafen
- William Beaumont School of Medicine, Oakland University, Auburn Hills, Michigan, USA
| | - Collin L. Braithwaite
- William Beaumont School of Medicine, Oakland University, Auburn Hills, Michigan, USA
| | - Kevin X. Farley
- Department of Orthopaedics, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan, USA
| | | | - Joseph H. Guettler
- Department of Orthopaedics, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan, USA
| | - James Bicos
- Department of Orthopaedics, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan, USA
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15
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Cronström A, Ageberg E, Häger CK. Are demographics, physical function and psychological response associated with return to sport at one year following ACL-reconstruction? Phys Ther Sport 2024; 68:22-30. [PMID: 38905755 DOI: 10.1016/j.ptsp.2024.06.001] [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] [Received: 02/14/2024] [Revised: 06/09/2024] [Accepted: 06/10/2024] [Indexed: 06/23/2024]
Abstract
OBJECTIVE To determine the relative contribution of each of the following aspects: demographics, physical function, and patient-reported outcome measures (PROMs), including both physical and psychological constructs, to return to sport (RTS) (any level) one-year post anterior cruciate ligament reconstruction (ACLR). DESIGN Cross-sectional cohort study. METHODS We included data for 143 participants (73 women, mean (SD) age 24 (5.8) years) ∼ one-year post-ACLR. Data comprised demographics, physical function (hop performance, hip and knee peak torque) and PROMs (Knee Osteoarthritis Outcome Score subscales, perceived stress, and ACL Return to Sport after Injury scale (ACL-RSI)). We then used a Z-normalized multivariable logistic regression model to establish the relative contribution of factors associated with RTS. RESULTS Sixty-four (45%) of the participants had returned to sport at one year post-ACLR. In the regression model, greater hip abduction peak torque (OR = 1.70, 95% CI; 1.01 to 2.84) and greater psychological readiness to RTS (OR = 2.32, 95% CI; 1.30 to 4.12) were the only variables associated with RTS (R2 = 0.352). CONCLUSIONS The significant contribution of hip abduction strength and psychological readiness to RTS was still relatively small, suggesting other potential factors explaining RTS which may not be captured by common RTS criteria.
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Affiliation(s)
- Anna Cronström
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden; Department of Health Sciences, Lund University, Lund, Sweden.
| | - Eva Ageberg
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Charlotte K Häger
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
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Eshraghi N, Mirghaderi P, Omid R, Sajadi M, Pashapour‐Yeganeh A, Hosseini‐Dolama R, Rahimzadeh P, Moharrami A, Rakhshan A, Javad Mortazavi SM. Anterior cruciate ligament-Return to sport after injury scale brief version after ACL reconstruction: Persian translation, cross-cultural adaptation and validation. J Exp Orthop 2024; 11:e12074. [PMID: 38978972 PMCID: PMC11228620 DOI: 10.1002/jeo2.12074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 05/30/2024] [Accepted: 06/03/2024] [Indexed: 07/10/2024] Open
Abstract
PURPOSE The purpose of this study is to analyze the short anterior cruciate ligament return to sport after injury (ACL-RSI) (Persian) version's cultural adaption and validity. METHODS To assess test-retest reliability, 102 participants were filled out the short ACL-RSI(Per) scale 6 months or more after ACLR surgery. Internal consistency (Cronbach's alpha), test-retest reliability (intraclass correlation coefficients), construct validity (Pearson's r) and sensitivity (floor/ceiling effect) were determined. In addition, patient completed other relevant measures such as Lysholm scores, the hospital for special surgery ACL satisfaction survey (HSS ACL-SS), the visual analogue scale (VAS) of pain and patient's satisfaction, the Tegner activity score (TAS), the single assessment numeric evaluation (SANE) and the Cincinnati Knee Rating System (CKRS). RESULTS The short ACL-RSI(Per) scale showed high internal consistency (Cronbach's alpha = 0.91) and test-retest reliability (ICC = 0.923). Significant correlations between short ACL-RSI(Per) and other scales supported validity. There was a statistically significant connection between the short ACL-RSI(Per) and the following outcomes: HSS ACL-SS (r = 0.698, p < 0.001), VAS pain (r = 0.356, p < 0.001), CKRS (r = 0.644, p < 0.001), TAS (r = 0414, p < 0.001), Lysholm score (r = 0.467, p < 0.001) and SANE score (r = 0.536; p < 0.001). In addition to a satisfactory ceiling impact (15%), a sizeable floor effect (16.7%) was also seen. CONCLUSION The short ACL-RSI(Per) scale is a reliable and valid tool for assessing psychological readiness for return to sport after ACL reconstruction in Persian. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Nasim Eshraghi
- Surgical Research Society (SRS), Students' Scientific Research CenterTehran University of Medical SciencesTehranIran
- Joint Reconstruction Research CenterTehran University of Medical SciencesTehranIran
- Vali‐E‐Asr Reproductive Health Research Center, Family Health Research InstituteTehran University of Medical SciencesTehranIran
| | - Peyman Mirghaderi
- Surgical Research Society (SRS), Students' Scientific Research CenterTehran University of Medical SciencesTehranIran
- Joint Reconstruction Research CenterTehran University of Medical SciencesTehranIran
| | - Reza Omid
- Surgical Research Society (SRS), Students' Scientific Research CenterTehran University of Medical SciencesTehranIran
- Joint Reconstruction Research CenterTehran University of Medical SciencesTehranIran
| | - Mohamad Sajadi
- Surgical Research Society (SRS), Students' Scientific Research CenterTehran University of Medical SciencesTehranIran
- Joint Reconstruction Research CenterTehran University of Medical SciencesTehranIran
| | - Amirreza Pashapour‐Yeganeh
- Surgical Research Society (SRS), Students' Scientific Research CenterTehran University of Medical SciencesTehranIran
- Joint Reconstruction Research CenterTehran University of Medical SciencesTehranIran
| | - Reza Hosseini‐Dolama
- Surgical Research Society (SRS), Students' Scientific Research CenterTehran University of Medical SciencesTehranIran
- Joint Reconstruction Research CenterTehran University of Medical SciencesTehranIran
| | - Payman Rahimzadeh
- Surgical Research Society (SRS), Students' Scientific Research CenterTehran University of Medical SciencesTehranIran
| | - Alireza Moharrami
- Joint Reconstruction Research CenterTehran University of Medical SciencesTehranIran
| | - Amir Rakhshan
- Department of Foreign LanguagesTehran University of Medical SciencesTehranIran
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Tranaeus U, Gledhill A, Johnson U, Podlog L, Wadey R, Wiese Bjornstal D, Ivarsson A. 50 Years of Research on the Psychology of Sport Injury: A Consensus Statement. Sports Med 2024; 54:1733-1748. [PMID: 38862845 PMCID: PMC11258162 DOI: 10.1007/s40279-024-02045-w] [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] [Accepted: 05/09/2024] [Indexed: 06/13/2024]
Abstract
Factors influencing sport injury risk, rehabilitation outcomes, and return to sport processes have been the focus in various research disciplines (sports medicine, psychology and sociology). One discipline, with over 50 years of scholarship, is the psychology of sport injury. Despite the research in this field, there is no evidence-based consensus to inform professional practice. The aim of this original and timely consensus statement is to summarise psychological sport injury research and provide consensus recommendations for sport practitioners seeking to implement psychological principles into clinical practice. A total of seven experts with extensive experience outlined the consensus objectives and identified three psychology of sport injury sub-domains: risk, rehabilitation and return to sport. The researchers, grouped in pairs, prepared initial drafts of assigned sub-domains. The group met in Stockholm, and the three texts were merged into a draft and revised in an iterative process. Stress responses are the strongest psychological risk factor for acute injuries. Intra- and interpersonal factors, as well as sociocultural factors, are demonstrated psychosocial risk factors for overuse injuries. Stress management and mindfulness interventions to prevent injuries have been successfully implemented. The rehabilitation process may influence athlete's cognitive, emotional, and behavioural responses. Social support, mindfulness, acceptance-based practices, and cognitive-behavioural based intervention programs reduce negative reactions. Return to sport includes various stages and different trajectories. Returning athletes typically experience concerns regarding competence, autonomy, and relatedness. It is recommended that athletes focus on the physical, technical, and psychological demands of their sport as they progress to increasingly intense activities. Interdisciplinary collaboration (e.g., sports medicine and psychology) would be beneficial in enhancing clinical practice and improving athlete outcomes.
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Affiliation(s)
- Ulrika Tranaeus
- Stockholm Sports Trauma Research Centre, FIFA Medical Centre of Excellence, The Swedish School of Sport and Health Sciences, GIH, Box 5626, 114 86, Stockholm, Sweden.
- Department of Physiology, Nutrition, Biomechanics, Sport Performance and Exercise Research and Innovation Centre-Stockholm, SPERIC-S, The Swedish School of Sport and Health Sciences, Stockholm, Sweden.
- Unit of Intervention and Implementation for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Adam Gledhill
- Carnegie School of Sport, Leeds Beckett University, Leeds, UK
| | - Urban Johnson
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Leslie Podlog
- School of Kinesiology and Physical Activity Sciences, Faculté de Médecine, Université de Montréal, Montreal, QC, Canada
- Centre de Recherche, CHU-Saint Justine, Montreal, QC, Canada
| | - Ross Wadey
- St Mary's University, Twickenham, London, UK
| | | | - Andreas Ivarsson
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
- Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway
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Frouin A, Desfontaines N, Lacourpaille L, Nordez A, Le Sant G. Preoperative Rehabilitation Enhances Mental and Physical Well-Being in Anterior Cruciate Ligament-Injured Individuals: A Mixed Methods Study. J Sport Rehabil 2024; 33:289-296. [PMID: 38580299 DOI: 10.1123/jsr.2023-0312] [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] [Received: 09/18/2023] [Revised: 02/14/2024] [Accepted: 02/27/2024] [Indexed: 04/07/2024]
Abstract
CONTEXT Rehabilitation after an anterior cruciate ligament injury is recommended to be started soon after the injury. When surgery is required, research supports the delivery of physiotherapy before anterior cruciate ligament reconstruction (prehabilitation) to optimize recovery and positive outcomes. Individuals attending prehabilitation have never been questioned regarding their adherence to prehabilitation, perception of utility in meeting needs, upcoming events, or anticipated recovery goals. DESIGN Mixed methods cross-sectional study: Methods: 25 individuals before anterior cruciate ligament reconstruction (43% of eligible individuals from 12 clinics during the delivery period) were surveyed on their mindset and recovery expectancies. Semistructured interviews conducted in 9 of 25 participants assessed their lived experience of prehabilitation. RESULTS Participants reported that preventing a reinjury (96% of responses) and feeling confident during daily activities about their knee (92%) were the higher rating expectations at this stage of their treatment course. Three themes were developed from the interviews and analyses. (1) Participants reported that prehabilitation was a period full of challenges with memories of the injury and uncertainties. (2) They viewed prehabilitation as a step to move forward by finding support and self-motivating. (3) They believed that prehabilitation would have positive impacts on the treatment outcomes. Participants were confident that prehabilitation would accelerate the recovery of muscle volume (88%) and strength (84%). CONCLUSION Participants had positive experiences of prehabilitation, aligning with the findings on functional outcomes in the existing literature on prehabilitation.
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Affiliation(s)
- Antoine Frouin
- Nantes Université, Movement-Interactions-Performance, MIP, UR 4334, Nantes, France
- Institut Sport Atlantique, ISA Clinic, Saint-Herblain, France
| | | | - Lilian Lacourpaille
- Nantes Université, Movement-Interactions-Performance, MIP, UR 4334, Nantes, France
| | - Antoine Nordez
- Nantes Université, Movement-Interactions-Performance, MIP, UR 4334, Nantes, France
- Institut Universitaire de France, IUF, Paris, France
| | - Guillaume Le Sant
- Nantes Université, Movement-Interactions-Performance, MIP, UR 4334, Nantes, France
- School of Physiotherapy, IFM3R, St-Sebastien/Loire, France
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Yu F, Xiao LE, Wang T, Hu Y, Xiao J. Nurse-Assisted Rehabilitation Protocols Following Anterior Cruciate Ligament Reconstruction. Orthop Nurs 2024; 43:163-178. [PMID: 38861747 DOI: 10.1097/nor.0000000000001030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/13/2024] Open
Abstract
Despite significant advancements in surgical instruments and operation skills, short- and long-term outcomes following anterior cruciate ligament reconstruction (ACLR) remain unsatisfactory, as many patients fail to return to their pre-injury level of sports. Inadequate ACL rehabilitation is the primary cause of poor outcomes. Nurses have become a crucial element in the rehabilitation process. Although there is no consensus regarding the optimal post-operative rehabilitation protocols, restoring muscle strength and neuromuscular control are consistently the primary goals. This literature review presents nurse-assisted rehabilitation protocols aiming at improving muscle strength and neuromuscular control. The review discusses postoperative rehabilitation, including home-based and supervised rehabilitation, open and closed kinetic chain exercises, eccentric and concentric training, blood flow restriction training, and plyometric training. Each training protocol has its benefits and drawbacks, and should be used cautiously in specific stages of rehabilitation. Neuromuscular training, such as neuromuscular electrical stimulation, neuromuscular control exercises, and vibration therapy, is considered crucial in rehabilitation.
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Affiliation(s)
- Fang Yu
- Fang Yu, BD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Li-En Xiao, BD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Tao Wang, PhD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Yong Hu, PhD, Department of Joint Surgery, the Fifth Affiliated Hospital of Southern Medical University, GuangZhou City, GuangDong Province, China
- Jun Xiao, PhD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
| | - Li-En Xiao
- Fang Yu, BD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Li-En Xiao, BD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Tao Wang, PhD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Yong Hu, PhD, Department of Joint Surgery, the Fifth Affiliated Hospital of Southern Medical University, GuangZhou City, GuangDong Province, China
- Jun Xiao, PhD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
| | - Tao Wang
- Fang Yu, BD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Li-En Xiao, BD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Tao Wang, PhD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Yong Hu, PhD, Department of Joint Surgery, the Fifth Affiliated Hospital of Southern Medical University, GuangZhou City, GuangDong Province, China
- Jun Xiao, PhD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
| | - Yong Hu
- Fang Yu, BD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Li-En Xiao, BD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Tao Wang, PhD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Yong Hu, PhD, Department of Joint Surgery, the Fifth Affiliated Hospital of Southern Medical University, GuangZhou City, GuangDong Province, China
- Jun Xiao, PhD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
| | - Jun Xiao
- Fang Yu, BD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Li-En Xiao, BD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Tao Wang, PhD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Yong Hu, PhD, Department of Joint Surgery, the Fifth Affiliated Hospital of Southern Medical University, GuangZhou City, GuangDong Province, China
- Jun Xiao, PhD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
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Borman A, Derman W, Grobbelaar H. Psychosocial experiences of competitive rugby players on the "long, long journey" to recovery following ACL ruptures and reconstruction. Scand J Med Sci Sports 2024; 34:e14604. [PMID: 38551139 DOI: 10.1111/sms.14604] [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] [Received: 05/29/2023] [Revised: 02/15/2024] [Accepted: 03/04/2024] [Indexed: 04/02/2024]
Abstract
Anterior Cruciate Ligament (ACL) injuries are serious and potentially career-ending. Reconstruction surgery and extended rehabilitation typically follow, but some athletes never attain the same level of sport performance. The psychosocial experiences of athletes who sustain ACL injuries and their cognitive appraisal, emotional and behavioral responses to the injury, and reconstruction require further attention during the different recovery phases. The aim is to explore these psychosocial experiences, social support needs and sources thereof of competitive athletes who sustained unilateral ACL ruptures and underwent reconstruction surgery. Semi-structured interviews with six competitive rugby players (M age: 22.3 ± 2.92 years), elicited information at seven time-points. We analyzed the qualitative information through thematic analysis. Five common themes emerged: (1) cognitive appraisal, (2) emotional responses (negative and positive affective responses), (3) behavioral responses, (4) social support needs and sources thereof, and (5) adversity-induced identity expansion (athletic and person-centered identities). In-vivo quotes gave a rich description of the athletes' experiences throughout the "long, long journey" to return-to-sport. These findings may sensitize and assist sports healthcare professionals, coaches, teammates, family, and friends to explore various psychosocial experiences throughout the injury and recovery period. Phase-appropriate psychosocial support or referral to sport psychology services is recommended to enhance the recovery process, improve long-term physical and mental health, and subsequent performance.
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Affiliation(s)
- Anel Borman
- Division of Sport Science, Department of Exercise, Sport and Lifestyle Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Wayne Derman
- Division of Sport and Exercise Medicine, Department of Exercise, Sport and Lifestyle Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Heinrich Grobbelaar
- Division of Sport Science, Department of Exercise, Sport and Lifestyle Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
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Newmarch T, Betsch M, Michalik R, Dwyer T, Whelan D, Chahal J, Theodoropoulos J. How Important are Psychological Measures to Determine Readiness to Return to Sports after Reconstruction of the Anterior Cruciate Ligament? An Online Survey Study. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2024; 162:185-192. [PMID: 36265494 DOI: 10.1055/a-1938-8359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Recent studies have suggested that psychological factors are important components of a successful return to sports (RTS) after anterior cruciate ligament reconstruction (ACLR). The purpose of this study was to survey physicians with respect to their criteria used to determine readiness to RTS after ACLR and to understand the significance of psychological factors on RTS. METHODS A survey was designed to understand the practices of clinicians managing rehabilitation after ACLR, consisting of 25 questions divided into 3 different sections, including one section about psychological scores and factors affecting RTS. The survey was delivered to three North American organizations for orthopedic sports medicine. RESULTS The total number of respondents was 113. Of the respondents, 95% considered psychological tests at least "somewhat important" (33% "important", 23% selected "very important"). Routine use of psychological tests in practice was only reported by 35% of respondents. The ACL-Return to Sport after Injury Scale was the most frequently used psychological test (23%). Fear of reinjury was considered the most common patient-cited psychological factor affecting RTS. Psychological factors ranked 8th out of 9 outcomes measures in determining readiness to RTS. CONCLUSION This study demonstrates a discrepancy between the importance of psychological tests and the frequency of use in practice. Additional education on this topic, web-based applications, and a multidisciplinary approach may increase the usage of psychological tests to determine RTS after ACLR.
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Affiliation(s)
- Tate Newmarch
- Orthopaedic Sports Medicine Program (UTOSM), Women's College Hospital, Toronto, Canada
| | - Marcel Betsch
- Orthopaedic Sports Medicine Program (UTOSM), Women's College Hospital, Toronto, Canada
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Mannheim, Mannheim, Germany
| | - Roman Michalik
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital Aachen, Aachen, Germany
| | - Tim Dwyer
- Orthopaedic Sports Medicine Program (UTOSM), Women's College Hospital, Toronto, Canada
| | - Daniel Whelan
- Orthopaedic Sports Medicine Program (UTOSM), Women's College Hospital, Toronto, Canada
| | - Jaskarndip Chahal
- Orthopaedic Sports Medicine Program (UTOSM), Women's College Hospital, Toronto, Canada
| | - John Theodoropoulos
- Orthopaedic Sports Medicine Program (UTOSM), Women's College Hospital, Toronto, Canada
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Kvist J, Pettersson M. Knee-Related Quality of Life Compared Between 20 and 35 Years After an Anterior Cruciate Ligament Injury Treated Surgically With Primary Repair or Reconstruction, or Nonsurgically. Am J Sports Med 2024; 52:311-319. [PMID: 38230888 PMCID: PMC10838479 DOI: 10.1177/03635465231218237] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 10/06/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Quality of life (QoL) is affected up to 5 years after an anterior cruciate ligament (ACL) injury. Knee impairment and osteoarthritis (OA) development increase over time, and this may affect QoL at a long-term follow-up. PURPOSE To investigate changes in health- and knee-related QoL between 20 and 35 years after ACL injury and compare it between patients treated with or without ACL surgery, as well as to study how symptomatic OA (SOA) is associated with change in QoL. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Between 1980 and 1983, 139 patients with acute ACL rupture were allocated to surgical or nonsurgical treatment of the ACL. Both groups completed a structured rehabilitation program. Of those patients, 59 were followed for 20 and 35 years after ACL rupture. After 10 crossovers, 33 patients were treated with primary repair or ACL reconstruction, and 26 were treated without ACL surgery. Combined radiographic OA and knee symptoms at 35 years was defined as SOA. QoL was assessed at 20 and 35 years after injury with the Knee injury and Osteoarthritis Outcome Score QoL (KOOS-QoL) subscale (range, 1-100), ACL-QoL questionnaire (total score and 5 subscales; range, 1-100), European QoL-5 Dimensions Questionnaire, and visual analog scale. Results were analyzed with paired and independent-sample t tests and chi-square tests. RESULTS Knee-related QoL was impaired at both 20 and 35 years after ACL injury, and differences were dependent on the measurement outcome. In the total cohort, KOOS-QoL did not change but both total ACL-QoL score (7.1 points; 95% CI, 2.2-11.9) and 4 of 5 subscales (5-10 points) decreased (P < .05). No differences were found between treatment groups. QoL decreased overall in patients with SOA, with a 21-point difference within-group change in KOOS-QoL (SOA or non-SOA) between 20 and 35 years of follow-up (P = .001; Cohen d = 1.0). CONCLUSION An ACL injury impairs knee-related QoL for up to 35 years, with no difference between treatment approaches (initial repair or later reconstruction compared with nonsurgical treatment). The deterioration decreases with longer follow-up. Clinicians should be aware of differences in QoL depending on the measurement outcome.
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Affiliation(s)
- Joanna Kvist
- Unit of Physiotherapy, Department of Health, Medicine and Caring Science, Linköping University, Linköping, Sweden
- Stockholm Sports Trauma Research Center, FIFA Medical Centre of Excellence, Karolinska Institute, Stockholm, Sweden
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Sengoku T, Nakase J, Yoshimizu R, Kimura M, Kanayama T, Sakurai G, Yoshida S, Kitagawa T, Kitaoka K, Tsuchiya H. Preoperative psychological competitive ability has little relationship with subjective knee function and return to sports at 6 months postoperatively in patients with anterior cruciate ligament reconstruction. Asia Pac J Sports Med Arthrosc Rehabil Technol 2024; 35:9-14. [PMID: 38025405 PMCID: PMC10656217 DOI: 10.1016/j.asmart.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/07/2023] [Accepted: 10/11/2023] [Indexed: 12/01/2023] Open
Abstract
Objective This prospective study aimed to investigate the relationship between preoperative psychological competitive ability and preoperative and 6 months postoperative subjective knee function in patients undergoing anterior cruciate ligament (ACL) reconstruction. Methods Eighty-four patients who underwent ACL reconstruction and had a Tegner Activity Scale score of 6 or more were included in this study. Preoperatively, all patients were administered the Diagnostic Inventory of Psychological Competitive Ability for Athletes (DIPCA.3) for psychological competitive ability assessment and the International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form for subjective knee function assessment. The IKDC subjective score was re-evaluated 6 months postoperatively. We evaluated the associations of volition for competition, mental stability and concentration, confidence, strategic ability, and cooperation (DIPCA.3 factors) with the IKDC subjective score preoperatively and 6 months postoperatively. Furthermore, patients were classified into two groups according to whether they could return to participate in the entire practice and compared the DIPCA.3 total score and IKDC subjective score. Results The DIPCA.3 confidence score negatively correlated with the preoperative IKDC subjective score (β = -0.34, p = 0.04). However, there was no association between the DIPCA.3 score for all variables and IKDC subjective score at 6 months after ACL reconstruction. Moreover, the DIPCA.3 total score was not related to return to participate in the entire practice 6 months after ACL reconstruction. Conclusion Psychological competitive ability is not associated with a return to participate in the entire practice, and a low preoperative IKDC subjective score should not be viewed too negatively.
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Affiliation(s)
- Takuya Sengoku
- Section of Rehabilitation, Kanazawa University Hospital, 13-1 Takaramachi, Kanazawa, 920-8641, Japan
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan
| | - Junsuke Nakase
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan
| | - Rikuto Yoshimizu
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan
| | - Mitsuhiro Kimura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan
| | - Tomoyuki Kanayama
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan
| | - Goro Sakurai
- Section of Rehabilitation, Kanazawa University Hospital, 13-1 Takaramachi, Kanazawa, 920-8641, Japan
| | - Shinya Yoshida
- Section of Rehabilitation, Kanazawa University Hospital, 13-1 Takaramachi, Kanazawa, 920-8641, Japan
| | - Takashi Kitagawa
- Department of Physical Therapy, School of Health Science, Shinshu University, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Katsuhiko Kitaoka
- Department of Orthopaedic Surgery, Kijima Hospital, Matsuteramachi, Kanazawa, Ishikawa, 920-0011, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan
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Baez S, Harkey M, Birchmeier T, Triplett A, Collins K, Kuenze C. Psychological Readiness, Injury-Related Fear, and Persistent Knee Symptoms After Anterior Cruciate Ligament Reconstruction. J Athl Train 2023; 58:998-1003. [PMID: 38104626 PMCID: PMC10784889 DOI: 10.4085/1062-6050-0229.22] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
CONTEXT Poor psychological responses after anterior cruciate ligament reconstruction (ACLR) have been associated with a failure to return to sport and increased secondary injury risk. However, we do not know whether poor psychological responses after ACLR influence patient-reported knee function and knee symptoms. OBJECTIVE To examine the association between psychological factors (ie, psychological readiness and injury-related fear) and the presence of persistent knee symptoms in individuals 6 to 12 months after ACLR. DESIGN Cross-sectional study. SETTING Research laboratory. PATIENTS OR OTHER PARTICIPANTS In total, 101 participants, aged 13 to 25 years old, between 6 and 12 months after primary unilateral ACLR were enrolled in the study. MAIN OUTCOME MEASURE(S) Persistent knee symptoms were identified using an established criterion based on the subscales of the Knee injury and Osteoarthritis Outcome Score. Participants also completed the Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) and the Tampa Scale of Kinesiophobia-11 (TSK-11) to assess psychological readiness and injury-related fear, respectively. Higher ACL-RSI scores indicate higher psychological readiness, and higher TSK-11 scores indicate higher injury-related fear. RESULTS Twenty-nine participants (29%) met the criteria for persistent knee symptoms. For every 1 SD lower in the ACL-RSI score, participants had 2.1 times greater odds of persistent knee symptoms after ACLR (95% CI = 1.3, 3.6). For every 1 SD higher in the TSK-11 score, participants had 1.9 times greater odds of persistent knee symptoms after ACLR (95% CI = 1.1, 3.3). Both the ACL-RSI and TSK-11 were considered good at classifying persistent knee symptoms, as the areas under the curve were 0.78 and 0.73, respectively. CONCLUSIONS Individuals with a lower level of psychological readiness and more injury-related fear after ACLR had greater odds of persistent knee symptoms. Overall, these results highlight the potential clinical benefit of a comprehensive, biopsychosocial approach to managing health and wellness for individuals after ACLR.
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Affiliation(s)
- Shelby Baez
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - Matthew Harkey
- Department of Kinesiology, Michigan State University, East Lansing
| | - Thomas Birchmeier
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - Ashley Triplett
- Department of Kinesiology, Michigan State University, East Lansing
| | | | - Christopher Kuenze
- Department of Kinesiology, University of Virginia, Charlottesville; Katherine Collins is now at Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
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Sonesson S, Kuster RP, Kvist J. Accelerometer-assessed physical activity patterns during the first two years after a non-surgically treated ACL injury. Phys Ther Sport 2023; 64:123-132. [PMID: 37864852 DOI: 10.1016/j.ptsp.2023.09.011] [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] [Received: 06/29/2023] [Revised: 09/28/2023] [Accepted: 09/29/2023] [Indexed: 10/23/2023]
Abstract
OBJECTIVES To describe physical activity patterns and analyze changes during the first two years after a non-surgically treated ACL injury, and to assess correlations between accelerometer-assessed physical activity and self-reported knee function and knee-related quality of life. DESIGN Prospective cohort study. PARTICIPANTS 128 patients (61 females, 25.2 ± 7.1 years) with acute ACL injury. MAIN OUTCOME MEASURES Physical activity patterns were measured with accelerometry. Self-reported knee function was assessed using the International Knee Documentation Committee Subjective Knee Form, and knee-related quality of life was assessed using the Anterior Cruciate Ligament Quality of Life questionnaire. RESULTS Moderate to vigorous physical activity (MVPA) and steps per day increased from baseline to 3 months (p < .001), with no further increase from 3 to 24 months (p > .05). Time in MVPA did not correlate to patient-reported outcome measures at 3, 6, 12, or 24 months (p > .05). CONCLUSIONS Physical activity increased from acute phase to 3 months after non-surgically treated ACL injury, but almost one in four patients did not reach recommended levels of physical activity. Physical activity did not correlate with knee function or quality of life. Patients may need improved support to return to physical activity after ACL injury. LEVEL OF EVIDENCE Level II. TRIAL REGISTRATION NCT02931084.
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Affiliation(s)
- Sofi Sonesson
- Department of Health, Medicine and Caring Science, Division of Physiotherapy, Linköping University, Linköping, Sweden.
| | - Roman Peter Kuster
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Huddinge, Sweden
| | - Joanna Kvist
- Department of Health, Medicine and Caring Science, Division of Physiotherapy, Linköping University, Linköping, Sweden; Stockholm Sports Trauma Research Center, FIFA Medical Centre of Excellence, Department of Molecular Medicine & Surgery, Karolinska Institute, Sweden; Center for Medical Image Science and Visualization (CMIV), Department of Health, Medicine and Caring Sciences, Linköping University, Sweden
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Cronström A, Häger CK, Thorborg K, Ageberg E. Factors Associated With Sports Function and Psychological Readiness to Return to Sports at 12 Months After Anterior Cruciate Ligament Reconstruction: A Cross-sectional Study. Am J Sports Med 2023; 51:3112-3120. [PMID: 37681565 PMCID: PMC10543957 DOI: 10.1177/03635465231192983] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 07/05/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Sports function and psychological readiness to return to sports (RTS) are important outcomes when evaluating rehabilitation after anterior cruciate ligament reconstruction (ACLR). It is, however, unclear which specific factors contribute most to these outcomes. PURPOSE To determine associations between demographic characteristics, objective measurements of physical function, patient-reported outcome measure scores, sports-related function assessed with the Knee injury and Osteoarthritis Outcome Score (KOOS) Sport and Recreation subscale, and psychological readiness to RTS assessed with the Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) scale at 1 year after ACLR. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS At a mean of 12.5 ± 2.0 months after ACLR, 143 participants (50.3% female), with a mean age of 25.0 ± 5.7 years, were assessed for demographic characteristics, physical factors (hop performance, muscle strength, ankle and hip range of motion), and psychological factors (KOOS Pain and Symptoms subscales, Perceived Stress Scale, fear of reinjury) as well as the KOOS Sport and Recreation subscale and ACL-RSI scale. Backward linear regression models were used to evaluate factors associated with sports function and psychological readiness to RTS. RESULTS Lower isokinetic knee extension peak torque (limb symmetry index) (B = 18.38 [95% CI, 3.01-33.75]), lower preinjury activity level (B = 2.00 [95% CI, 0.87-3.14]), greater knee pain (B = 0.90 [95% CI, 0.70-1.10]), shorter time between injury and reconstruction (B = 0.16 [95% CI, 0.05-0.26]), and greater fear of reinjury (B = 0.11 [95% CI, 0.01-0.20]) were associated with a worse KOOS Sport and Recreation subscore (R2 = 0.683). A shorter hop distance (B = 0.15 [95% CI, 0.00-0.29]) was associated with a lower ACL-RSI score (R2 = 0.245). CONCLUSION A combination of knee muscle strength, activity level, knee pain, timing of surgery, and fear of reinjury accounted for approximately 70% of the variation in sports function at 1 year after ACLR. In contrast, there was only 1 weak association between physical function and psychological readiness to RTS at this time point. Thus, factors associated with current sports function are much better known than features related to psychological readiness to RTS.
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Affiliation(s)
- Anna Cronström
- Department of Health Sciences, Lund University, Lund, Sweden
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Charlotte K. Häger
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Kristian Thorborg
- Department of Health Sciences, Lund University, Lund, Sweden
- Department of Orthopaedic Surgery, Copenhagen University Hospital, Copenhagen, Denmark
| | - Eva Ageberg
- Department of Health Sciences, Lund University, Lund, Sweden
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Alzakri AA, Alsultan OA, Alhuqbani MN, Aldosari ZA, Alghadir OM, Aldosari OA, Alshehri BF, Alsaleh KA. Barriers and facilitators to physiotherapy among adult orthopedic patients at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia: A cross-sectional study. Saudi Med J 2023; 44:679-686. [PMID: 37463715 PMCID: PMC10370374 DOI: 10.15537/smj.2023.44.7.20230276] [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] [Received: 04/23/2023] [Accepted: 06/21/2023] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVES To identify barriers and facilitators to physiotherapy adherence in adult patients who attended an orthopaedic clinic and underwent physical therapy at King Khalid University Hospital (KKUH), Riyadh, Saudi Arabia. METHODS This cross-sectional study was performed at KKUH between September 2022 and January 2023. After conducting a literature review, a survey questionnaire was created, and a pilot study was conducted to evaluate its validity and clarity. Patients were approached in the waiting areas of the outpatient clinics and provided with a consent form to participate in the study. RESULTS Ongoing pain, travel distance, and lack of transportation were common barriers while being given a choice in rehabilitation activities, regular assessments of progress and function, and regular goal setting with the physician were common facilitators. Living in rural areas and the belief that rehabilitation is important were associated with both higher barrier and facilitator scores. CONCLUSION A patient-centred approach to physical therapy, effective pain management, and regular evaluation of functional progress can increase adherence to physiotherapy. These findings have implications for physiotherapy providers, policymakers, and patients in promoting adherence to treatment for improved functional outcomes, reduced pain, and increased patient satisfaction.
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Affiliation(s)
- Abdulmajeed A. Alzakri
- From the Department of Orthopedics (Alzakri, Alsultan, Alhuqbani, Aldosari, Alghadir, Aldosari, Alshehri Alsaleh), College of Medicine, King Saud University; from the Department of Orthopedics (Alsultan, Alsaleh), King Saud University Medical City, King Saud University; and from the Department of Spine Surgery (Alzakri), King Faisal Specialist Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia.
| | - Omar A. Alsultan
- From the Department of Orthopedics (Alzakri, Alsultan, Alhuqbani, Aldosari, Alghadir, Aldosari, Alshehri Alsaleh), College of Medicine, King Saud University; from the Department of Orthopedics (Alsultan, Alsaleh), King Saud University Medical City, King Saud University; and from the Department of Spine Surgery (Alzakri), King Faisal Specialist Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia.
| | - Mohammed N. Alhuqbani
- From the Department of Orthopedics (Alzakri, Alsultan, Alhuqbani, Aldosari, Alghadir, Aldosari, Alshehri Alsaleh), College of Medicine, King Saud University; from the Department of Orthopedics (Alsultan, Alsaleh), King Saud University Medical City, King Saud University; and from the Department of Spine Surgery (Alzakri), King Faisal Specialist Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia.
| | - Zyad A. Aldosari
- From the Department of Orthopedics (Alzakri, Alsultan, Alhuqbani, Aldosari, Alghadir, Aldosari, Alshehri Alsaleh), College of Medicine, King Saud University; from the Department of Orthopedics (Alsultan, Alsaleh), King Saud University Medical City, King Saud University; and from the Department of Spine Surgery (Alzakri), King Faisal Specialist Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia.
| | - Omar M. Alghadir
- From the Department of Orthopedics (Alzakri, Alsultan, Alhuqbani, Aldosari, Alghadir, Aldosari, Alshehri Alsaleh), College of Medicine, King Saud University; from the Department of Orthopedics (Alsultan, Alsaleh), King Saud University Medical City, King Saud University; and from the Department of Spine Surgery (Alzakri), King Faisal Specialist Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia.
| | - Omar A. Aldosari
- From the Department of Orthopedics (Alzakri, Alsultan, Alhuqbani, Aldosari, Alghadir, Aldosari, Alshehri Alsaleh), College of Medicine, King Saud University; from the Department of Orthopedics (Alsultan, Alsaleh), King Saud University Medical City, King Saud University; and from the Department of Spine Surgery (Alzakri), King Faisal Specialist Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia.
| | - Badr F. Alshehri
- From the Department of Orthopedics (Alzakri, Alsultan, Alhuqbani, Aldosari, Alghadir, Aldosari, Alshehri Alsaleh), College of Medicine, King Saud University; from the Department of Orthopedics (Alsultan, Alsaleh), King Saud University Medical City, King Saud University; and from the Department of Spine Surgery (Alzakri), King Faisal Specialist Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia.
| | - Khalid A. Alsaleh
- From the Department of Orthopedics (Alzakri, Alsultan, Alhuqbani, Aldosari, Alghadir, Aldosari, Alshehri Alsaleh), College of Medicine, King Saud University; from the Department of Orthopedics (Alsultan, Alsaleh), King Saud University Medical City, King Saud University; and from the Department of Spine Surgery (Alzakri), King Faisal Specialist Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia.
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Kvist J, Bengtsson J, Lundqvist C. The experience and influence of fear after anterior cruciate ligament reconstruction: an interview study with young athletes. BMC Sports Sci Med Rehabil 2023; 15:50. [PMID: 37013605 PMCID: PMC10068218 DOI: 10.1186/s13102-023-00659-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 03/24/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND Despite good physical function, many athletes do not return to sports after an anterior cruciate ligament reconstruction (ACLR). One important reason for this is fear of new injury. The aim of this study was to investigate young athletes' experiences of knee-related fear after an ACLR and how they perceive this fear to affect them in their sporting and everyday life. METHODS A qualitative interview study was conducted, using semi-structured interviews. Athletes who were active in contact or pivoting sport before an ACL injury, with the goal of returning to the same sport and who scored highly on fear of new injury at six months post-ACLR, were asked to participate. Ten athletes (six women and four men, aged 17-25 years), were interviewed by an independent researcher, 7-9 months after ACLR. Content analysis employing an abductive approach was used. RESULTS The analysis resulted in three categories with associated subcategories: 1. The expressions of fear; (i) reason for fear, (ii) changes in fear over time, and (iii) injury situation. 2. Reactions, consequences, and adaptations; (i) reactions, (ii) behavioural adaptation and influence on rehabilitation and daily life, (iii) present consequences, and (iv) consequences for the future. 3. Fear and adaptations related to returning to sports; (i) fear related to returning to sports and, (ii) adaptations in sports and life due to fear. Fear was described in broad and complex ways, with fear of a new injury being expressed as one of several aspects. Various reasons (e.g., seeing others getting injured in the past, previous experience of injury, failed rehabilitation, perceived knee instability) were given to explain the fear, and athletes reacted both physically and mentally to fear. Both positive and negative adaptations to fear were described, in both daily life and sports. CONCLUSION The results contribute to an increased understanding of fear as an essential psychological factor to consider during rehabilitation and leaves the way open for research to investigate how physiotherapists can work to manage fear better among ACLR patients.
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Affiliation(s)
- Joanna Kvist
- Unit of Physiotherapy, Department of Health, Medicine and Caring Science, Linköping University, Linköping, 581 85, Sweden.
- Stockholm Sports Trauma Research Centre, Karolinska Institute, Stockholm, Sweden.
| | - Johanna Bengtsson
- Unit of Physiotherapy, Department of Health, Medicine and Caring Science, Linköping University, Linköping, 581 85, Sweden
| | - Carolina Lundqvist
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
- Athletics Research Center, Department of Health, Medicine and Caring Sciences, Linkoping University, Sweden
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Zhou L, Xu Y, Wang S, Wang S, Xu W. Quadriceps strength and psychological readiness are associated with multiplanar knee kinematics after anterior cruciate ligament reconstruction. Gait Posture 2023; 101:101-105. [PMID: 36773479 DOI: 10.1016/j.gaitpost.2023.02.005] [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: 08/02/2022] [Revised: 10/25/2022] [Accepted: 02/08/2023] [Indexed: 02/13/2023]
Abstract
BACKGROUND Gait asymmetry, negative psychological factors and quadriceps strength deficits are common after anterior cruciate ligament reconstruction (ACLR). Whether quadriceps strength and psychological factors have impacts on multiplanar knee kinematics remains unclear. RESEARCH QUESTION What are the relationships of multiplanar knee kinematics during the gait cycle and psychological readiness to quadriceps strength after ACLR? METHOD In total, 45 patients were enrolled in this study at 8.3 ± 1.5 months after ACLR. All patients underwent gait analysis and isokinetic testing. Interlimb differences in the range of motion (ROM) and maximum and initial contact (IC) angles in abduction-adduction, flexion-extension, and internal-external rotation were calculated. The limb symmetry index (LSI) for quadriceps strength was calculated. Psychological readiness was measured using the Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) scale. The paired t test analyzed the differences between contralateral and affected limbs in quadriceps and hamstrings strength. Pearson or Spearman correlation was used to assess relationships between the variables of interest. RESULTS Significant differences between contralateral and affected limbs were observed in isokinetic knee quadriceps strength (P < 0.001) and hamstring strength (P = 0.009). The ACL-RSI score correlated negatively with interlimb differences in the knee flexion angle at IC (r = -0.35, P = 0.02) and ROM in the transverse plane (r = -0.41, P = 0.003). The LSI for quadriceps strength correlated negatively with the peak knee flexion angle (r = -0.37, P = 0.02) and positively with the ACL-RSI score (r = 0.3, P = 0.05). SIGNIFICANCE Greater psychological readiness and quadriceps strength are associated with more symmetrical multiplanar knee kinematics. The improvement of these parameters may aid the recovery of knee kinematics after ACLR, and reduce the rate of reinjury and incidence of posttraumatic osteoarthritis.
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Affiliation(s)
- Lan Zhou
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of kinesiology, Shanghai University of Sport, Shanghai, China
| | - Yihong Xu
- Department of Orthopedics, Changhai Hospital, The Navy Medical University, Shanghai, China
| | - Siya Wang
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of kinesiology, Shanghai University of Sport, Shanghai, China
| | - Shaobai Wang
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of kinesiology, Shanghai University of Sport, Shanghai, China.
| | - Weidong Xu
- Department of Orthopedics, Changhai Hospital, The Navy Medical University, Shanghai, China.
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Chaaban CR, Turner JA, Padua DA. Think outside the box: Incorporating secondary cognitive tasks into return to sport testing after ACL reconstruction. Front Sports Act Living 2023; 4:1089882. [PMID: 36873910 PMCID: PMC9975395 DOI: 10.3389/fspor.2022.1089882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 12/30/2022] [Indexed: 02/17/2023] Open
Abstract
The optimal set of return to sport (RTS) tests after anterior cruciate ligament (ACL) injury and ACL reconstruction (ACLR) remains elusive. Many athletes fail to pass current RTS test batteries, fail to RTS, or sustain secondary ACL injuries if they do RTS. The purpose of this review is to summarize current literature regarding functional RTS testing after ACLR and to encourage clinicians to have patients "think" (add a secondary cognitive task) outside the "box" (in reference to the box used during the drop vertical jump task) when performing functional RTS tests. We review important criteria for functional tests in RTS testing, including task-specificity and measurability. Firstly, tests should replicate the sport-specific demands the athlete will encounter when they RTS. Many ACL injuries occur when the athlete is performing a dual cognitive-motor task (e.g., attending to an opponent while performing a cutting maneuver). However, most functional RTS tests do not incorporate a secondary cognitive load. Secondly, tests should be measurable, both through the athlete's ability to complete the task safely (through biomechanical analyses) and efficiently (through measures of performance). We highlight and critically examine three examples of functional tests that are commonly used for RTS testing: the drop vertical jump, single-leg hop tests, and cutting tasks. We discuss how biomechanics and performance can be measured during these tasks, including the relationship these variables may have with injury. We then discuss how cognitive demands can be added to these tasks, and how these demands influence both biomechanics and performance. Lastly, we provide clinicians with practical recommendations on how to implement secondary cognitive tasks into functional testing and how to assess athletes' biomechanics and performance.
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Affiliation(s)
- Courtney R. Chaaban
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Beischer S, Hamrin Senorski E, Thomeé R. Patients that maintain their pre-injury level of physical activity 3-5 years after ACL reconstruction are, 18 months after surgery, characterised by higher levels of readiness to return to sport. Knee Surg Sports Traumatol Arthrosc 2023; 31:596-607. [PMID: 36401649 PMCID: PMC9676853 DOI: 10.1007/s00167-022-07230-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 11/08/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE To characterise patients who had returned to their pre-injury physical activity (PA) or higher at 18 months and maintained that level of PA 3-5 years after the primary ACL reconstruction and to describe the level, frequency, and type of PA participation during the first 5 years after ACL reconstruction METHOD: Data, from follow-ups at 18 months and 3-5 years after an ACL reconstruction, were extracted from a rehabilitation-specific register. Patients, 15-65 years of age, were included. The data comprised patient-reported outcomes and the results from two questions with respect to the level, frequency, and type of PA. Comparisons were made between patients who had and had not maintained their pre-injury level of PA at the follow-up 3-5 years after an ACL reconstruction. RESULTS A total of 272 patients met the inclusion criteria. The mean follow-up time was 3.8 years (min-max: 2.9-5.1) after the ACL reconstruction. Of patients who had returned to their pre-injury or a higher level of PA at the 18 month follow-up (n = 114), 68% (n = 78) maintained that level at the 3- to 5-year follow-up after ACL reconstruction. These patients reported a higher level of psychological readiness to return to sport (98 versus 79; p = 0.013). Moreover, these patients were 6.0 years older (p = 0.016) and were characterised by male sex (56% versus 44%; p = 0.028) and a lower level of pre-injury PA (p = 0.013). At the follow-up 3-5 years after the ACL reconstruction, more than 90% met the recommendations for PA. However, the prevalence of physical inactivity had increased and the involvement in organised PA had decreased compared with the 18-month follow-up. CONCLUSIONS Two out of three patients who have returned to their previous level of PA at 18 months can be expected to maintain that level, 3-5 years following ACL reconstruction. These patients were mainly characterised by a higher level of psychological readiness, especially in patients who participated in knee-strenuous sport and were younger than 20 years of age. The results of this study suggest that patients become more physically inactive over time, implicating the importance of clinicians helping patients find a suitable PA that may help patients maintain an active lifestyle.
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Affiliation(s)
- S Beischer
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Box 455, 405 30, Gothenburg, Sweden. .,Sportrehab Sports Medicine Clinic, Gothenburg, Sweden.
| | - E Hamrin Senorski
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Box 455, 405 30, Gothenburg, Sweden.,Sportrehab Sports Medicine Clinic, Gothenburg, Sweden.,Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - R Thomeé
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Box 455, 405 30, Gothenburg, Sweden.,Sportrehab Sports Medicine Clinic, Gothenburg, Sweden
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Broman D, Piussi R, Thomeé R, Hamrin Senorski E. A clinician-friendly test battery with a passing rate similar to a 'gold standard' return-to-sport test battery 1 year after ACL reconstruction: Results from a rehabilitation outcome registry. Phys Ther Sport 2023; 59:144-150. [PMID: 36566585 DOI: 10.1016/j.ptsp.2022.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/16/2022] [Accepted: 12/16/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To 1) present passing rates for different clinician-friendly (CF) test batteries and 2) determine the relationship between passing CF test batteries and passing gold standard (GS) return-to-sport (RTS) muscle function testing, 1 year after ACL reconstruction. STUDY DESIGN Cross-sectional registry study, level of evidence: 3. SETTING Primary care. PARTICIPANTS Data from 588 patients (52% women, mean age 29.3 ± 9.8 years) were extracted from the Project ACL registry. MAIN OUTCOME MEASURES The passing rates for the different test batteries. RESULTS The passing rate for GS test battery was 28% (95% CI, 24-32%) and the passing rate for the CF test battery with the lowest passing rate was 27% (95% CI 24-31%). The two CF test batteries with the strongest relationships with passing GS test battery showed that 51% (95% CI 43-59%) and 49% (95% CI 44-55%) of the patients who passed the respective CF test battery also passed the GS test battery. CONCLUSION A CF test battery can be as demanding to pass as a GS test battery, 1 year after ACL reconstruction. However, passing a CF test battery only gives patients a chance similar to a "coin flip" of also passing a GS RTS test battery.
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Affiliation(s)
- Daniel Broman
- Sportrehab Sports Medicine Clinic, Stampgatan 14, SE-411 01, Gothenburg, Sweden
| | - Ramana Piussi
- Sportrehab Sports Medicine Clinic, Stampgatan 14, SE-411 01, Gothenburg, Sweden; Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, SE-405 30, Gothenburg, Sweden; Sahlgrenska Sports Medicine Center, Sahlgrenska Academy, Gothenburg, Sweden
| | - Roland Thomeé
- Sportrehab Sports Medicine Clinic, Stampgatan 14, SE-411 01, Gothenburg, Sweden; Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, SE-405 30, Gothenburg, Sweden
| | - Eric Hamrin Senorski
- Sportrehab Sports Medicine Clinic, Stampgatan 14, SE-411 01, Gothenburg, Sweden; Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, SE-405 30, Gothenburg, Sweden; Sahlgrenska Sports Medicine Center, Sahlgrenska Academy, Gothenburg, Sweden; Swedish Olympic Committee, Sweden.
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The Swedish version of the Anterior Cruciate Ligament Quality Of Life measure (ACL-QOL): translation and measurement properties. Qual Life Res 2023; 32:593-604. [PMID: 36227526 PMCID: PMC9911474 DOI: 10.1007/s11136-022-03265-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE To translate the ACL-QOL from English to Swedish and evaluate measurement properties for use after surgical and non-surgical management of anterior cruciate ligament (ACL) injury. METHODS The ACL-QOL was translated from English to Swedish and data were pooled from 13 cohorts to enable a comprehensive evaluation of measurement properties in line with COSMIN guidelines. We evaluated internal consistency, test-re-test reliability, measurement error, structural validity [confirmatory factor analysis (CFA)], construct validity and responsiveness (hypothesis testing), and floor/ceiling effects. Results were stratified by time since injury (≤ 1.5 years; 2-10 years, 15-25 years; > 30 years) and ACL management strategy [surgical (n = 1163), non-surgical (n = 570)]. RESULTS The Swedish ACL-QOL had sufficient internal consistency (total and domain scores) for use in surgically managed (Cronbach's alpha ≥ 0.744) and non-surgically managed (≥ 0.770) ACL-injured individuals at all time-points. Test-re-test reliability was sufficient [intraclass correlation coefficients: all domains > 0.80, total score 0.93 (95% CI 0.86-0.96)]. The standard error of measurement was 5.6 for the total score and ranged from 7.0 to 10.3 for each domain. CFA indicated sufficient SRMR values when using the total score or five domains; however, CFI and RMSEA values did not meet cut-offs for good model fit. Hypothesis testing indicated sufficient construct validity and responsiveness. Floor effects were negligible and ceiling effects were negligible or minor. CONCLUSION The Swedish version of the ACL-QOL has sufficient internal consistency, test-re-test reliability, construct validity and responsiveness, for use in people with ACL injury managed with or without ACL surgery. Model fit could be improved and investigation into the source of misfit is warranted.
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Du T, Shi Y, Huang H, Liang W, Miao D. Current study on the influence of psychological factors on returning to sports after ACLR. Heliyon 2022; 8:e12434. [PMID: 36590562 PMCID: PMC9798193 DOI: 10.1016/j.heliyon.2022.e12434] [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: 03/24/2022] [Revised: 09/20/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022] Open
Abstract
It is considered that psychological factors are important in determining exercise regression outcomes of patients with anterior cruciate ligament reconstruction (ACLR). This review summarizes the definition and research progress of current undefined psychological factors related to returning to sports (RTS) after ACLR, as well as the application of corresponding measuring scales, and common psychological interventions in the field. The aim is to understand and clarify the impact of psychological factors in the ACL injury and rehabilitation, and to provide a theoretical basis for the application of psychological evaluation and intervention in the later stage. It is believed that there are still many prospects for the research in this field.
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Affiliation(s)
- Tianshu Du
- Department of Medical Psychology, Air Force Medical University, No. 17, Changle West Road, Xincheng District, Xi'an, Shaanxi Province, 710032, China,PLA Institute of Orthopaedics, Xijing Hospital, Air Force Medical University, No. 17, Changle West Road, Xincheng District, Xi'an, Shaanxi Province, 710032, China
| | - Yanru Shi
- Department of Psychiatry, Xijing Hospital, Air Force Medical University, No. 17, Changle West Road, Xincheng District, Xi'an, Shaanxi Province, 710032, China
| | - He Huang
- Department of Medical Psychology, Air Force Medical University, No. 17, Changle West Road, Xincheng District, Xi'an, Shaanxi Province, 710032, China
| | - Wei Liang
- Department of Medical Psychology, Air Force Medical University, No. 17, Changle West Road, Xincheng District, Xi'an, Shaanxi Province, 710032, China
| | - Danmin Miao
- Department of Medical Psychology, Air Force Medical University, No. 17, Changle West Road, Xincheng District, Xi'an, Shaanxi Province, 710032, China,Corresponding author.
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Bullock GS, Sell TC, Zarega R, Reiter C, King V, Wrona H, Mills N, Ganderton C, Duhig S, Räisäsen A, Ledbetter L, Collins GS, Kvist J, Filbay SR. Kinesiophobia, Knee Self-Efficacy, and Fear Avoidance Beliefs in People with ACL Injury: A Systematic Review and Meta-Analysis. Sports Med 2022; 52:3001-3019. [PMID: 35963980 DOI: 10.1007/s40279-022-01739-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND To improve the understanding of the psychological impacts of anterior cruciate ligament (ACL) injury, a systematic review synthesizing the evidence on knee self-efficacy, fear avoidance beliefs and kinesiophobia following ACL injury is needed. OBJECTIVE The aim of this systematic review was to investigate knee self-efficacy, fear avoidance beliefs and kinesiophobia following ACL injury, and compare these outcomes following management with rehabilitation alone, early and delayed ACL reconstruction (ACLR). METHODS Seven databases were searched from inception to April 14, 2022. Articles were included if they assessed Tampa Scale of Kinesiophobia (TSK), Knee Self-Efficacy Scale (KSES), or Fear Avoidance Beliefs Questionnaire (FABQ). Risk of bias (RoB) was assessed using domain-based RoB tools (ROBINS-1, RoB 2, RoBANS), and GRADE-assessed certainty of evidence. Random-effects meta-analyses pooled outcomes, stratified by time post-injury (pre-operative, 3-6 months, 7-12 months, > 1-2 years, > 2-5 years, > 5 years). RESULTS Seventy-three studies (70% high RoB) were included (study outcomes: TSK: 55; KSES: 22; FABQ: 5). Meta-analysis demonstrated worse kinesiophobia and self-efficacy pre-operatively (pooled mean [95% CI], TSK-11: 23.8 [22.2-25.3]; KSES: 5.0 [4.4-5.5]) compared with 3-6 months following ACLR (TSK-11: 19.6 [18.7-20.6]; KSES: 19.6 [18.6-20.6]). Meta-analysis suggests similar kinesiophobia > 3-6 months following early ACLR (19.8 [4.9]) versus delayed ACLR (17.2 [5.0]). Only one study assessed outcomes comparing ACLR with rehabilitation only. CONCLUSIONS Knee self-efficacy and kinesiophobia improved from pre-ACLR to 3-6 months following ACLR, with similar outcomes after 6 months. Since the overall evidence was weak, there is a need for high-quality observational and intervention studies focusing on psychological outcomes following ACL injury.
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Affiliation(s)
- Garrett S Bullock
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Charlotte, NC, USA.
- Centre for Sport, Exercise and Osteoarthritis Research-Versus Arthritis, University of Oxford, Oxford, UK.
| | | | | | | | | | | | - Nilani Mills
- Atrium Health, Charlotte, NC, USA
- University of New South Wales, Sydney, NSW, Australia
| | | | - Steven Duhig
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Gold Coast, Australia
| | - Anu Räisäsen
- Department of Physical Therapy, Western University of Health Sciences, Lebanon, OR, USA
- Department of Kinesiology, University of Calgary, Calgary, AB, Canada
| | | | - Gary S Collins
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Joanna Kvist
- Unit of Physiotherapy, Department of Health, Medicine, and Caring Medicine, Linkoping University, Linköping, Sweden
- Stockholm Sports Trauma Research Center, Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Stephanie R Filbay
- Centre of Health, Exercise, and Sport Medicine, University of Melbourne, Melbourne, VIC, Australia
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Return to sport soccer after anterior cruciate ligament reconstruction: ISAKOS consensus. J ISAKOS 2022; 7:150-161. [PMID: 35998884 DOI: 10.1016/j.jisako.2022.08.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 08/07/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Many factors can affect the return to pivoting sports, after an Anterior Cruciate Ligament Reconstruction. Prehabilitation, rehabilitation, surgical and psychological aspects play an essential role in the decision to return to sports. The purpose of this study is to reach an international consensus about the best conditions for returning to sports in soccer-one of the most demanding level I pivoting sports after anterior cruciate ligament (ACL) reconstruction. METHODS 34 International experts in the management of ACL injuries, representing all the Continents were convened and participated in a process based on the Delphi method to achieve a consensus. 37 statements related to ACL reconstruction were reviewed by the experts in three rounds of surveys in complete anonymity. The statements were prepared by the working group based on previous literature or systematic reviews. Rating agreement through a Likert Scale: strongly agree, agree, neither agree or disagree, disagree and strongly disagree was used. To define consensus, it was established that the assertions should achieve a 75% of agreement or disagreement. RESULTS Of the 37 statements, 10 achieved unanimous consensus, 18 non-unanimous consensus and 9 did not achieve consensus. In the preoperative, the correction of the range of motion deficit, the previous high level of participation in sports and a better knowledge of the injury by the patient and compliance to participate in Rehabilitation were the statements that reached unanimous consensus. During the surgery, the treatment of associated injuries, as well as the use of autografts, and the addition of a lateral extra-articular tenodesis in some particular cases (active young athletes, <25 years old, hyperlaxity, high rotatory laxity and revision cases) obtained also 100% consensus. In the postoperative period, psychological readiness and its validation with scales, adequate physical preparation, as well as not basing the RTSS purely on the time of evolution after surgery, were the factors that reached unanimous Consensus. CONCLUSIONS The consensus statements derived from this international ISAKOS leaders, may assist clinicians in deciding when to return to sports soccer in patients after an ACL reconstruction. Those statements that reached 100% consensus have to be strongly considered in the final decision to RTS soccer.
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Little C, Lavender AP, Starcevich C, Mesagno C, Mitchell T, Whiteley R, Bakhshayesh H, Beales D. An Investigation of the Nature of Fear within ACL-Injured Subjects When Exposed to Provocative Videos: A Concurrent Qualitative and Quantitative Study. Sports (Basel) 2022; 10:sports10110183. [PMID: 36422952 PMCID: PMC9692454 DOI: 10.3390/sports10110183] [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: 10/13/2022] [Revised: 11/15/2022] [Accepted: 11/15/2022] [Indexed: 11/22/2022] Open
Abstract
Fear is a factor contributing to poor return to sport after an anterior cruciate (ACL) injury, however the identification and assessment of fear is challenging. To improve understanding of fear, this study qualitatively and quantitatively assessed responses to videos depicting threat to knee stability in people who had experienced an ACL injury. ACL-injured participants who had above average fear on the Tampa Scale of Kinesiophobia and were at least 1-year post-injury/surgery were eligible. Participants were shown four videos depicting sequentially increasing threat to their knee stability (running, cut-and-pivot, feigned knee injury during cut-and-pivot, series of traumatic knee injuries). Qualitative interviews explored participants feeling related to viewing the videos. Participants quantitatively self-rated fear and distress in response to each video. Seventeen participants were included in this study (71% female, with an average time since last ACL injury of 5 ½ years). Five themes were identified: (1) Evoked physiological responses, (2) Deeper contextualisation of the meaning of an ACL injury influencing bodily confidence, (3) Recall of psychological difficulties, (4) Negative implications of a re-injury, and (5) Change to athletic identity. Quantitatively, direct proportionality was noticed between threat level and reported fear and distress. Specifically, participants reported increasing levels of fear and distress as the videos progressed in threat level, with the largest increase seen between a cut-and-pivot movement to a feigned injury during a cut and pivot. The results support the notion that in addition to being a physical injury, an ACL injury has more complex neurophysiological, psychological, and social characteristics which should be considered in management. Using video exposure in the clinic may assist identification of underlying psychological barriers to recovery following an ACL injury, facilitating person-centred care.
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Affiliation(s)
- Cameron Little
- Curtin enAble Institute and Curtin School of Allied Health, Curtin University, Perth, WA 6102, Australia
- Correspondence:
| | - Andrew P. Lavender
- Institute of Health and Wellbeing, Federation University Australia, Ballarat, VIC 3350, Australia
| | - Cobie Starcevich
- Curtin enAble Institute and Curtin School of Allied Health, Curtin University, Perth, WA 6102, Australia
| | - Christopher Mesagno
- Institute for Health & Sport, Victoria University, Melbourne, VIC 3011, Australia
| | | | | | - Hanieh Bakhshayesh
- Curtin School of Electrical Engineering, Computing and Mathematical Sciences, Curtin University, Perth, WA 6102, Australia
| | - Darren Beales
- Curtin enAble Institute and Curtin School of Allied Health, Curtin University, Perth, WA 6102, Australia
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Manara JR, Salmon LJ, Kilani FM, Zelaya de Camino G, Monk C, Sundaraj K, Pinczewski LA, Roe JP. Repeat Anterior Cruciate Ligament Injury and Return to Sport in Australian Soccer Players After Anterior Cruciate Ligament Reconstruction With Hamstring Tendon Autograft. Am J Sports Med 2022; 50:3533-3543. [PMID: 36190172 DOI: 10.1177/03635465221125467] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Soccer is the most commonly played team sport in the world and a high-risk sport for anterior cruciate ligament (ACL) injury and subsequent ACL reconstruction (ACLR). PURPOSE To assess the rate of further ACL injury in patients who have undergone ACLR with hamstring tendon autograft after soccer injuries in Australia and to determine factors associated with repeat ACL injury and return to soccer. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS From a prospectively collected database, a series of 1000 consecutive ACLRs using hamstring autografts performed in soccer players were identified. Patients were surveyed at a minimum 5 years after reconstruction, including details of further ACL injuries to either knee, return to soccer or other sports, and psychological readiness per the Anterior Cruciate Ligament Return to Sport after Injury (ACL-RSI) scale. RESULTS Of the 862 participants reviewed, ACL graft rupture occurred in 85 (10%) and contralateral ACL rupture in 68 (8%) within 5 years after the reconstruction. The 5-year ACL graft survivorship was 94% for females and 88% for males. The survivorship of the contralateral ACL was 92% for males and 90% for females. When compared with those aged >25 years, the odds of ACL graft rupture was increased by 4 to 5 times in those aged 19 to 25 years and 3 to 7 times in those ≤18 years. Further ACL injury to the graft or contralateral knee occurred in 44% of males aged ≤18 years. Risk factors for further ACL injury were younger age at time of surgery, male sex, and return to soccer. Graft diameter did not influence ACL graft rupture rates, and 70% of patients returned to soccer after ACLR. The mean ACL-RSI score was 59, and patients who reported more fear of reinjury on this scale were less likely to have returned to soccer. CONCLUSION The prevalence of ACL graft rupture (10%) and contralateral ACL rupture (8%) was near equivalent over 5 years in this large cohort of mostly recreational Australian soccer players. ACLR with hamstring autograft is a reliable procedure, allowing 70% of patients to return to soccer in this high-risk population. Risk factors for further ACL injury are progressively younger age at time of surgery, male sex, and return to soccer. Graft diameter was not a factor in ACL graft rupture, indicating that other factors, particularly age, are of primary importance.
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Affiliation(s)
- Jonathan R Manara
- North Sydney Orthopaedic and Sports Medicine Centre, Sydney, Australia
| | - Lucy J Salmon
- North Sydney Orthopaedic and Sports Medicine Centre, Sydney, Australia.,School of Medicine, University of Notre Dame, Sydney, Australia
| | - Faisal M Kilani
- School of Medicine, University of Notre Dame, Sydney, Australia
| | | | - Claire Monk
- North Sydney Orthopaedic and Sports Medicine Centre, Sydney, Australia
| | - Keran Sundaraj
- North Sydney Orthopaedic and Sports Medicine Centre, Sydney, Australia
| | - Leo A Pinczewski
- North Sydney Orthopaedic and Sports Medicine Centre, Sydney, Australia.,School of Medicine, University of Notre Dame, Sydney, Australia
| | - Justin P Roe
- North Sydney Orthopaedic and Sports Medicine Centre, Sydney, Australia.,School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
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Warming S, Herzog RB, Lundgaard-Nielsen M, Rathcke MW, Krogsgaard MR. No correlation between performance tests, clinical measurements and data from patient-reported outcome measures (PROM) in children reconstructed for anterior cruciate ligament injury. Knee Surg Sports Traumatol Arthrosc 2022; 31:2386-2393. [PMID: 36149469 DOI: 10.1007/s00167-022-07174-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 09/15/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE To investigate if patient-reported outcome measures (PROMs), functional tests and clinical measures correlate well in children after reconstruction of the anterior cruciate ligament (ACL). It was hypothesized that these outcomes correlate, so it is sufficient to report only one of them. METHODS A consecutive group of children (< 16 years old) who had an ACL reconstruction, were prospectively followed and assessed after 1-year with Pedi-IKDC and KOOS-Child, instrumented laxity measurement, range of motion, extension strength and four performance tests. Relations between the different outcomes were calculated by partial correlation coefficient analysis, controlling for gender, age, height, and weight. RESULTS Outcomes were available for 141 of 163 children. There were only few positive and weak correlations between performance tests and PROM scores and between clinical measurements and PROM scores. There were weak to strong correlations between the scores from Pedi-IKDC and the scores from each of the five domains of KOOS-Child and a weak to moderate correlation between the different domains of KOOS-Child. Similar correlations were found between the different performance tests. CONCLUSION For children who had their ACL reconstructed there was no clinically important correlation between scores obtained by PROMs, a battery of functional performance tests and instrumented laxity of the knee at 1-year follow-up. This is an argument for always to include and report all three types of outcomes. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Susan Warming
- Department of Physical and Occupational Therapy, Copenhagen University Hospital, Bispebjerg-Frederiksberg, Denmark.
| | - Robert Bennike Herzog
- Department of Physical and Occupational Therapy, Copenhagen University Hospital, Bispebjerg-Frederiksberg, Denmark
| | - Mathilde Lundgaard-Nielsen
- Department of Physical and Occupational Therapy, Copenhagen University Hospital, Bispebjerg-Frederiksberg, Denmark
| | - Martin Wyman Rathcke
- Section for Sports Traumatology M51, Copenhagen University Hospital, Bispebjerg-Frederiksberg, Denmark
| | - Michael Rindom Krogsgaard
- Section for Sports Traumatology M51, Copenhagen University Hospital, Bispebjerg-Frederiksberg, Denmark
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Ortiz E, Zicaro JP, Garcia Mansilla I, Yacuzzi C, Costa-Paz M. Revision anterior cruciate ligament reconstruction: Return to sports at a minimum 5-year follow-up. World J Orthop 2022; 13:812-824. [PMID: 36189337 PMCID: PMC9516620 DOI: 10.5312/wjo.v13.i9.812] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 05/04/2022] [Accepted: 08/10/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Between 43% and 75% of patients who undergo primary anterior cruciate ligament (ACL) surgery return to sport activity. However, after a revision ACL reconstruction (ACLR) the rate of return to sports is variable. A few publications have reported returns to sports incidence between 56% to 100% after revision ACLR. AIM To determine return to sports and functional outcomes after a single-stage revision ACLR with a 5-year minimum follow-up at a single institution. METHODS All patients operated between 2010 and 2016 with a minimum 5 years of follow-up were included. Type of sport, intensity, frequency, expectation, time to return to sport and failure rate were recorded. Lysholm, Tegner and International Knee Documentation Committee forms were evaluated prior to the first ACLR surgery, at 6 mo after primary surgery and after revision ACLR at 5 years minimum of follow-up. Objective stability was tested with the knee arthrometer test (KT-1000 knee arthrometer, Medmetric Corp). RESULTS A total of 41 patients who underwent revision ACLR during that period of time were contacted and available for follow-up. Median patient age at time of revision was 29 years old [interquartile range (IQR): 24.0-36.0], and 39 (95.0%) were male. The median time from revision procedure to follow-up was 70 mo (IQR: 58.0-81.0). Regarding return to sports, 16 (39.0%) were at the same level compared to preinjury period, and 25 patients (61.0%) returned at a lower level. Sixty-three percent categorized the sport as very important and 37.0% as important. One patient (2.4%) failed with a recurrent ACL torn. Mean preoperative Lysholm and subjective International Knee Documentation Committee scores were 58.8 [standard deviation (SD) 16] and 50 (SD 11), respectively. At follow-up, mean Lysholm and subjective International Knee Documentation Committee scores were 89 (SD 8) and 82 (SD 9) (P = 0.0001). Mean Tegner score prior to primary ACLR was 6.7 (SD 1.3), 5.1 (1.5 SD) prior to revision ACLR and 5.6 (1.6 SD) at follow-up (P = 0.0002). Overall, knee arthrometer test measurement showed an average of 6 mm (IQR: 4.0-6.0) side-to-side difference of displacement prior to revision ACLR and 3mm (IQR: 1.5-4.0) after revision. CONCLUSION Almost 40.0% of patients returned to preinjury sports level and 60.0% to a lower level. These may be useful when counseling a patient regarding sports expectations after a revision ACLR.
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Affiliation(s)
- Ezequiel Ortiz
- Knee Division, Hospital Italiano de Buenos Aires, Ciudad Autónoma 1181, Buenos Aires, Argentina
| | - Juan Pablo Zicaro
- Knee Division, Hospital Italiano de Buenos Aires, Ciudad Autónoma 1181, Buenos Aires, Argentina
| | - Ignacio Garcia Mansilla
- Knee Division, Hospital Italiano de Buenos Aires, Ciudad Autónoma 1181, Buenos Aires, Argentina
| | - Carlos Yacuzzi
- Knee Division, Hospital Italiano de Buenos Aires, Ciudad Autónoma 1181, Buenos Aires, Argentina
| | - Matias Costa-Paz
- Knee Division, Hospital Italiano de Buenos Aires, Ciudad Autónoma 1181, Buenos Aires, Argentina
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Zhou L, Xu Y, Zhang J, Guo L, Zhou T, Wang S, Xu W. Multiplanar knee kinematics-based test battery helpfully guide return-to-sports decision-making after anterior cruciate ligament reconstruction. Front Bioeng Biotechnol 2022; 10:974724. [PMID: 36185444 PMCID: PMC9523368 DOI: 10.3389/fbioe.2022.974724] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 09/01/2022] [Indexed: 11/24/2022] Open
Abstract
Background: There are currently no well-established criteria to guide return to sports (RTS) after anterior cruciate ligament reconstruction (ACLR). In this study, a new test battery consisting of subjective and objective tests, especially multiplanar knee kinematics assessment, was developed to aid RTS decision making after ACLR. Methods: This study was conducted with 30 patients who were assessed a mean of 9.2 ± 0.5 months after ACLR. All patients underwent complete evaluations of both lower limbs with four objective assessments [isokinetic, hop, knee laxity, and 6–degree of freedom (6DOF, angle: flexion-extension, varus-valgus, internal-external rotation; translation: anteroposterior, proximodistal, mediolateral) knee kinematics tests] and two subjective assessments [International Knee Documentation Committee (IKDC) and Anterior Cruciate Ligament Return to Sport after Injury (ACL-RSI) questionnaires]. Limb symmetry indices (LSIs) of knee strength, hop distance, and range of motion (ROM) of knee kinematics were calculated. LSI ≥90%, IKDC scale score within the 15th percentile for healthy adults, and ACL-RSI score >56 were defined as RTS criteria. Results: Significant differences between affected and contralateral knees were observed in the quadriceps strength (p < 0.001), hamstring strength (p = 0.001), single hop distance (p < 0.001), triple hop distance (p < 0.001), and rotational ROM (p = 0.01). Only four patients fulfilled the overall RTS criteria. The percentages of patients fulfilling individual criteria were: quadriceps strength, 40%; hamstring strength, 40%; single hop distance, 30%; triple hop distance, 36.7%; knee ligament laxity, 80%; flexion-extension, 23.3%; varus-valgus rotation, 20%; internal-external rotation, 66.7%; anteroposterior translation, 20%; proximodistal translation, 33.3%; mediolateral translation, 26.7%; IKDC scale score, 53.3%; and ACL-RSI score, 33.3%. Conclusion: At an average of 9 months after ACLR, objectively and subjectively measured knee functional performance was generally unsatisfactory especially the recovery of knee kinematics, which is an important prerequisite for RTS.
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Affiliation(s)
- Lan Zhou
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai, China
| | - Yihong Xu
- Department of Orthopedics, Changhai Hospital, The Navy Medical University, Shanghai, China
| | - Jing Zhang
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai, China
| | - Luqi Guo
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai, China
| | - Tianping Zhou
- Department of Orthopedics, Changhai Hospital, The Navy Medical University, Shanghai, China
| | - Shaobai Wang
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai, China
- *Correspondence: Shaobai Wang, ; Weidong Xu,
| | - Weidong Xu
- Department of Orthopedics, Changhai Hospital, The Navy Medical University, Shanghai, China
- *Correspondence: Shaobai Wang, ; Weidong Xu,
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Bakhsh HR, Metikala S, Billy GG, Vairo GL. Association Between Self-Reported Kinesiophobia and Single-Leg Hop for Distance in Patients With ACL Reconstruction: A Systematic Review. Sports Health 2022; 14:674-680. [PMID: 34651507 PMCID: PMC9460087 DOI: 10.1177/19417381211049357] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
CONTEXT Psychological readiness is a significant factor in determining successful return to sport (RTS) and physical activities after anterior cruciate ligament (ACL) reconstruction. Knowing the influence of kinesiophobia on physical tests that are used to guide RTS, such as the single-leg hop for distance (SLHD), would contribute to advancing clinical practice. OBJECTIVE To investigate the association between kinesiophobia and SLHD performance in patients after ACL reconstruction. DATA SOURCES A comprehensive search strategy entailed surveying 6 databases for relevant articles published from January 2009 to March 2021. STUDY SELECTION Articles published in English that were a minimum of level 3 evidence describing kinesiophobia, as measured by the Tampa Scale for Kinesiophobia, and related to SLHD performance in patients after ACL reconstruction. STUDY DESIGN Systematic review. LEVEL OF EVIDENCE Level 3. DATA EXTRACTION Study characteristics, sample population demographics, instrument(s), or approach(s) used to assess kinesiophobia and SLHD performance, and corresponding results. RESULTS A total of 152 potential studies were identified, 106 studies underwent screening, 40 were reviewed in full, and 7 studies were included. Meta-analysis could not be performed because of differences in experimental design among studies and instances of missing outcome data. Currently, moderate evidence indicates patients with ACL reconstruction that exhibit less kinesiophobia perform better on the SLHD test. CONCLUSION The outcomes of this review propose that sports health practitioners consider the influence of kinesiophobia on SLHD performance as a criterion for RTS and physical activities in patients after ACL reconstruction. Higher quality studies are necessary to establish the extent of association between these variables.
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Affiliation(s)
- Hadeel R. Bakhsh
- Department of Rehabilitation, College
of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University,
Riyadh, Saudi Arabia
| | - Sreenivasulu Metikala
- Department of Orthopaedic Surgery,
Virginia Commonwealth University Medical Center, Richmond, Virginia
| | - Gregory G. Billy
- Department of Orthopaedics &
Rehabilitation, College of Medicine, Pennsylvania State University, University Park,
Pennsylvania
| | - Giampietro L. Vairo
- Department of Orthopaedics &
Rehabilitation, College of Medicine, Pennsylvania State University, University Park,
Pennsylvania
- Department of Kinesiology, College of
Health and Human Development, Pennsylvania State University, University Park,
Pennsylvania
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Lim DGW, Chou ACC, Chang PCC, Tan ETS, Lie DTT. Delayed Surgery, Low Presurgery Activity, and Poor Preoperative IKDC Scores Are Correlated with Lower Rates of Return to Sports after ACL Reconstruction in an Asian Population. J Knee Surg 2022; 35:1079-1086. [PMID: 33389730 DOI: 10.1055/s-0040-1721789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
There is limited literature regarding the early postsurgical outcomes of anterior cruciate ligament (ACL) reconstruction in Asian populations, particularly in the rates of return to sports. We aimed to quantify early clinical outcomes for ACL reconstruction, determine the predictive value of surgeon- and patient-reported outcomes on the rate of return to sports in the early postoperative period, and identify factors predictive of return to sports. We analyzed the data of 55 patients who underwent ACL reconstruction at our tertiary medical center from 2015 to 2016. All patients underwent transportal ACL reconstruction and a standardized post-ACL reconstruction rehabilitation protocol. Patients with concurrent meniscal injury and repair were included. Patients were evaluated at the 3-month, 6-month, 1-year, and 2-year postoperative periods. Surgeon- and patient-reported outcome scores were collected at each follow-up through a systematic questionnaire designed to determine the patient's level of return to sport and reasons for not returning. Surgeon- and patient-reported outcome measures improved significantly over the 2-year postoperative period (p < 0.001). Overall rate of return to sports was 58.2%. The International Knee Documentation Committee (IKDC) subjective (p = 0.02), symptomatic (p = 0.001), composite (p = 0.005), Tegner (p < 0.001) and Lysholm (p = 0.049) scores at 2-year follow-up were significantly worse in patients who failed to return to sports. Earliest difference in scores manifested at 3-month postsurgery (p = 0.011). IKDC grade-D patients were 18.1 times less likely to return to sports (p = 0.035). Delayed surgery (p = 0.01) and presurgery inactivity (p = 0.023) were negatively predictive of return to sports. The rate of return to sport is consistent with the literature analyzing other ethnic populations. Both surgeon- and patient-reported outcome scores at 2-year postsurgery exhibited significant differences between those who did and did not return to sports. Patients should be advised to seek surgical treatment as soon as possible and stay active preoperatively to maximize return to sports.
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Affiliation(s)
- Dominic G W Lim
- Department of Orthopaedic Surgery, National University of Singapore, Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Andrew C C Chou
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Paul C C Chang
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Edwin T S Tan
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Denny T T Lie
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
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The Effects of a Combined Pre- and Post-Operative Anterior Cruciate Ligament Reconstruction Rehabilitation Program on Lower Extremity Muscle Imbalance. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12157411] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study examined whether the 5-week pre-operative progressive exercise rehabilitation program with weekly monitoring contributed to a significantly lower muscle activity imbalance in the treatment group, both before and immediately after anterior cruciate ligament reconstruction (ACLR), as well as during the next 5 weeks in comparison to the control group. Twelve professional soccer players took part in the study (from among the top three Polish levels of competition) (age: 26 ± 5 years, body mass: 73 ± 7 kg, stature: 180 ± 6 cm, training experience: 15 ± 4 years). The participants were randomly assigned to the treatment group (n = 6) or to the control group (n = 6). Both groups performed the same pre- and post-operative progressive exercise rehabilitation program, while the rehabilitation of the treatment group was extended by supplementary body-weight functional stabilization training. The three-way repeated-measures ANOVA revealed a statistically significant interaction for muscle × group × time (p < 0.0001; F = 24.897; η2 = 0.806). The post-hoc analysis for the interaction effect of muscle × group × time indicated a significantly higher muscle activity imbalance for every measured muscle in the control group at any time point than in the treatment group (from p = 0.036 to p < 0.0001). The muscle activity imbalance was significantly higher from the 1st to 4th weeks than in the last week before surgery for quadriceps (p < 0.016 for all) and hamstrings (p < 0.001). However, in the case of gluteal muscles’ activity imbalance, it was significantly higher at every time point of the post-operative phase than in the last week before surgery (p < 0.001). The results of this study showed that the 5-week pre-operative rehabilitation program with weekly monitoring influenced outcomes of the post-operative phase. Nevertheless, performing both pre- and post-ACLR rehabilitation significantly reduced the muscle activity imbalance of lower limbs, but in the case of the quadriceps muscles, not to a sufficient level.
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Marigi EM, Hale RF, Bernard CD, Bates N, Stuart MJ, Hewett TE, Krych AJ. Are 6-Month Functional and Isokinetic Testing Measures Risk Factors for Second Anterior Cruciate Ligament Injuries at Long-T Follow-Up? J Knee Surg 2022. [PMID: 35688443 DOI: 10.1055/s-0042-1748824] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Second anterior cruciate ligament (SACL) injuries are a devastating complication following return to sport (RTS). Appropriate and safe RTS criteria that reduce the risk of SACL injuries are needed. The goal of this study was to investigate the relationship between functional and isokinetic testing at 6 months following primary ACL reconstruction (ACLR) as risk factors for SACL injuries. METHODS Patients with primary ACLR from 1990 to 2010 were identified. Those with 6-month postoperative functional and isokinetic testing and a minimum of 2-year follow-up were included. Functional testing included vertical jump, single-leg hop, and single-leg triple hop. Isokinetic testing included concentric quadriceps and hamstrings (HSs) strength at 60 and 180 degree/s speeds. Statistical analysis evaluated the significance of the various tests between those with and without a secondary tear. RESULTS In total, 344 patients with a mean age of 26.0 ± 9.8 years at an average time of 9.1 ± 3.5 years of follow-up were analyzed. Fifty-nine patients (17%) experienced SACL injuries at an average time of 4.8 years following ACLR with 34 (58%) ipsilateral graft ruptures and 25 (43%) contralateral tears. Several isokinetic measures were significantly different between the NO SACL and the SACL groups: quadriceps 60 degree/s limb symmetry index (LSI) (75 vs. 82% p = 0.01), HS 60 degree/s LSI (92 vs. 97%, p = 0.04), quadriceps 180 degree/s involved/body weight (BW) (41 vs. 47%, p = 0.04), and HS 180 degree/s involved/BW (30 vs. 34%, p = 0.04). Patients with involved limb peak quadriceps torque value greater than 65 or 50% of BW (60 and 180 degree/s) had a 2.2 and 3.1 times higher risk of an SACL injury. CONCLUSIONS Patients with certain elevated isokinetic scores in the injured limb at 6 months after ACLR experienced a higher rate of subsequent ACL injuries than those who had lower peak torque. Although a quantitative only analysis may not be sufficient to determine RTS criteria, clinicians should caution high-performing patients about the risk of subsequent ACL injury. LEVEL OF EVIDENCE Cohort study; 3.
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Affiliation(s)
- Erick M Marigi
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Rena F Hale
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Nathaniel Bates
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Michael J Stuart
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Timothy E Hewett
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Aaron J Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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Glattke KE, Tummala SV, Chhabra A. Anterior Cruciate Ligament Reconstruction Recovery and Rehabilitation: A Systematic Review. J Bone Joint Surg Am 2022; 104:739-754. [PMID: 34932514 DOI: 10.2106/jbjs.21.00688] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The success of anterior cruciate ligament (ACL) reconstruction is influenced by effective rehabilitation. Previously published, comprehensive systematic reviews evaluating rehabilitation after ACL reconstruction have studied Level-I and II evidence published through 2012. Interval studies continue to evaluate the efficacy of various rehabilitative modalities. METHODS A total of 824 articles from 2012 to 2020 were identified using multiple search engines. Fifty Level-I or II studies met inclusion criteria and were evaluated using the Consolidated Standards of Reporting Trials (CONSORT) criteria and National Institutes of Health (NIH) Study Quality Assessment Tools. RESULTS Accelerated rehabilitation can be effective for patients with semitendinosus-gracilis grafts. Blood flow restriction (BFR) training with high-intensity exercise is not effective for ACL reconstruction recovery. Postoperative bracing does not offer any advantages or improve limb asymmetry. Cryotherapy is an effective analgesic when used perioperatively. The early introduction of open kinetic chain exercises may improve ACL reconstruction outcomes, and high-intensity plyometric exercise is not effective. Estimated pre-injury capacity (EPIC) levels may be more accurate than the Limb Symmetry Index (LSI) when using functional test results to predict reinjury rates, and hip external rotation strength may be the most accurate predictor of the hop test performance. Nerve blocks can provide postoperative analgesia with minimal complication risk. Neuromuscular electrical stimulation is effective when used independently and in combination with rehabilitative exercises. Psychological readiness should be evaluated both objectively and subjectively before allowing patients to safely return to sport. Electromyography biofeedback may help to regain muscular function, and whole-body vibration therapy can improve postural control. Supervised rehabilitation is more effective than unsupervised rehabilitation. CONCLUSIONS Various rehabilitative modalities following ACL reconstruction are effective in improving surgical outcomes and return-to-sport rates. Further evidence and improved study design are needed to further validate modalities including accelerated rehabilitation, BFR training, functional testing, and return-to-sport criteria. LEVEL OF EVIDENCE Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Kaycee E Glattke
- Division of Sports Medicine, Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona
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Costa GG, Perelli S, Grassi A, Russo A, Zaffagnini S, Monllau JC. Minimizing the risk of graft failure after anterior cruciate ligament reconstruction in athletes. A narrative review of the current evidence. J Exp Orthop 2022; 9:26. [PMID: 35292870 PMCID: PMC8924335 DOI: 10.1186/s40634-022-00461-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 02/28/2022] [Indexed: 01/11/2023] Open
Abstract
Anterior cruciate ligament (ACL) tear is one of the most common sport-related injuries and the request for ACL reconstructions is increasing nowadays. Unfortunately, ACL graft failures are reported in up to 34.2% in athletes, representing a traumatic and career-threatening event. It can be convenient to understand the various risk factors for ACL failure, in order to properly inform the patients about the expected outcomes and to minimize the chance of poor results. In literature, a multitude of studies have been performed on the failure risks after ACL reconstruction, but the huge amount of data may generate much confusion.The aim of this review is to resume the data collected from literature on the risk of graft failure after ACL reconstruction in athletes, focusing on the following three key points: individuate the predisposing factors to ACL reconstruction failure, analyze surgical aspects which may have significant impact on outcomes, highlight the current criteria regarding safe return to sport after ACL reconstruction.
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Affiliation(s)
- Giuseppe Gianluca Costa
- Orthopaedic and Traumatologic Unit, Umberto I Hospital, Azienda Sanitaria Provinciale di Enna, C.da Ferrante, 94100, Enna, Italy. .,Knee and Arthroscopy Unit, Institut Catalá de Traumatologia I Medicina de L'Esport (ICATME), Hospital Universitari Quiron Dexeus, Universitat Autonoma de Barcelona, Barcelona, Catalunya, Spain.
| | - Simone Perelli
- Knee and Arthroscopy Unit, Institut Catalá de Traumatologia I Medicina de L'Esport (ICATME), Hospital Universitari Quiron Dexeus, Universitat Autonoma de Barcelona, Barcelona, Catalunya, Spain.,Department of Surgery and Morphologic Science, Orthopaedic Surgery Service, Universitat Autonoma de Barcelona, Hospital Del Mar, Barcelona, Spain
| | - Alberto Grassi
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Arcangelo Russo
- Orthopaedic and Traumatologic Unit, Umberto I Hospital, Azienda Sanitaria Provinciale di Enna, C.da Ferrante, 94100, Enna, Italy
| | - Stefano Zaffagnini
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Juan Carlos Monllau
- Knee and Arthroscopy Unit, Institut Catalá de Traumatologia I Medicina de L'Esport (ICATME), Hospital Universitari Quiron Dexeus, Universitat Autonoma de Barcelona, Barcelona, Catalunya, Spain.,Department of Surgery and Morphologic Science, Orthopaedic Surgery Service, Universitat Autonoma de Barcelona, Hospital Del Mar, Barcelona, Spain
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Chen B. CHARACTERISTICS OF SPORTS INJURIES IN TAEKWONDO ATHLETES IN PHYSICAL TRAINING. REV BRAS MED ESPORTE 2022. [DOI: 10.1590/1517-8692202228012021_0463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Introduction: Taekwondo is one of the main events of the Olympic Games. It mainly uses hands and feet for fighting or confrontation and the competition is extremely fierce. Therefore, Taekwondo is more prone to muscle, bone, and joint sports injuries. Objective: To understand the characteristics of taekwondo sports injuries. Methods: Using the literature and questionnaire survey methods, mathematical statistics is used to investigate the sports injuries of young Taekwondo athletes. Results: Among 100 young Taekwondo athletes, 93individuals had different degrees of sports injuries, accounting for 93%, and 7had no sports injuries, accounting for only 7%. The total number of injuries was 160 or 1.6injuries per capita. Conclusions: Athletes should improve their ideological understanding and training level and pay attention to the timely treatment of acute injuries, which can effectively reduce sports injuries. Level of evidence II; Therapeutic studies - investigation of treatment results.
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Keays SL, Mellifont DB, Keays AC, Stuelcken MC, Lovell DI, Sayers MGL. Long-term Return to Sports After Anterior Cruciate Ligament Injury: Reconstruction vs No Reconstruction-A Comparison of 2 Case Series. Am J Sports Med 2022; 50:912-921. [PMID: 35148249 DOI: 10.1177/03635465211073152] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Reconstruction is considered to provide the best opportunity for return to sports (RTS) after anterior cruciate ligament (ACL) rupture. However, recent studies report that <50% of athletes return to preinjury sporting levels and that RTS rates at 1 year after injury are the same for athletes undergoing reconstruction and nonoperative management. Long-term studies are essential to confirm these findings and guide decisions regarding surgery. PURPOSE First, to compare long-term sports participation after ACL reconstruction and nonreconstruction and, second, to relate RTS level to strength and stability. STUDY DESIGN Cohort study; Level of evidence, 3. METHOD Patients with ACL deficiency (n = 101) who were referred for physical therapy at the time of diagnosis were followed long term: 56 were treated surgically 2.5 years (interquartile range [IQR], 1-4) after injury and 45 were treated nonoperatively. At long-term follow-up, the reconstructed group was at 9 years (IQR, 7-11) after injury and aged 33.3 ± 6.2 years (mean ± SD, 70% male; 61% meniscal injury), and the nonreconstructed group was at 11 years (IQR, 7-14) after injury and aged 38.7 ± 8.3 years (67% male; 58% meniscal injury). Measures of objective stability, subjective stability, and quadriceps/hamstring strength were compared between groups using independent-samples t tests. Current RTS level, scored on a 6-point scale, was compared between groups using chi-square tests. Spearman rho correlated RTS with outcome measures. RESULTS Of the total group of patients, 96% with reconstruction and 93% without continued to play sports. In the reconstructed and nonreconstructed groups, 4% and 7% did not RTS, and 8% and 17% returned to safe sports, respectively: 13% and 12% to running, 20% and 26% to sports involving limited twisting, 12% and 24% to recreational pivoting sports, and 43% and 14% to competitive pivoting sports. The only significant difference was in return to competitive pivoting sports (P = .003). Five patients with reconstruction ruptured the contralateral ACL, and 1 ruptured his graft. Most patients treated nonoperatively modified their sports participation. Their RTS levels correlated significantly with quadriceps strength (r = 0.65; P < .001), hamstring strength (r = 0.721; P < .001), and subjective stability (r = 0.405; P = .01). CONCLUSION Surgically treated patients returned to competitive pivoting sports at 3 times the rate of those managed nonoperatively, confirming that reconstruction provides the best opportunity for continued participation in competitive pivoting sports. Regardless of grouping, RTS correlated with modifiable factors, including strength and stability. Higher rates of subsequent injuries observed after reconstruction may result from increased participation in competitive pivoting sports.
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Affiliation(s)
- Susan L Keays
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Queensland, Australia.,Private orthopaedic and physical therapy practice, Sunshine Coast, Australia
| | - Daniel B Mellifont
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Queensland, Australia
| | - Anthony C Keays
- Private orthopaedic and physical therapy practice, Sunshine Coast, Australia
| | - Max C Stuelcken
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Queensland, Australia
| | - Dale I Lovell
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Queensland, Australia
| | - Mark G L Sayers
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Queensland, Australia
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Beneito Pastor D, Morales-Santias M, Bustamante Suarez de Puga D, Más Martínez J, Garcia Miralles S, Sanz-Reig J. Preparación psicológica para la reincorporación deportiva tras cirugía reconstructiva del ligamento cruzado anterior en el deportista aficionado. Rev Esp Cir Ortop Traumatol (Engl Ed) 2022; 66:113-120. [DOI: 10.1016/j.recot.2021.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 06/26/2021] [Accepted: 07/18/2021] [Indexed: 11/29/2022] Open
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