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ElNemer W, Elsabbagh Z, Cartagena-Reyes MA, Nazario-Ferrer G, Park S, Mikula JD, Jain A, Best MJ. Impact of anterior cruciate ligament tears on player efficiency ratings and salary in National Basketball Association over the past 20 years: a retrospective case control study. PHYSICIAN SPORTSMED 2025; 53:203-211. [PMID: 39659049 DOI: 10.1080/00913847.2024.2441108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2024] [Revised: 11/29/2024] [Accepted: 12/09/2024] [Indexed: 12/12/2024]
Abstract
OBJECTIVES Players in the National Basketball Association (NBA) are at high risk for ACL tears which are detrimental to their career due to the months of rehabilitation. The authors hypothesize that after anterior crucial ligament (ACL) injury, older players will be less likely to return to the NBA, players that do return will have a lower performance efficiency rating (PER), and the decrease in PER will be associated with a lower salary. METHODS This case-control study utilized the publicly available database maintained by the NBA, professional basketball players from 2002 to 2022 who suffered an ACL tear were identified. Controls, without ACL tears, were matched by age, BMI, position, race, and average minutes played before the injury date to uninjured controls. Return to NBA, pre-injury and post-return player efficiency ratings (PER), and salary change after injury were analyzed by multivariate analyses. RESULTS A total of 67 players suffered an ACL tear. Fifty-six (83.6%) players returned to the NBA at some point after their injury, while 11 (16.4%) did not. Multivariate logistic regression showed that older age and the presence of multi-ligament injury predicted retiring from the NBA (ß = 1.4 and 10.7). Older age and greater minutes played before surgery to be the only significant predictors of decreased PER after return to the NBA (ß = -0.5 and -0.2). Players with a multiyear contract and with improvements in PER after injury tended to have greater salary increases (ß = 6.5 and 0.7). All p < 0.05. PER in players with ACL tears decreased by about 3 points (13.1 to 9.9) compared to controls without ACL tears (13.2 to 12.9). CONCLUSION Older age and multiligament injuries are associated with retiring for the NBA; older and increased minutes played are associated with a decreased PER upon return; and, PER decreases are associated with decreased salary. Players with ACL tears, even when case-control matched, showed decreased PER upon return. These results can be attributed to age-related changes in athleticism and health.
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Affiliation(s)
- William ElNemer
- School of Medicine, The Johns Hopkins University, Baltimore, MD, USA
| | - Zaid Elsabbagh
- School of Medicine, The Johns Hopkins University, Baltimore, MD, USA
| | | | | | - Sangjun Park
- Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Jacob D Mikula
- Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Amit Jain
- Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Matthew J Best
- Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
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Hinz N, Müller MM, Eggeling L, Drenck T, Breer S, Kowald B, Frosch KH, Akoto R. MCL augmentation using a peroneus longus split tendon autograft satisfactorily restores knee stability with no impairment in foot function and with a low failure rate for concurrent ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2025; 33:2122-2135. [PMID: 39474848 DOI: 10.1002/ksa.12522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Revised: 10/12/2024] [Accepted: 10/15/2024] [Indexed: 05/27/2025]
Abstract
PURPOSE Addressing grade 2 and 3 medial-sided instabilities during anterior cruciate ligament (ACL) reconstruction is crucial to reduce the risk of ACL graft failure. This study introduced a minimally invasive, medial collateral ligament (MCL) augmentation technique using a peroneus longus split tendon autograft, which was fixed to the femoral deep MCL insertion and tibial superficial MCL insertion. METHODS This prospective, longitudinal, single-centre case series included patients who underwent MCL augmentation concurrent with primary or revision ACL reconstruction due to anteromedial instability. Preoperatively and at 1-year follow-up, clinical examinations, such as rolimeter test of anterior tibial translation and medial instability, knee (International Knee Documentation Committee subjective knee form [IKDC], Lsyholm, Knee Injury and Osteoarthritis Outcome Score [KOOS]) and foot function scores (American Orthopaedic Foot and Ankle Society score [AOFAS]) and complications, were analyzed. RESULTS Thirty-one patients with a mean follow-up of 13.5 ± 2.6 months and a mean age of 27.8 ± 9.6 years were included. The side-to-side difference for anterior tibial translation significantly improved from preoperative to 1-year follow-up with an ACL reconstruction failure rate of 6.5%. No patient retained a grade 2 or 3 medial instability on valgus stress testing with 30° flexion. Significant improvements from preoperative to 1-year postoperative follow-up were observed in knee function scores: IKDC (48.9 ± 26.9- 71.3 ± 11.5, p < 0.001) and Lysholm (59.9 ± 28.5-80.5 ± 11.2, p = 0.002) as well as KOOS pain, ADL, sport and QoL, each reaching the respective minimal clinically important difference values. The foot function score AOFAS showed no significant impairment (100 ± 0-99.3 ± 2.5, p = 0.250). Complications included cyclops lesions of ACL reconstruction in three patients. CONCLUSION At 1-year follow-up, MCL augmentation using a peroneus longus split tendon autograft for patients simultaneously undergoing ACL reconstruction satisfactorily restores knee stability, has a low ACL reconstruction failure rate and does not significantly impair foot function. LEVEL OF EVIDENCE Level IV therapeutic study; case series.
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Affiliation(s)
- Nico Hinz
- Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Klinikum Hamburg, Hamburg, Germany
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maximilian Michael Müller
- Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Klinikum Hamburg, Hamburg, Germany
| | - Lena Eggeling
- Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Klinikum Hamburg, Hamburg, Germany
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tobias Drenck
- Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Klinikum Hamburg, Hamburg, Germany
| | - Stefan Breer
- Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Klinikum Hamburg, Hamburg, Germany
| | - Birgitt Kowald
- Centre for Clinical Research, BG Klinikum Hamburg, Hamburg, Germany
| | - Karl-Heinz Frosch
- Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Klinikum Hamburg, Hamburg, Germany
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ralph Akoto
- Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Klinikum Hamburg, Hamburg, Germany
- Department of Orthopaedic Surgery, Trauma Surgery and Sports Medicine, Cologne Merheim Medical Center, University of Witten/Herdecke, Cologne, Germany
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Haas MC, Martin-Niedecken AL, Wild L, Schneeberger L, Graf ES. Biomechanical risk factors for ACL injury during a high-intensity exergame differ between the sexes based on exercise type. PLoS One 2025; 20:e0324702. [PMID: 40397966 DOI: 10.1371/journal.pone.0324702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2024] [Accepted: 04/30/2025] [Indexed: 05/23/2025] Open
Abstract
Incidence rates in anterior cruciate ligament injuries, which are linked to multiple factors, are higher in females than in males. Modifiable contributors to the difference in risk are biomechanical factors such as knee valgus and knee rotation or neuromuscular control. Despite considerable research efforts, re-rupture rates are still high necessitating the need for improved risk reduction and rehabilitation programs. Incorporating exergaming, physically active serious games including a dual-task, has high potential to address this need. However, the execution of dual-tasks leads to altered movement patterns. Consequently, a comprehensive understanding of these movement patterns and their sex-specific differences is essential to subsequently tailor the training approach. The aim of this study was to explore biomechanical differences between males and females when performing a high-intensive exergame. Using three-dimensional motion capture (Vicon) during a 25-min exergame (Sphery Racer, ExerCube), kinematics were measured in 18 healthy athletes (9 male, 9 female). Knee valgus, knee internal rotation, and hip flexion angles during 10-30° knee flexion, were compared between the sexes and in each of the nine different exercises. Touches, and punches showed significant sex differences for knee internal rotation angle (main effect of sex F(1,16) = 6.14, p = .025). Depending on the exercise and side, the difference in estimated means between males and females in touches and punches ranged from 4.6-7.8°, with females showing higher values. Therefore, females display distinct movement patterns linked to anterior cruciate ligament injury, indicating that these movements should be carefully integrated into routine training and late-stage post-injury rehabilitation.
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Affiliation(s)
- Michelle C Haas
- School of Health Sciences, ZHAW Zurich University of Applied Sciences, Winterthur, Switzerland
| | | | - Larissa Wild
- Department of Design, Zurich University of the Arts, Zurich, Switzerland
| | | | - Eveline S Graf
- School of Health Sciences, ZHAW Zurich University of Applied Sciences, Winterthur, Switzerland
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Battaglia M, Arner JW, Midtgaard KS, Haber DB, Peebles LA, Peebles AM, Ganokroj P, Whalen RJ, Provencher MT, Torre G, Ciatti R, Mariani PP. Early versus standard return to play following ACL reconstruction: impact on volume of play and career longevity in 180 professional European soccer players: a retrospective cohort study. J Orthop Traumatol 2025; 26:29. [PMID: 40353956 PMCID: PMC12069203 DOI: 10.1186/s10195-025-00837-y] [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: 08/26/2024] [Accepted: 03/22/2025] [Indexed: 05/14/2025] Open
Abstract
BACKGROUND Patients typically follow a 7-9-month return to play (RTP) protocol following anterior cruciate ligament reconstruction (ACLR); however, much of these data have been based on non-elite athletes. The purpose of this study is to understand whether professional soccer players returning to competition < 6-months following ACLR will have an increased risk of graft failure, play fewer seasons postoperatively, and have lower volume of play compared with those returning > 6 months. MATERIALS AND METHODS A total of 180 male professional European soccer players were enrolled and underwent ACLR with a single surgeon between April 2008 and December 2016 and returned to sport < 6 months (early RTP group, n = 92) or > 6 months (standard RTP group, n = 88). Time from intervention to RTP (days), same season returns, total games and average minutes played in return season, seasons played after surgery, and playing status were recorded. RESULTS The early RTP group returned to soccer sooner (142.8 ± 21.4 days) than the standard RTP group (276.2 ± 118.9) (p < 0.01), and more players returned the same season as the injury in the early RTP group (n = 55/92, 62.5%) than the standard RTP group (n = 18/88, 20.5%) (p < 0.01). The difference in average minutes per game in the first season back was not statistically significant (early RTP, 56.7 ± 22.3 min; standard RTP 49.9 ± 29.8 min, p = 0.094). The early RTP group had significantly longer careers following ACLR (5.7 ± 2.2 seasons) than the standard RTP group (4.7 ± 2.4 seasons) (p = 0.005). The early RTP group sustained more reruptures (n = 4, 4.4%) than the standard RTP group (n = 1, 1.1%). CONCLUSIONS Professional European soccer players returning to competition < 6 months following ACLR did not have poorer outcomes than those who returned > 6 months despite the fact that there were three more failures. However, the early RTP group players were more likely to return during the same season, had longer careers after ACLR, and played a similar number of games and minutes per game, but had more graft failures. LEVEL OF EVIDENCE Retrospective cohort study level IV. TRIAL REGISTRATION Retrospectively registered according to prot. Professionisti_OSS_22.
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Affiliation(s)
- Michael Battaglia
- Villa Stuart Sport Clinic-FIFA Medical Centre of Excellence, Rome, Italy
| | - Justin W Arner
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kaare S Midtgaard
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | | | | | | | - Phob Ganokroj
- Steadman Philippon Research Institute, Vail, CO, USA
- Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Ryan J Whalen
- Steadman Philippon Research Institute, Vail, CO, USA
| | - Matthew T Provencher
- Steadman Philippon Research Institute, Vail, CO, USA
- The Steadman Clinic, Vail, CO, USA
| | - Guglielmo Torre
- Department of Movement, Human and Health Sciences, University of Rome Foro Italico, Rome, Italy
| | - Riccardo Ciatti
- Villa Stuart Sport Clinic-FIFA Medical Centre of Excellence, Rome, Italy.
- Università San Raffaele, Rome, Italy.
| | - Pier Paolo Mariani
- Department of Movement, Human and Health Sciences, University of Rome Foro Italico, Rome, Italy
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Murrell-Smith ZN, Alabdullah MM, Zhang F, Jennings LM, Astill SL, Liu A. Knee biomechanics during rehabilitation exercise in individuals with and without anterior cruciate ligament reconstruction: A systematic review. Clin Biomech (Bristol, Avon) 2025; 126:106559. [PMID: 40393328 DOI: 10.1016/j.clinbiomech.2025.106559] [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: 01/30/2025] [Revised: 05/09/2025] [Accepted: 05/09/2025] [Indexed: 05/22/2025]
Abstract
BACKGROUND Post-traumatic osteoarthritis rates are similar in individuals with anterior cruciate ligament injury who receive surgical reconstruction and those who opt for non-surgical management, indicating continuing changes in knee biomechanics post-surgery. There is no gold standard rehabilitation strategy for the post-reconstruction patient, however investigating the biomechanics of the knee during rehabilitation exercises will drive the development of more efficacious rehabilitation paradigms. This systematic review aimed to synthesise biomechanical data from healthy participants and participants with anterior cruciate ligament reconstruction during rehabilitation exercises to provide insights into knee biomechanical changes induced by injury and surgery. METHODS A systematic literature search was conducted in Web of Science, MEDLINE, EMBASE, PubMed, CINAHL and Scopus, using key terms relating to anterior cruciate ligament reconstruction, lower limb rehabilitation exercises, and knee biomechanics. 34 articles matching the inclusion criteria were identified following abstract and full text screening. FINDINGS The included studies reported data on 607 healthy participants and 175 participants with an anterior cruciate ligament reconstruction across five different exercises. Peak knee flexion angle was the most reported variable, whereas tibial anterior translation and adduction biomechanics were reported infrequently, despite their relevance to the ligament injury status. INTERPRETATION There is limited biomechanical data of rehabilitation exercise in the knee, with the exception of knee flexion angles. Furthermore, variations in data collection and reporting methods across studies cause difficulties in systematic analysis of results and demonstrate inconsistent kinematic results between articles.
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Affiliation(s)
- Zhané N Murrell-Smith
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, UK; Institute of Medical and Biological Engineering, Faculty of Engineering and Physical Sciences, University of Leeds, Leeds, UK
| | - Meernah Mohammed Alabdullah
- School of Electronic and Electrical Engineering, Faculty of Engineering and Physical Sciences, University of Leeds, Leeds, UK; Biomedical Engineering, Imam Abdurahman Bin Faisal University, Dammam, Saudi Arabia
| | - Fengtao Zhang
- Institute of Medical and Biological Engineering, Faculty of Engineering and Physical Sciences, University of Leeds, Leeds, UK
| | - Louise M Jennings
- Institute of Medical and Biological Engineering, Faculty of Engineering and Physical Sciences, University of Leeds, Leeds, UK
| | - Sarah L Astill
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, UK
| | - Aiqin Liu
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, UK.
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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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Alarifi SM, Herrington LC, Althomali OW, Alenezi F, Bin Sheeha B, Jones RK. Biomechanical Analysis After Anterior Cruciate Ligament Reconstruction at the Return-to-Sport Time Point. Orthop J Sports Med 2025; 13:23259671251340302. [PMID: 40438185 PMCID: PMC12117235 DOI: 10.1177/23259671251340302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2025] [Accepted: 02/11/2025] [Indexed: 06/01/2025] Open
Abstract
Background Biomechanical alterations after anterior cruciate ligament reconstruction (ACLR) may increase the risk of knee reinjury. Furthermore, individuals may experience persistent biomechanical differences in the lower limbs after finishing the rehabilitation program and being ready to return to sport, which may lead to an increase in the risk of reinjury. Limited data exist on individuals after ACLR and biomechanical alterations during running in elite athletes. Purpose To measure kinetic and kinematic data during overground running 6 to 8 months after ACLR in an elite sports cohort. Study Design Controlled laboratory study. Methods Three-dimensional motion capture tested the running gait of the participants. A total of 34 elite sports professionals who underwent ACLR and were cleared to return to sport and 34 noninjured high-level athlete participants matched by age and sex participated as the control group in this study. Results A significant reduction was identified in internal knee extensor moment and knee flexion angles between the ACLR limb and the contralateral side (P = .01, .02) and between the ACLR limb and the control limb (P = .01, .01). The external knee adduction moment was increased significantly between the ACLR and control limbs (P = .01). No other differences were seen in the knee or hip kinetics and kinematics. Conclusion After ACLR, the elite participants demonstrated altered knee joint kinematics and kinetics at the time of being cleared to return to sport. These biomechanical deficits suggest that, despite being cleared, the athletes may not have been fully prepared for a safe return to sport, potentially increasing the risk of knee reinjury. Clinical Relevance Alterations in kinematics and kinetics in the sagittal plane of the ACLR knee observed during running may predispose participants to joint-related issues, such as patellofemoral pain. Similarly, increased knee adduction moments in the affected limb may indicate unresolved biomechanical deficits. These findings suggest that the elite population may not be fully prepared to resume high-level activity within the 6-month time frame outlined in current rehabilitation protocols. A longer recovery period may be necessary to restore joint kinematics and kinetics to levels more consistent with a safe return to sport.
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Affiliation(s)
- Saud M. Alarifi
- Rehabilitation Center, Riyadh First Health Cluster, Ministry of Health, Riyadh, Saudi Arabia
| | - Lee C. Herrington
- Centre for Health, Sport and Rehabilitation Sciences, University of Salford, Salford, England, UK
| | - Omar W. Althomali
- Department of Physiotherapy, College of Applied Medical Sciences, University of Ha'il, Ha’il, Saudi Arabia
| | - Faisal Alenezi
- Therapeutic Deputyship, Saudi Ministry of Health, Riyadh, Saudi Arabia
| | - Bodor Bin Sheeha
- Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Richard K. Jones
- Human Movement and Rehabilitation, School of Health and Society, University of Salford, Salford, UK
- The Manchester Institute of Health and Performance, Manchester, UK
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Rund JM, Christensen GV, Fleming JA, Wolf BR. Anterior Cruciate Ligament Tears among Football Players. Curr Rev Musculoskelet Med 2025; 18:183-189. [PMID: 39930256 PMCID: PMC12014870 DOI: 10.1007/s12178-025-09952-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] [Accepted: 01/27/2025] [Indexed: 04/23/2025]
Abstract
PURPOSE OF REVIEW Anterior Cruciate Ligament (ACL) tears are one of the most common causes of lost playing time in American football athletes. Recently, there has been a push to get athletes back to sport faster. As such, numerous studies have evaluated management and rehabilitation protocols for return to play after ACL injury in football players. The purpose of this review is to synthesize information, both classic and new, to aid orthopedic surgeons in treatment of football players with ACL injuries. RECENT FINDINGS Recent studies have demonstrated that not all ACL injuries are alike. Management should be a shared decision-making process between athlete and surgeon. Studies have demonstrated low failure rates when using bone-patellar tendon-bone (BTPB) autograft which is the most common graft utilized for elite football athletes. Outcomes are continually being evaluated by multicenter study groups such as the Multicenter Orthopaedic Outcome Network which has established a thorough rehabilitation protocol focusing on athlete milestones. ACL tears in the football athlete are common and challenging injuries. Treatment revolves around ACL reconstruction, most commonly with BTPB autograft. Post-operative rehabilitation is essential and should focus on objective criteria rather than time elapsed. Return to play criteria rely upon symptoms, athlete confidence, strength, and both functional and football specific testing. Return-to-play timelines are individualized for each football athlete but recent trends have highlighted a more delayed return of at least 7-9 months. Rate of returning to play varies from 63-82% and depends upon many factors including level of play and position.
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Affiliation(s)
- Joseph M Rund
- Department of Orthopaedics and Rehabilitation, University of Iowa Health Care, 200 Hawkins Drive, Iowa City, IA, 52242, USA.
| | - Garrett V Christensen
- Department of Orthopaedics and Rehabilitation, University of Iowa Health Care, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Jeffrey A Fleming
- Department of Orthopaedics and Rehabilitation, University of Iowa Health Care, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Brian R Wolf
- Department of Orthopaedics and Rehabilitation, University of Iowa Health Care, 200 Hawkins Drive, Iowa City, IA, 52242, USA
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Middlebrook A, Rushton AB, Halpin C, Heneghan NR. Perceptions, expectations and experiences of recovery before and after anterior cruciate ligament reconstruction: the patient voice - a protocol for a qualitative systematic review with meta-aggregation. BMJ Open 2025; 15:e097437. [PMID: 40295137 PMCID: PMC12039038 DOI: 10.1136/bmjopen-2024-097437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2024] [Accepted: 04/16/2025] [Indexed: 04/30/2025] Open
Abstract
INTRODUCTION Anterior cruciate ligament (ACL) injuries are a common yet significant musculoskeletal problem and are increasingly prevalent outside of elite athlete populations. As a result, individuals may undergo ACL reconstruction (ACLR), but long-term complications frequently persist. Individuals commonly believe that post-ACLR, they will eventually return to preinjury levels of function. However, for multiple reasons, the reality is that more than half fail to reach this preinjury level. Rehabilitation has traditionally focused on physical factors, which have been researched extensively. More recently, psychological factors affecting recovery have been examined. However, most literature focuses on 'outcome', with the patient voice, in terms of their views and perceptions of ACLR neglected. Therefore, the aim of this systematic review is to understand individuals' perceptions, expectations and experiences pre-ACLR and post-ACLR and to understand key factors influencing this journey. Such knowledge would assist in maximising the chances of successful recovery. METHODS AND ANALYSIS This meta-aggregative systematic review protocol is reported according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. Medline, CINAHL, EMBASE and SportDiscus databases, grey literature and key journals will be searched from inception. Qualitative research of any study design that includes individuals aged 16+ years who are awaiting or have undergone ACL reconstruction will be included. Studies focusing on ACL revision, ACL repair or multiligament reconstruction surgeries will be excluded. Two independent reviewers will conduct searches, determine study eligibility, extract data, assess methodological quality (Joanna Briggs Institute (JBI) critical appraisal checklist for qualitative research) and rate the overall confidence in findings (JBI ConQual). ETHICS AND DISSEMINATION Findings will be published in a peer-reviewed journal, as well as presented at conferences and locally to physiotherapy teams. Ethical approval is not required for this systematic review. PROSPERO REGISTRATION NUMBER CRD42024594621.
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Affiliation(s)
- Andrew Middlebrook
- Musculoskeletal Physiotherapy Department, Sandwell and West Birmingham NHS Trust, West Bromwich, UK
| | - Alison B Rushton
- School of Physical Therapy, Western University Faculty of Health Sciences, London, Ontario, Canada
| | - Charlotte Halpin
- Department of Musculoskeletal Therapy, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Nicola R Heneghan
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
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10
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van der List JP. Editorial Commentary: Proper Graft Choice and Lateral Extra-Articular Tenodesis Are Key to Successful Anterior Cruciate Ligament Reconstruction in Female Soccer Players. Arthroscopy 2025:S0749-8063(25)00291-9. [PMID: 40286996 DOI: 10.1016/j.arthro.2025.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2025] [Accepted: 04/17/2025] [Indexed: 04/29/2025]
Abstract
Over the last decade, techniques and outcomes of anterior cruciate ligament reconstruction have evolved dramatically. We have improved our graft choices from favoring autograft over allograft in younger patients and transitioned from transtibial to independent drilling to improve our femoral tunnel position, but our outcomes were still disappointing in high-risk populations such as those with generalized ligament laxity and female soccer (football) players with low return to sports rates, incomplete restoration of rotatory stability, and relatively high rates of osteoarthritis. With the renewed focus on extra-articular procedures, predominantly anterolateral ligament reconstruction and lateral extra-articular tenodesis, and avoiding the use of isolated soft-tissue grafts in high-risk patients, outcomes have significantly improved over the last decade. The indications for extra-articular procedures have expanded and the minimal downsides seem to validate this trend. Careful documentation and monitoring of long-term incidence of posttraumatic osteoarthritis will be the final step in implementing these additional procedures most active patients.
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11
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Hewitt C, Kostyun R, Fulkerson JP, Shuman ME, Rios CG. Most Patients Report Acceptable Knee Function, Satisfaction, and Clinical Outcomes at a Minimum Ten Years After Quadriceps Free Tendon Anterior Cruciate Ligament Reconstruction. Arthrosc Sports Med Rehabil 2025; 7:101062. [PMID: 40297073 PMCID: PMC12034069 DOI: 10.1016/j.asmr.2024.101062] [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: 08/29/2024] [Accepted: 11/25/2024] [Indexed: 04/30/2025] Open
Abstract
Purpose To describe the long-term outcomes of anterior cruciate ligament reconstruction (ACLR) with quadriceps-free tendon autograft (QFT) in terms of subjective function, clinical outcomes, and knee satisfaction. Methods A retrospective chart review design with prospective descriptive survey was used to determine clinical and subjective outcomes for patients treated with a QFT-ACLR from 2000 to 2013. Patients with multiligament reconstructions were excluded. The primary outcomes were clinical outcomes (reinjury of indexed knee, ACL injury to contralateral knee after indexed surgery), subjective function (International Knee Documentation Committee subjective score, Lysholm score), knee satisfaction (single assessment numeric evaluation), and global health and wellbeing (Patient-Reported Outcomes Measurement Information System Global-10). Results In total, 34 patients were contacted (average: 18.2 years, range: 10-23 years) after surgery (response rate, 17.3%). The mean age at time of surgery was 32.3 ± 11.1 years, and 50.4 ± 11.6 years at follow-up. For clinical outcomes, 23.5% of patients reported a reinjury of their QFT reconstructed ACL. Contralateral ACL injuries were reported in 17.6% of patients. No differences in subjective function and knee satisfaction were identified between patients with and without concomitant procedure at the time of surgery. Nearly two-thirds of patients reported strong mental health and physical function on the PROMIS Global Health. Conclusions This study presents a minimum of 10-year follow-up on QFT-ACLR, revealing 74% of patients reporting no reinjury, 67% of patients reporting acceptable-exceptional subjective knee function, and 74% indicating better physical and mental health compared to the general population. No differences were observed in knee function or satisfaction scores among patients who underwent a concomitant cartilage procedure at the time of QFT-ALCR with patients without these concomitant injuries. Level of Evidence Level IV, therapeutic case-series.
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Affiliation(s)
- Cory Hewitt
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Regina Kostyun
- Hartford Hospital’s Bone and Joint Institute, Hartford, Connecticut, U.S.A
| | | | - Matthew E. Shuman
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Clifford G. Rios
- Hartford Hospital’s Bone and Joint Institute, Hartford, Connecticut, U.S.A
- Orthopedic Associates of Hartford, Farmington, Connecticut, U.S.A
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12
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Fucaloro S, Schreiner G, Ward M, Krivicich L, Bragg J, Harkey M, Salzler M. Utility of preoperative ultrasound in assessing the adequacy of autograft for anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Skeletal Radiol 2025; 54:869-878. [PMID: 39730837 DOI: 10.1007/s00256-024-04860-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2024] [Revised: 12/10/2024] [Accepted: 12/14/2024] [Indexed: 12/29/2024]
Abstract
OBJECTIVE Anterior cruciate ligament (ACL) reconstruction using tendon autograft requires imaging to evaluate graft adequacy. Ultrasound (US) offers an efficient adjunct to MRI; however, the utility of US is variable in prior literature and should be investigated. The primary aim of this study is to provide a statistical appraisal of literature assessing correlation of preoperative US measurements with intraoperative size of autografts during ACL reconstruction. MATERIALS AND METHODS PubMed, Embase, and Web of Science databases were queried for studies comparing preoperative US-based measurements to intraoperative measurements of autografts to assess graft adequacy (defined as > 8 mm diameter). Correlation coefficients from studies comparing combined cross-sectional area (CCSA) of autograft tendons on US to intraoperative autograft tendon diameters were collected and pooled. Random-effects models were generated to compare sensitivity, specificity, positive predictive values (PPV), and negative predictive value (NPV) for the identification of adequate graft sizes. RESULTS Eleven studies compared preoperative measurements of autograft size to intraoperative measurements. Meta-analysis of studies assessing hamstring tendon CCSA on US in comparison to intraoperative tendon diameters revealed a pooled correlation coefficient of 0.54 (CI 0.41-0.66, I2 = 9.6%). Three studies reported if US correctly identified adequate graft sizes, demonstrating sensitivity of 83% (I2 = 0.0%) and specificity of 78% (I2 = 49.2%). PPV was 91% (I2 = 0.0%), and NPV was 62% (I2 = 11.7%). CONCLUSION Hamstring CCSA on US has moderate correlation with intraoperative diameter, high sensitivity (83%), moderate specificity (78%), and very high PPV (91%) for identifying adequately sized autografts for ACL reconstruction.
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Affiliation(s)
| | | | - Mark Ward
- Tufts University School of Medicine, Boston, MA, USA
| | - Laura Krivicich
- Department of Orthopaedic Surgery, Tufts Medical Center, Boston, MA, USA
| | - Jack Bragg
- Department of Orthopaedic Surgery, Tufts Medical Center, Boston, MA, USA
| | - Matthew Harkey
- Athletic Injury and Rehabilitation Labs, Michigan State University, East Lansing, MI, USA
| | - Matthew Salzler
- Department of Orthopaedic Surgery, Tufts Medical Center, Boston, MA, USA.
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Chu CR, Hochberg M, White D, Rodeo S, Huard J, Shapiro S, Lattermann C, Guilak F. Transformative approaches for effective clinical trials to reduce the disease burden of osteoarthritis. Semin Arthritis Rheum 2025; 71:152652. [PMID: 39970622 DOI: 10.1016/j.semarthrit.2025.152652] [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: 09/26/2024] [Revised: 12/19/2024] [Accepted: 01/06/2025] [Indexed: 02/21/2025]
Abstract
Osteoarthritis (OA) is a leading cause of disability and morbidity that has eluded development of effective disease modifying drugs and therapies. While established OA in the form of symptomatic radiographic disease is a recognizable final common pathway, OA development encompasses a broad spectrum of pathological changes, susceptibilities, and etiological pathways that cannot be considered a single disease process. Beginning with preclinical disease where radiographs are normal, the concept of pre-osteoarthritis (pre-OA) offers a systems-based approach to OA prevention by targeting reduction of OA risk prior to the onset of definable OA. Early OA ensues when cellular, molecular, and joint tissue changes begin to overlap that of OA, a process that can begin before the onset of definitive symptoms or radiographic changes. A myriad of pathways and crossroads of pre-OA and early OA eventually leads to poorly irreversible symptomatic radiographic OA. With increasing recognition of pre-OA and early OA markers, pathways and subtypes, opportunities arise to address these new therapeutic targets. The current status of clinical trials in OA was identified as a critical barrier to progress by the 2022 National Institute of Arthritis, Musculoskeletal, and Skin Diseases (NIAMS) Roundtable on "Cartilage Preservation and Restoration in Knee Osteoarthritis: Challenges, Gaps, and Opportunities". This manuscript summarizes the recommendations of the work group established from the Roundtable to address this issue. The work group recommends that clinical trial design and endpoints evolve to effectively evaluate new treatment approaches suitable for pre-osteoarthritis and early OA by different criteria than what has been set for symptomatic radiographic OA. While symptomatic improvement is the primary goal for palliation of irreversible established OA, important goals for treating earlier disease states include disease modification and prevention, with the potential to alter the natural history of progressive OA. Because symptoms may not correlate with structural changes in pre-OA and early OA, the primary outcomes in these trials need to match the intended mechanistic target and the therapeutic goal for the disease state being treated. The purpose of this manuscript is to transform the approach to clinical trials in OA by establishing a new benchmark of identifying critical outcomes that are appropriate for the joint disease states and subtypes of the target patient population, and the therapeutic or mechanistic target of the intervention being tested. By shifting the approach from using standardized outcomes based on established OA towards customizing clinical trials according to these principles, new precision medicine strategies to address the full spectrum of disease from pre-OA to OA can be more readily advanced into clinical practice.
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Affiliation(s)
- Constance R Chu
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway St 94061, Redwood City, CA 94063, United States.
| | - Marc Hochberg
- Departments of Medicine and Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, 20742, United States
| | - Daniel White
- Department of Physical Therapy, University of Delaware, Newark, DE 19716, United States
| | - Scott Rodeo
- Hospital for Special Surgery, New York, NY 10021, United States
| | - Johnny Huard
- Steadman Clinic, Steadman Philippon Research Institute, Vail CO 81657, United States
| | - Shane Shapiro
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL 32224, United States
| | - Christian Lattermann
- Department of Orthopaedic Surgery, Massachusetts General-Brigham Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - Farshid Guilak
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO 63110, United States; Shriners Hospitals for Children - St. Louis, St. Louis, MO 63110, United States
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Figueroa Poblete D, Gonzalez Duque W, Landea Caroca D, Tapia Castillo C, Erskine Ventura D. Return-to-sport tests: Do they reduce risk of re-rupture after anterior cruciate ligament reconstruction? J ISAKOS 2025; 11:100399. [PMID: 39938748 DOI: 10.1016/j.jisako.2025.100399] [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: 11/25/2024] [Revised: 01/27/2025] [Accepted: 02/03/2025] [Indexed: 02/14/2025]
Abstract
INTRODUCTION Anterior cruciate ligament (ACL) rupture is one of the most common knee injuries. Despite the effectiveness of reconstruction, re-rupture rates of up to 15 % have been reported. Static and dynamic test of strength and movement control have been used to determine when return to sports (RTS) is appropriate. OBJECTIVE To determine whether successfully passing return to sport (RTS) tests reduces the re-rupture rate. METHODS Retrospective cohort study. Patients who underwent ACL reconstruction (ACLR) from June 2018 to May 2023, and who performed RTS tests after rehabilitation, were analyzed. Patients who, in addition to ACLR, underwent extra-articular tenodesis, osteotomy, or multiligament injuries were excluded. RTS tests included the following: repeat sprint ability, dynamic valgus, proagility, unilateral counter movement jump (CMJ), isokinetic, triple hop test, and functional movement screen (FMS). All statistical analyses were performed with STATA version 18.0. RESULTS Ninety five patients underwent RTS tests after ACLR, with a follow-up time of 27.8 months. 71.6 % of patients were men with a mean age of 25.15 ± 10.7 years. The overall re-rupture rate was 13.68 % (13 patients). When comparing patients who passed and did not pass the RTS tests, there were no differences by sex (p = 0.06) or age (p = 0.11). The only statistically significant difference between the groups was the mean risk score (passed: 11.5 ± 0.7 vs. not passed: 15.5 ± 2.1; p < 0.001). Patients with re-rupture were more likely to be from the non-passed group (passed: 0 % v/s not passed: 18.1 %; p = 0.03), with a statistical power of 0.70. CONCLUSION Our records show that passing RTS test after an ACLR could guarantee the absence of re-rupture in the medium term. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- David Figueroa Poblete
- Faculty of Medicine, Clinica Alemana Santiago - Universidad del Desarrollo, Santiago, Chile
| | - Waldo Gonzalez Duque
- Faculty of Medicine, Clinica Alemana Santiago - Universidad del Desarrollo, Santiago, Chile.
| | - Daniela Landea Caroca
- Service of Physical Medicine and Rehabilitation, Clinica Alemana Santiago, Santiago, Chile
| | - Camila Tapia Castillo
- Service of Physical Medicine and Rehabilitation, Clinica Alemana Santiago, Santiago, Chile
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Castellanos Dolk D, Hedevik H, Stigson H, Wretenberg P, Kvist J, Stålman A. Nationwide incidence of anterior cruciate ligament reconstruction in higher-level athletes in Sweden: a cohort study from the Swedish National Knee Ligament Registry linked to six sports organisations. Br J Sports Med 2025; 59:470-479. [PMID: 39577873 PMCID: PMC12013579 DOI: 10.1136/bjsports-2024-108343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 10/31/2024] [Indexed: 11/24/2024]
Abstract
OBJECTIVE To determine and compare the incidence rate (IR) of anterior cruciate ligament reconstruction (ACL-R) among higher-level athletes across six sports in the Swedish National Knee Ligament Registry (SNKLR). METHODS Patient data from the SNKLR, between 2005 and 2020, was linked to team and event data of six sports (football, handball, basketball, ice hockey, floorball and alpine sports) to identify higher-level athletes aged 15-40 with ACL-R. Unadjusted and adjusted IR ratios (IRRs) with 99% CIs were calculated between sports, sex, age and divisions. RESULTS Female athletes had a 3.3 times higher ACL-R IR compared with males (1.08 vs 0.32, IRR=3.33, 99% CI: 2.65 to 4.19) per 1000 athlete exposures (AE). Basketball had the largest difference in ACL-R IR per 1000 AE between females and males (1.26 vs 0.22, IRR=5.69, 99% CI: 2.79 to 11.60). Female second-division athletes had higher ACL-R IR per 1000 AE compared with female highest-division athletes (1.27 vs 0.76, IRR=1.67, 99% CI: 1.30 to 2.15). No significant association between age and IR was observed. Compared with football, lower ACL-R IR was observed in floorball and ice hockey in females, as well as in floorball, basketball and ice hockey in males. CONCLUSION Female athletes had higher ACL-R IRs than males and second-division female athletes had higher ACL-R IRs than highest-division female athletes. Lower ACL-R IRs were observed in floorball and ice hockey compared with football for both sexes. The remaining sports had ACL-R IRs similar to football, except basketball where rates were lower for male athletes.
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Affiliation(s)
- Daniel Castellanos Dolk
- Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden
- Department of Orthopedic Surgery, Capio Specialistvård Motala, Motala, Sweden
| | - Henrik Hedevik
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Helena Stigson
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Folksam Research, Folksam Insurance Group Stockholm, Stockholm, Sweden
| | - Per Wretenberg
- Örebro University School of Medical Sciences, Örebro, Sweden
- Department of Orthopedics, Örebro University Hospital, Örebro, Sweden
| | - Joanna Kvist
- Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Anders Stålman
- Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden
- Capio Artro Clinic, FIFA Medical Centre of Excellence, Sophiahemmet Hospital, Stockholm, Sweden
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16
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Sabaté Ferris A, Bayon M, David G, Bohand MC, Rousseau R. Similar outcomes between gracilis-reinforced ITB and HT with modified Lemaire technique in combined ACL reconstruction with lateral tenodesis: A propensity score-matched analysis. Knee Surg Sports Traumatol Arthrosc 2025. [PMID: 40119696 DOI: 10.1002/ksa.12650] [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: 10/27/2024] [Revised: 02/15/2025] [Accepted: 02/24/2025] [Indexed: 03/24/2025]
Abstract
PURPOSE While both iliotibial band graft augmented by gracilis tendon (ITB + G) and hamstring autograft with modified Lemaire lateral extra-articular tenodesis (STG + LET) are established techniques for addressing rotatory instability in anterior cruciate ligament reconstruction, no direct comparison exists between these approaches. The purpose of this study was to provide the first direct comparison between these two surgical techniques regarding graft survival, functional outcomes and return to sport. METHODS This single-centre, single-surgeon retrospective study analyzed 56 patients (28 per group) after 1:1 propensity score matching based on age, gender and Tegner activity scale. Primary end point was failure (graft retear or secondary meniscal lesion). Secondary outcomes included the International Knee Documentation Committee (IKDC), anterior cruciate ligament-return to sport after surgery (ACL-RSI) scores, and return to sport rate. Kaplan-Meier survival analysis and between-group comparisons were performed using appropriate statistical tests. RESULTS At mean follow-up of 53.3 ± 6.4 months, failure-free survival rates at 24 months were 85.7% (95% confidence interval [CI]: 66.3-94.4) for STG + LET and 89.3% (95% CI: 70.4-96.4) for ITB + G (p = 0.664). Graft retear rate was 7.1% (STG + LET: 3.6%, ITB + G: 10.7%). Secondary meniscal injuries occurred equally (14.3%) in both groups. Return-to-sport rate was 89.3% at mean of 9.6 ± 3.9 months. Mean IKDC scores were 87.5 ± 11.4 for STG + LET and 83.6 ± 16.3 for ITB + G, with 73.7% achieving Patient Acceptable Symptom State criteria. ACL-RSI scores were similar between groups (STG + LET: 74.2 ± 24.3 and ITB + G: 73.5 ± 26.8). CONCLUSION No significant differences were found between ITB + G and STG + LET techniques regarding failure rates, return to sport and functional outcomes. Both techniques achieved satisfactory results in this cohort, with similar complication profiles. This comparison provides valuable clinical guidance, supporting surgical decision-making based on surgeon experience. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Alexandre Sabaté Ferris
- Orthopedic, Trauma and Reconstructive Department, Hôpital d'instruction des Armées Percy, Clamart, France
- Orthopedic and Trauma Surgery Department, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Maxime Bayon
- Orthopedic and Trauma Surgery Department, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Guillaume David
- Orthopedic Surgery Department, Angers University Hospital, Angers, France
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Ricupito R, Grassi A, Mourad F, Di Filippo L, Gobbo M, Maselli F. Anterior Cruciate Ligament Return to Play: "A Framework for Decision Making". J Clin Med 2025; 14:2146. [PMID: 40217597 PMCID: PMC11989641 DOI: 10.3390/jcm14072146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2025] [Accepted: 03/18/2025] [Indexed: 04/14/2025] Open
Abstract
Anterior cruciate ligament (ACL) injury is common in athletic individuals and often leads to physical impairments, a low rate of return to performance, reinjuries, and sometimes reductions in career length [...].
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Affiliation(s)
| | - Alberto Grassi
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, 40132 Bologna, Italy;
- 2nd Clinica Ortopedica e Traumatologica, Istituto Ortopedico Rizzoli IRCCS, 40136 Bologna, Italy
| | - Firas Mourad
- Department of Health, LUNEX University of Applied Sciences, 4671 Differdange, Luxembourg;
- Luxembourg Health & Sport Sciences Research Institute A.s.b.l., 4671 Differdange, Luxembourg
| | - Luigi Di Filippo
- FisioAnalysis Mædica, 15121 Alessandria, Italy;
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy;
| | - Massimiliano Gobbo
- Department of Clinical and Experimental Sciences, Neuroscience Unit, University of Brescia, 25123 Brescia, Italy;
| | - Filippo Maselli
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy;
- Sovrintendenza Sanitaria Regionale Puglia INAIL, 70126 Bari, Italy
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Moiroux--Sahraoui A, Mazeas J, Gold M, Kakavas G, Forelli F. Neuromuscular Control Deficits After Anterior Cruciate Ligament Reconstruction: A Pilot Study Using Single-Leg Functional Tests and Electromyography. J Funct Morphol Kinesiol 2025; 10:98. [PMID: 40137350 PMCID: PMC11942642 DOI: 10.3390/jfmk10010098] [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: 01/31/2025] [Revised: 03/05/2025] [Accepted: 03/18/2025] [Indexed: 03/27/2025] Open
Abstract
Purpose: This study aimed to evaluate neuromuscular control and muscle activation patterns in individuals following anterior cruciate ligament (ACL) reconstruction, compared to healthy controls. Methods: A cross-sectional comparative study was conducted following STROBE guidelines, including 16 participants (ACL group: n = 9; control group: n = 7). Participants performed the single-leg squat (SLS) test and the single-leg drop landing (SLDL) test. Neuromuscular control was assessed using the Qualitative Analysis of Single-Leg Loading Score (QASLS), while gluteus medius and vastus medialis activation were recorded using surface electromyography. Results: The ACL group showed significantly higher QASLSs in the SLS test (p = 0.0113), indicating poorer movement quality, while no difference was found in the SLDL test (p = 0.5484). Gluteus medius activation was lower in the ACL group during the SLS test (p = 0.0564), and vastus medialis activation was higher but not significantly different (p = 0.095). Conclusions: These findings highlight persistent neuromuscular deficits post-ACL-reconstruction, particularly in SLS tasks, reinforcing the need for targeted rehabilitation strategies focusing on hip stabilization and quadriceps motor control to optimize movement quality and reduce reinjury risk.
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Affiliation(s)
- Ayrton Moiroux--Sahraoui
- Orthosport Rehab Center, 95330 Domont, France; (A.M.--S.); (J.M.)
- Orthopaedic Surgery Department, Clinic of Domont, Ramsay Healthcare, @OrthoLab, 95330 Domont, France;
| | - Jean Mazeas
- Orthosport Rehab Center, 95330 Domont, France; (A.M.--S.); (J.M.)
- Orthopaedic Surgery Department, Clinic of Domont, Ramsay Healthcare, @OrthoLab, 95330 Domont, France;
| | - Maxime Gold
- Orthopaedic Surgery Department, Clinic of Domont, Ramsay Healthcare, @OrthoLab, 95330 Domont, France;
| | - Georgios Kakavas
- Fysiotek Spine & Sports Lab, 116 35 Athens, Greece;
- Department of Physical Education and Sport Sciences, ErgoMech-Lab, University of Thessaly, 421 00 Volos, Greece
| | - Florian Forelli
- Orthopaedic Surgery Department, Clinic of Domont, Ramsay Healthcare, @OrthoLab, 95330 Domont, France;
- SFMK Lab, 93380 Pierrefite sur Seine, France
- Haute-Ecole Arc Santé, HES-SO University of Applied Sciences and Arts Western Switzerland, 2000 Neuchâtel, Switzerland
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Sánchez AL, Pimentel GC, De Armas JN, Novo LM, Jara JF. Anterior cruciate ligament injuries in children and adolescents: mid-term clinical and functional results and return-to-sports after surgery. Arch Orthop Trauma Surg 2025; 145:189. [PMID: 40085268 DOI: 10.1007/s00402-025-05806-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2024] [Accepted: 03/02/2025] [Indexed: 03/16/2025]
Abstract
INTRODUCTION Anterior cruciate ligament (ACL) injuries in children and adolescents have increased in recent years. Controversy remains regarding their clinical and functional results, as well as return-to-sports (RTS) rate. The aim of this work is to analyze the clinical and patient-reported outcomes (PROMs) of ACL reconstruction (ACL-R) and determine which factors are associated with a better med-term outcome. METHODS 63 skeletally immature subjects (64 knees) with ACL injury treated by ligamentoplasty and with at least 2 years of follow-up were included. Demographic data, sports level, initial magnetic resonance imaging (MRI) findings, complications and RTS rate were collected. All the subjects completed the Knee Injury and Osteoarthritis Outcome Score (KOOS), Kujala Score, Lysholm Score and Tegner Activity Scale questionnaires. RESULTS The mean age at the time of the injury was 13.9 ± 2.3 years and the 66% performed organized sport. All-epiphyseal tunnels were performed in 23% (14% all-inside), and transphyseal tunnels in 73% (57.5% all-inside). The all-inside technique were associated with a higher proportion of grafts obtained with a single hamstring (p < 0.05), without differences in the RTS rate but with lower scores in Lysholm and Tegner scores (p < 0.05). Lateral extra-articular tenodesis (LEAT) was performed in 27% of the cases, showing them an earlier RTS and an even higher level (p < 0.05). After a mean follow-up of 3.2 years (range 2-10.4), the RTS rate is 80% and the mean PROMs are: KOOS 91.2 ± 6.4, Kujala 93.3 ± 5.7, Lysholm 93.2 ± 10.6, and Tegner level 7.7 ± 1.3. CONCLUSION The ACL-R in children and adolescents achieves a high RTS rate and excellent PROMs after a mean follow-up of 3.2 years. All-epiphyseal tunnels achieve similar results to transphyseal but respecting the physis, all-inside technique produces less morbidity with a similar function, and addition of LEAT allows an early RTS with a higher level.
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Affiliation(s)
- Alberto Losa Sánchez
- Department of Pediatric Orthopedic Surgery, La Paz University Hospital, Madrid, Spain.
- Department of Pediatric Orthopedic Surgery, La Zarzuela University Hospital, Madrid, Spain.
- Department of Pediatric Orthopedic Surgery, La Moraleja University Hospital, Madrid, Spain.
| | | | - Joaquín Núñez De Armas
- Department of Pediatric Orthopedic Surgery, La Paz University Hospital, Madrid, Spain
- Department of Pediatric Orthopedic Surgery, La Zarzuela University Hospital, Madrid, Spain
- Department of Pediatric Orthopedic Surgery, La Moraleja University Hospital, Madrid, Spain
| | - Luis Moraleda Novo
- Department of Pediatric Orthopedic Surgery, La Paz University Hospital, Madrid, Spain
- Department of Pediatric Orthopedic Surgery, La Zarzuela University Hospital, Madrid, Spain
- Department of Pediatric Orthopedic Surgery, La Moraleja University Hospital, Madrid, Spain
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Niederer D, Keller M, Jakob S, Wießmeier M, Petersen W, Schüttler KF, Efe T, Mengis N, Ellermann A, Guenther D, Brandl G, Engeroff T, Drews B, Achtnich A, Best R, Pinggera L, Schoepp C, Krause M, Groneberg DA, Stein T. Rehabilitation volume, psychological readiness, and motor function are important factors for a successful return to sport after anterior cruciate ligament reconstruction: A 2-year follow-up cohort study. J Sci Med Sport 2025:S1440-2440(25)00063-5. [PMID: 40089432 DOI: 10.1016/j.jsams.2025.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 01/17/2025] [Accepted: 02/28/2025] [Indexed: 03/17/2025]
Abstract
OBJECTIVES To find contributors to return to sport success or time until return to sport in individuals after an anterior cruciate ligament reconstruction. DESIGN Cohort study. METHODS Secondary analysis of the data of two intervention studies. PARTICIPANTS We included adults < 36 years of age with a tendon autograft anterior cruciate ligament reconstruction who were active in any type of sport prior to the injury and aiming to return to sport. All participants were prospectively monitored for 24 months. INTERVENTIONS At the end of the individual post-surgery rehabilitation and re-injury prevention programmes, self-report- and objective functional outcomes were quantified. MAIN OUTCOME MEASURES The potential return to sport success (return to the same type of sports, frequency, intensity, and quality of performance as pre-injury), secondary injuries, and all rehabilitation and training measures were prospectively monitored. To determine the contributing factors, Cox regressions for traits and baseline factors and a logistic mixed model, which also included prospective time-dependent factors, were calculated. RESULTS 203 participants were included; 104 (51 % of the total sample and 68 % of the full cases) successfully returned to their sporting activity. The median duration until return to sport was 302 days (interquartile range was 114 days). Contributing factors were the type of working (blue- vs. white collar: odds ratio for return to sport = 0.51 [95 % confidence interval = 0.29 to 0.90]) and the athletic status (elite vs. non-elite: odds ratio = 2.28 [1.03 to 5.03]). Prospectively, higher rehabilitation volumes until the end of the rehabilitation were predictive for return to sport success: the odds ratio per additional hour of rehabilitation was 1.004 [1.001 to 1.006]. Functional abilities such as the normalised knee separation distance during drop jump landing (odds ratio = 0.961 [0.924 to 0.999]) were predictive at a later stage, at the end of the re-injury prevention. Psychological readiness for return to sport was predictive at most of the timepoints: those who were confident to return to sport were more successful to return to sport at the end of the rehabilitation (odds ratio = 1.029 [1.004 to 1.056]) and at the end of the re-injury prevention (odds ratio = 1.038 [1.004 to 1.073]). CONCLUSIONS The most important factors for a successful pre-injury-level return to sport after anterior cruciate ligament reconstruction were the exercise volume, psychological readiness and functional hop/jump abilities. Whilst the impact of these modifiable factors was robust against multilevel modelling, the impact of athletic and working status vanishes when the prospective factors are included.
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Affiliation(s)
- Daniel Niederer
- Institute of Occupational, Social and Environmental Medicine, Goethe University Frankfurt, Germany.
| | | | - Sarah Jakob
- Department of Sports Medicine and Exercise Physiology, Goethe University Frankfurt, Germany
| | - Max Wießmeier
- Department of Sports Medicine and Exercise Physiology, Goethe University Frankfurt, Germany
| | | | | | | | - Natalie Mengis
- Kantonsspital Baselland, University Department for Knee Surgery and Sports Medicine, Switzerland; DKF Department of the University of Basel, Switzerland
| | | | - Daniel Guenther
- Department of Orthopaedic Surgery, Trauma Surgery, and Sports Medicine, Cologne Merheim Medical Center, Witten/Herdecke University, Germany
| | - Georg Brandl
- Department of Orthopaedic Surgery II, Herz-Jesu Krankenhaus, Austria
| | - Tobias Engeroff
- Institute of Occupational, Social and Environmental Medicine, Goethe University Frankfurt, Germany
| | | | - Andrea Achtnich
- Department for Orthopaedic Sports Medicine, Klinikum rechts der Isar, Germany
| | - Raymond Best
- Department of Orthopaedic and Trauma Surgery, Sportklinik Stuttgart, Germany
| | - Lucia Pinggera
- Department of Orthopaedic and Trauma Surgery, Sportklinik Stuttgart, Germany
| | - Christian Schoepp
- Department of Arthroscopic Surgery, Sports Traumatology and Sports Medicine, BG Klinikum Duisburg gGmbH, Germany
| | - Matthias Krause
- Department of Trauma, Hand and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Germany
| | - David A Groneberg
- Institute of Occupational, Social and Environmental Medicine, Goethe University Frankfurt, Germany
| | - Thomas Stein
- Department of Sports Medicine and Exercise Physiology, Goethe University Frankfurt, Germany; SPORTHOLOGICUM - Knee Center Frankfurt - Center for Sport and Joint Injuries, Germany
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Lee SJ, Park JG, Han SB, Bae JH, Jang KM. Lower Patient-Reported Outcomes After Isolated Anterior Cruciate Ligament Reconstruction Are Associated With Lower Muscle Strength Rather Than Graft Status During Second-Look Arthroscopic Evaluation. Arthroscopy 2025:S0749-8063(25)00152-5. [PMID: 40056945 DOI: 10.1016/j.arthro.2025.02.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 02/06/2025] [Accepted: 02/19/2025] [Indexed: 03/24/2025]
Abstract
PURPOSE To determine the relationship between patient-reported outcomes (PROs), objective graft status on second-look arthroscopy, and knee muscle strength during the early period after isolated primary anterior cruciate ligament reconstruction (ACLR). METHODS Patients who underwent second-look arthroscopy at least 1 year after primary ACLR between 2012 and 2020 were retrospectively reviewed. Those who completed follow-up muscle strength tests and PRO measures were included in this study. Subjective clinical outcomes were assessed on the basis of patient-reported outcome measures using the Lysholm score preoperatively and during second-look arthroscopy. Objective graft status was assessed during second-look arthroscopy using a numeric scale system consisting of the following 4 subscales: tension, vascularity, synovialization, and continuity of the graft. The graft score (0-8) was determined by adding the points from each subscale (0-2). Muscle strength was measured using isokinetic dynamometry to assess peak torque, limb symmetry index for both the quadriceps and hamstrings and the ratio of the hamstring and quadriceps before second-look arthroscopy. Second-look arthroscopy patients included in analysis were those without concomitant meniscal or cartilage procedures. Multivariate logistic regression was used to identify factors associated with inferior PROs (Lysholm score ≤83). RESULTS A total of 82 patients were enrolled in this study. At an average follow-up of 22.4 ± 4.8 months, 25 patients (30.5%) scored less than 83 on the Lysholm scale. No significant differences were found in total graft status scores between groups with superior or inferior outcomes (6.9 ± 1.8 vs 7.1 ± 1.2, P = .573). However, the group with inferior PROs showed significantly lower peak torque in both hamstring and quadriceps (P = .001 and P < .001, respectively). Multivariate analysis indicated that older age and lower limb symmetry index for extension and flexion (<70% and 90%, respectively) were significantly correlated with inferior PROs (odds ratios: 1.08, 5.11, and 5.66; P = .014, .013, and .006, respectively). CONCLUSIONS Early inferior subjective outcomes after ACLR were associated with delayed recovery of quadriceps and hamstring muscle strength compared to graft appearance and tension. LEVEL OF EVIDENCE Level III, retrospective comparative case series.
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Affiliation(s)
- Seo-Jun Lee
- Department of Orthopaedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jun-Gu Park
- Department of Orthopaedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Seung-Beom Han
- Department of Orthopaedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Ji-Hoon Bae
- Department of Orthopaedic Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Ki-Mo Jang
- Department of Orthopaedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
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22
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Yensen K, Mayfield CK, Bolia IK, Palmer RA, Brown M, Kim DR, Abu-Zahra MS, Kotlier JL, Webb T, Cleary E, Saboori N, Petrigliano FA, Weber AE. Subjective Causes for Failure to Return to Sport After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis. Sports Health 2025; 17:243-251. [PMID: 38532528 PMCID: PMC11569586 DOI: 10.1177/19417381241231631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024] Open
Abstract
CONTEXT While current literature has explored the outcomes of athletes who return to sport (RTS) after anterior cruciate ligament (ACL) injuries, less is known about the outcomes of those who are unsuccessful in returning to sport. OBJECTIVE To determine the rate of athletes who did not RTS after primary ACL reconstruction (ACLR) and to identify the specific subjective reasons for failure to RTS. DATA SOURCES A comprehensive search of the PubMed/MEDLINE, Scopus, and Web of Science databases was conducted through April 2021. STUDY SELECTION Eligible studies included those explicitly reporting the rate of failure for RTS after ACLR as well as providing details on reasons for athletes' inability to return; 31 studies met the inclusion criteria. STUDY DESIGN Systematic review and meta-analysis. LEVEL OF EVIDENCE Level 2 to 4. DATA EXTRACTION The reasons for failure to RTS referred to in our study are derived from those established previously in the studies included. Data were collected on the number of athletes, mean age, mean follow-up time, type of sport played, failure to RTS rate, and specific reasons for failure to return. RESULTS The weighted rate of failure to RTS after ACLR was 25.5% (95% CI, 19.88-31.66). The estimated proportion of psychosocial-related reasons cited for failure to RTS was significantly greater than knee-related reasons for failure RTS (55.4% vs 44.6%, P < 0.01). The most cited reason for failure to RTS was fear of reinjury (33.0%). CONCLUSION This study estimates the rate of failure to RTS after ACLR to be 25.5%, with the majority of athletes citing fear of reinjury as the major deterrent for returning to sports. We highlight how factors independent of surgical outcomes may impact an athlete's ability to return to play given that the predominant reason for no RTS after ACLR was unrelated to the knee.
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Affiliation(s)
- Katie Yensen
- Keck School of Medicine of USC, Los Angeles, California
| | | | | | | | - Michael Brown
- Keck School of Medicine of USC, Los Angeles, California
| | - Daniel R. Kim
- Keck School of Medicine of USC, Los Angeles, California
| | | | | | - Thomas Webb
- Keck School of Medicine of USC, Los Angeles, California
| | - Emmett Cleary
- Keck School of Medicine of USC, Los Angeles, California
| | - Nima Saboori
- Keck School of Medicine of USC, Los Angeles, California
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Picinini F, Della Villa F, Tallent J, Patterson SD, Galassi L, Parigino M, La Rosa G, Nanni G, Olmo J, Stride M, Aggio F, Buckthorpe M. High Return to Competition Rate After On-Field Rehabilitation in Competitive Male Soccer Players After ACL Reconstruction: GPS Tracking in 100 Consecutive Cases. Orthop J Sports Med 2025; 13:23259671251320093. [PMID: 40052178 PMCID: PMC11881939 DOI: 10.1177/23259671251320093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2024] [Accepted: 09/26/2024] [Indexed: 03/09/2025] Open
Abstract
Background Despite published guidelines describing on-field rehabilitation (OFR) frameworks for soccer, available evidence for practitioners who work with players with anterior cruciate ligament reconstruction (ACLR) is limited. Purpose To document the activity and workloads completed by a large cohort of amateur and professional soccer players during OFR following ACLR after completing their indoor rehabilitation and to establish their return to competition (RTC) outcomes. Study Design Case series; Level of evidence, 4. Methods OFR measurements/activities, global positioning system (GPS), and heart rate data were collected from 100 male 11-a-side soccer players with ACLR undergoing a criteria-based rehabilitation process, concluding with a 5-stage OFR program. Consent was obtained directly from the players involved in this study before completing a follow-up questionnaire to document RTC outcomes. Differences between the level of play (professional and amateur) and 5 OFR stages were investigated using separate linear mixed models. Results A minimum 9-month follow-up was possible for 97 players (97%), with a median time of 2.3 years after ACLR and 84% RTC, with higher rates in professionals (100%) than amateurs (80%). Ten (10%) players sustained an ACL reinjury. Professionals completed more OFR sessions (20.6 ± 7.7 vs 13.2 ± 7.7; P < .001) over a shorter period (44.7 ± 30.3 vs 59.3 ± 28.5 days; P = .044) and achieved higher workloads mostly in the high-intensity GPS metrics in each OFR stage. Typical external workload outputs in the final OFR stage aligned with team training demands for the total distance (TD) (106%), high-intensity distance (HID) (104%), peak speed (PS) (88%), acceleration distance (ACC) (110%), and deceleration distance (DEC) (48%), but they were lower compared with match play demands (TD: 44%; HID: 51%; PS: 82%; ACC: 63%; and DEC: 26%). Conclusion High RTC rates were reported in those players who participated in OFR after indoor rehabilitation. Completion of all five OFR stages almost prepared them for team training demands; however, workloads remain low compared to match play.
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Affiliation(s)
- Filippo Picinini
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
- Faculty of Sport, Technology and Health Sciences, St Mary’s University, Twickenham, London, UK
| | - Francesco Della Villa
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Jamie Tallent
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, UK
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Australia
| | - Stephen David Patterson
- Faculty of Sport, Technology and Health Sciences, St Mary’s University, Twickenham, London, UK
| | - Lorenzo Galassi
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Matteo Parigino
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Giovanni La Rosa
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Gianni Nanni
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Jesus Olmo
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Matthew Stride
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Fabrizio Aggio
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Matthew Buckthorpe
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
- Faculty of Sport, Technology and Health Sciences, St Mary’s University, Twickenham, London, UK
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24
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Kahraman Marasli M, Bøe B. ACL Graft Selection Based on Age and Sport. VIDEO JOURNAL OF SPORTS MEDICINE 2025; 5:26350254241308584. [PMID: 40308987 PMCID: PMC11949908 DOI: 10.1177/26350254241308584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Accepted: 08/12/2024] [Indexed: 05/02/2025]
Abstract
Background The issue of graft selection in anterior cruciate ligament (ACL) reconstruction continues to be debated in the literature. It has been reported in the literature that different graft types give different results, especially in different demographic characteristics (age, sex) and different sports. In this study, we attempted to provide an overview of how graft selection should be made according to demographic characteristics (age, sex) and sport types. Indications In this study, we tried to review the studies in the literature that compared graft types in ACL reconstruction according to age, sex, or type of sport. Technique Description A narrow review of the literature was performed to compare graft selection specific to different sports. Results There is no perfect graft selection for everyone. Given the distinct characteristics of each sport branch, including the grade of pivoting, frequency of repeated movements, and expectations, it is evident that dedicated research is required for each sport. Comparative studies on graft selection specific to each sport may increase the accuracy of the selection. Discussion/Conclusion A review of the literature reveals a paucity of studies on the selection and outcomes of grafts in different sports. When choosing a graft for ACL reconstruction, factors such as age, sex, sport type, and expectations should be taken into consideration and a personalized decision should be made. Patient Consent Disclosure Statement The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
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Affiliation(s)
| | - Berte Bøe
- Department of Orthopaedic, Oslo University Hospital, Oslo, Norway
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25
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Kowalczyk KM, Shumski EJ, Lisee C, Lynall RC. Female collegiate soccer players post anterior cruciate ligament reconstruction utilize aberrant movement strategies to achieve similar performance to uninjured players. Clin Biomech (Bristol, Avon) 2025; 122:106424. [PMID: 39732037 DOI: 10.1016/j.clinbiomech.2024.106424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2024] [Revised: 12/10/2024] [Accepted: 12/16/2024] [Indexed: 12/30/2024]
Abstract
BACKGROUND Female soccer athletes with a history of anterior cruciate ligament injury are more susceptible to secondary injuries and potentially worse sport performance. The purpose of this study was to determine if female soccer athletes post anterior cruciate ligament reconstruction demonstrate worse jump height and reactive strength index performance and lower involved limb hip, knee, and ankle joint power and absorption, and larger joint power and absorption asymmetries compared to matched uninjured athletes. METHODS Eleven Division I female soccer athletes post anterior cruciate ligament reconstruction (18.8 ± 1.0 years, 1.72 ± 0.04 m, 66.4 ± 3.4 kg) and twenty-two matched controls (19.2 ± 1.0 years, 1.72 ± 0.05 m, 65.8 ± 5.0 kg) completed three trials of a standard bilateral jump landing. Separate 2 × 2 (group, limb) mixed-model ANOVAs, independent t-tests, and Mann-Whitney U tests (α ≤ 0.05) were used for analysis. Post-hoc t-tests with false discovery rate P-values were used on significant interactions. FINDINGS We found no differences between groups in jump height, reactive strength index, ankle power and absorption asymmetry, hip power and absorption asymmetry, and knee absorption asymmetry (P > 0.05). Athletes post anterior cruciate ligament reconstruction had decreased knee power in their involved limb compared to their uninvolved limb (P < 0.001). Regardless of limb, athletes post anterior cruciate ligament reconstruction absorbed more at the hip compared to controls (P = 0.013). INTERPRETATION Female soccer athletes post anterior cruciate ligament reconstruction utilize aberrant strategies to achieve the same level of performance as their uninjured peers. Specifically, the athletes utilized a hip dominant strategy to achieve similar performance outcomes.
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Affiliation(s)
- Kayla M Kowalczyk
- UGA Biomechanics Laboratory, Department of Kinesiology, University of Georgia, Athens, GA, USA.
| | - Eric J Shumski
- UGA Biomechanics Laboratory, Department of Kinesiology, University of Georgia, Athens, GA, USA
| | - Caroline Lisee
- UGA Biomechanics Laboratory, Department of Kinesiology, University of Georgia, Athens, GA, USA
| | - Robert C Lynall
- UGA Biomechanics Laboratory, Department of Kinesiology, University of Georgia, Athens, GA, USA
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26
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Ifarraguerri AM, Collins MS, Bloomer AK, Gachigi KK, Trofa DP, Siparsky PN, Piasecki DP, Fleischli JE, Saltzman BM. Lateral Femoral Notch Sign Presence, Location, and Depth Are Not Associated With Primary Anterior Cruciate Ligament Reconstruction Failure: A Retrospective Case-Control Study. Arthroscopy 2025:S0749-8063(25)00047-7. [PMID: 39892426 DOI: 10.1016/j.arthro.2025.01.029] [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: 09/17/2024] [Revised: 12/26/2024] [Accepted: 01/13/2025] [Indexed: 02/03/2025]
Abstract
PURPOSE To assess the relationship between the presence, depth, and location of the lateral femoral notch sign (LFNS) on preoperative magnetic resonance imaging (MRI) and the risk of anterior cruciate ligament reconstruction (ACLR) graft failure, as well as secondary return to sport (RTS) endpoints. METHODS Patients with primary ACLR failure between 2012 and 2021 were identified and matched to patients without primary ACLR failure by sex, age, and body mass index. Patients with incomplete medical records, inadequate follow-up, or concomitant lateral extra-articular tenodesis or anterolateral ligament reconstruction were excluded. The presence, depth, and location of the LFNS were recorded from patients' preoperative MRI. Intraoperative data, concomitant injuries, ACLR failure, and RTS were collected. RESULTS Of the 253 included patients, 158 (62.5%) were male, the mean age was 22 ± 9.1 years old, and the mean body mass index was 25.7 ± 5.7. 87(34.4%) had a LFNS on preoperative MRI. There was no difference in the prevalence of the LFNS between patients with primary ACLR failure (42 [32.1%]) and without primary ACLR failure (45 [36.9%]) (odds ratio 1.24, 95% confidence interval 0.74-2.08; P = .42). Among patients with the LFNS, there was no difference in mean depth between those with and without primary ACLR failure, or when stratifying depth by 1.0-1.5 mm, 1.5-2.0 mm, and >2.0 mm. The mean location of the LFNS from Blumensaat line did not differ between patients with or without primary ACLR failure, and RTS rate, level, and time were comparable between patients with and without the LFNS. CONCLUSIONS There was no significant difference in the presence, depth or location of the LFNS in patients with and without primary ACLR failure. Presence of the LFNS is not associated with additional risk of primary ACLR failure, and clinical outcomes were comparable in patients with and without the LFNS. LEVEL OF EVIDENCE Level IV, retrospective case-control study.
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Affiliation(s)
- Anna M Ifarraguerri
- OrthoCarolina - Sports Medicine Center, Charlotte, North Carolina, U.S.A.; OrthoCarolina Research Institute, Charlotte, North Carolina, U.S.A.; Atrium Health - Musculoskeletal Institute, Charlotte, North Carolina, U.S.A
| | - Michael S Collins
- IU Health Physicians Orthopedics & Sports Medicine, Indianapolis, Indiana, U.S.A.; Indiana University School of Medicine - Department of Orthopaedic Surgery, IU Health University Hospital, Indianapolis, Indiana, U.S.A
| | - Ainsley K Bloomer
- Atrium Health - Musculoskeletal Institute, Charlotte, North Carolina, U.S.A
| | | | - David P Trofa
- Department of Orthopaedics, New York Presbyterian, Columbia University Medical Center, New York, New York, U.S.A
| | - Patrick N Siparsky
- IU Health Physicians Orthopedics & Sports Medicine, Indianapolis, Indiana, U.S.A.; Indiana University School of Medicine - Department of Orthopaedic Surgery, IU Health University Hospital, Indianapolis, Indiana, U.S.A
| | - Dana P Piasecki
- OrthoCarolina - Sports Medicine Center, Charlotte, North Carolina, U.S.A.; OrthoCarolina Research Institute, Charlotte, North Carolina, U.S.A.; Atrium Health - Musculoskeletal Institute, Charlotte, North Carolina, U.S.A
| | - James E Fleischli
- OrthoCarolina - Sports Medicine Center, Charlotte, North Carolina, U.S.A.; OrthoCarolina Research Institute, Charlotte, North Carolina, U.S.A.; Atrium Health - Musculoskeletal Institute, Charlotte, North Carolina, U.S.A
| | - Bryan M Saltzman
- IU Health Physicians Orthopedics & Sports Medicine, Indianapolis, Indiana, U.S.A.; Indiana University School of Medicine - Department of Orthopaedic Surgery, IU Health University Hospital, Indianapolis, Indiana, U.S.A..
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27
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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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28
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Connors JP, Cusano A, Saleet J, Hao KA, Efremov K, Parisien RL, Seil R, Li X. Return to Sport and Graft Failure Rates After Primary Anterior Cruciate Ligament Reconstruction With a Bone-Patellar Tendon-Bone Versus Hamstring Tendon Autograft: A Systematic Review and Meta-analysis. Am J Sports Med 2025:3635465241295713. [PMID: 39836368 DOI: 10.1177/03635465241295713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2025]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) tears are frequent injuries in athletes that often require surgical reconstruction so that patients may return to their previous levels of performance. While existing data on patient-reported outcomes are similar between bone-patellar tendon-bone (BTB) and hamstring tendon (HT) autografts, the literature regarding return to sport (RTS), return to previous levels of sport activity, and graft failure rate remains limited. PURPOSE To compare rates of RTS, return to previous activity levels, and graft retears among athletes undergoing primary ACL reconstruction using a BTB versus HT autograft. STUDY DESIGN Systematic review and meta-analysis; Level of evidence, 4. METHODS The MEDLINE, Embase, and Cochrane Library databases were queried, and studies reporting on RTS after primary ACL reconstruction using a BTB or HT autograft were included. Exclusion criteria included revision reconstruction, ACL repair, quadriceps tendon autografts, allografts, graft augmentation, or double-bundle autografts. Rates of RTS, return to previous levels of activity, and retears were extracted and analyzed across included studies. RESULTS A total of 33 articles met inclusion criteria, with a patient cohort of 4810 athletes. The overall RTS rate for all athletes was 80.4% (95% CI, 75.3%-84.6%) at a mean follow-up of 35.7 months, with 54.6% (95% CI, 48.5%-60.6%) returning to preinjury levels of activity. No significant difference was found between BTB and HT autografts with respect to rates of RTS, return to preinjury activity levels, or reruptures. The overall RTS rate in patients after primary ACL reconstruction with a BTB autograft was 83.3% (95% CI, 77.0%-88.2%), with 56.1% (95% CI, 49.3%-62.7%) returning to preinjury levels of activity. Conversely, the overall RTS rate in patients after primary ACL reconstruction with an HT autograft was 77.9% (95% CI, 70.3%-84.0%), with 53.5% (95% CI, 42.8%-63.9%) returning to preinjury levels of activity. The overall graft rerupture rate for the entire patient cohort was 3.6% (95% CI, 2.5%-5.1%), for patients with BTB grafts was 3.2% (95% CI, 1.9%-5.3%), and for patients with HT grafts was 4.4% (95% CI, 2.8%-6.8%). CONCLUSION Primary ACL reconstruction using BTB autografts demonstrated similar rates of RTS, return to previous activity levels, and reruptures compared with reconstruction using HT autografts.
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Affiliation(s)
- John Patrick Connors
- Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Antonio Cusano
- Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jayson Saleet
- Department of Orthopedic Surgery, Boston Medical Center, Boston, Massachusetts, USA
| | - Kevin A Hao
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, Florida, USA
| | - Kristian Efremov
- Department of Orthopedic Surgery, Boston Medical Center, Boston, Massachusetts, USA
| | - Robert L Parisien
- Department of Orthopedic Surgery, Mount Sinai Health System, New York, New York, USA
| | - Romain Seil
- Centre Hospitalier de Luxembourg, Luxembourg City, Luxembourg
| | - Xinning Li
- Department of Orthopedic Surgery, Boston Medical Center, Boston, Massachusetts, USA
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Ifarraguerri AM, Graham GD, White AB, Berk AN, Gachigi KK, Siparsky PN, Trofa DP, Piasecki DP, Fleischli JE, Saltzman BM. Two-stage revision anterior cruciate ligament reconstruction reduces failure risk but leads to lesser clinical outcomes than single-stage revision after primary anterior cruciate ligament graft failure: a retrospective cohort study. Knee Surg Relat Res 2025; 37:5. [PMID: 39815325 PMCID: PMC11734444 DOI: 10.1186/s43019-024-00257-y] [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: 09/19/2024] [Accepted: 12/30/2024] [Indexed: 01/18/2025] Open
Abstract
BACKGROUND There are no studies that compare the outcomes and complications of single-versus two-stage revision anterior cruciate ligament reconstruction (ACLR) after primary ACLR failure. This purpose of this study is to examine clinical and functional outcomes and complications associated with single and two-stage revision ACLR after primary ACLR failure. METHODS All patients who underwent single or two-stage revision ACLR after primary ACLR failure between 2012 and 2021 with a minimum of a 2 year follow-up were included. Patients were excluded if they were not treated at our single academic institution, had inadequate follow-up, or had incomplete medical records. Revision intraoperative data, concomitant injuries, and complications were collected by chart review. Return to sport, numerical pain rating scale (NPRS) score, Knee injury and Osteoarthritis Outcome Score (KOOS), and Veteran Rands 12-item health survey (VR-12 scores) were collected. RESULTS The final analysis included 176 patients. A total of 147 (83.5%) had a single-stage revision ACLR (87 male, 60 female), and 29 (16.5%) had a two-stage revision ACLR (13 male, 16 female). Two-stage revision ACLR was significantly associated with anterior knee pain [odds ratio (OR) 4.36; 95% confidence interval (CI) 1.5 to 12.65; P = 0.007] but with lower failure rates (OR 0.12, 95% CI 0.02 to 0.9; P = 0.04). On multivariate analysis, a two-stage revision ACLR reduced the risk of graft failure by 85% (OR 0.15; 95% CI 0.02 to 1.17; P = 0.07). Two-stage revision ACLR was significantly associated with a lower KOOS pain score (OR -11.7; 95% CI -22.35 to -1.04; P = 0.031), KOOS symptoms score (OR -17.11; 95% CI -28.85 to -5.36; P = 0.004), KOOS Activities of Daily Living (ADL) score (OR -11.15; 95% CI -21.71 to -0.59; P = 0.039) and Veterans RAND 12-Item Health Survey (VR-12) physical component score (OR -9.99; 95% CI -15.77 to -4.22; P = 0.001). CONCLUSIONS The clinical outcomes and subjective patient scores significantly differed between the single-stage and two-stage revision ACLR after primary ACLR failure. Patients with a two-stage revision ACLR had a significantly reduced risk of revision graft failure but higher rates of postoperative anterior knee pain, lower pain scores, and lesser knee functional scores than single-stage revision patients. STUDY DESIGN Retrospective cohort study; level of evidence, 3.
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Affiliation(s)
- Anna M Ifarraguerri
- OrthoCarolina - Sports Medicine Center, 1915 Randolph Road, Charlotte, NC, 28207, USA
- OrthoCarolina Research Institute, 2001 Vail Ave, #300, Charlotte, NC, 28207, USA
- Atrium Health - Musculoskeletal Institute, 1320 Scott Ave, Charlotte, NC, 28203, USA
| | - George D Graham
- Atrium Health - Musculoskeletal Institute, 1320 Scott Ave, Charlotte, NC, 28203, USA
| | - Alexander B White
- Atrium Health - Musculoskeletal Institute, 1320 Scott Ave, Charlotte, NC, 28203, USA
| | - Alexander N Berk
- OrthoCarolina - Sports Medicine Center, 1915 Randolph Road, Charlotte, NC, 28207, USA
- OrthoCarolina Research Institute, 2001 Vail Ave, #300, Charlotte, NC, 28207, USA
- Atrium Health - Musculoskeletal Institute, 1320 Scott Ave, Charlotte, NC, 28203, USA
| | - Kennedy K Gachigi
- OrthoCarolina - Sports Medicine Center, 1915 Randolph Road, Charlotte, NC, 28207, USA
- OrthoCarolina Research Institute, 2001 Vail Ave, #300, Charlotte, NC, 28207, USA
| | - Patrick N Siparsky
- IU Health Physicians Orthopedics & Sports Medicine, 1801 N Senate Ave, Indianapolis, IN, 46202, USA
- Department of Orthopaedic Surgery, Indiana University School of Medicine, 550 N. University Blvd. 6201, Indianapolis, IN, 46202, USA
| | - David P Trofa
- Department of Orthopaedics, New York Presbyterian, Columbia University Medical Center, 622 West 168th St, PH 111-1130, New York, NY, 10032, USA
| | - Dana P Piasecki
- OrthoCarolina - Sports Medicine Center, 1915 Randolph Road, Charlotte, NC, 28207, USA
- OrthoCarolina Research Institute, 2001 Vail Ave, #300, Charlotte, NC, 28207, USA
- Atrium Health - Musculoskeletal Institute, 1320 Scott Ave, Charlotte, NC, 28203, USA
| | - James E Fleischli
- OrthoCarolina - Sports Medicine Center, 1915 Randolph Road, Charlotte, NC, 28207, USA
- OrthoCarolina Research Institute, 2001 Vail Ave, #300, Charlotte, NC, 28207, USA
- Atrium Health - Musculoskeletal Institute, 1320 Scott Ave, Charlotte, NC, 28203, USA
| | - Bryan M Saltzman
- IU Health Physicians Orthopedics & Sports Medicine, 1801 N Senate Ave, Indianapolis, IN, 46202, USA.
- Department of Orthopaedic Surgery, Indiana University School of Medicine, 550 N. University Blvd. 6201, Indianapolis, IN, 46202, USA.
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Sopilidis A, Stamatopoulos V, Giannatos V, Taraviras G, Panagopoulos A, Taraviras S. Integrating Modern Technologies into Traditional Anterior Cruciate Ligament Tissue Engineering. Bioengineering (Basel) 2025; 12:39. [PMID: 39851313 PMCID: PMC11762506 DOI: 10.3390/bioengineering12010039] [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: 11/10/2024] [Revised: 01/01/2025] [Accepted: 01/04/2025] [Indexed: 01/26/2025] Open
Abstract
The anterior cruciate ligament (ACL) is one of the most injured ligaments, with approximately 100,000 ACL reconstructions taking place annually in the United States. In order to successfully manage ACL rupture, it is of the utmost importance to understand the anatomy, unique physiology, and biomechanics of the ACL, as well as the injury mechanisms and healing capacity. Currently, the "gold standard" for the treatment of ACL ruptures is surgical reconstruction, particularly for young patients or athletes expecting to return to pivoting sports. Although ACL reconstruction boasts a high success rate, patients may face different, serious post-operative complications, depending on the type of graft and technique used in each one of them. Tissue engineering is a multidisciplinary field that could contribute to the formation of a tissue-engineered ACL graft manufactured by a combination of the appropriate stem-cell type, a suitable scaffold, and specific growth factors, combined with mechanical stimuli. In this review, we discuss the aspects that constitute the creation of a successful tissue-engineered graft while also underlining the current drawbacks that arise for each issue. Finally, we highlight the benefits of incorporating new technologies like artificial intelligence and machine learning that could revolutionize tissue engineering.
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Affiliation(s)
- Aris Sopilidis
- Department of Physiology, School of Medicine, University of Patras, Asklepiou Street 1, Rio, 26504 Patras, Greece; (A.S.); (V.S.); (G.T.)
| | - Vasileios Stamatopoulos
- Department of Physiology, School of Medicine, University of Patras, Asklepiou Street 1, Rio, 26504 Patras, Greece; (A.S.); (V.S.); (G.T.)
| | - Vasileios Giannatos
- Department of Orthopedics and Traumatology, Sports Medicine Department, University Hospital of Patras, Asklepiou Street 1, Rio, 26504 Patras, Greece; (V.G.); (A.P.)
| | - Georgios Taraviras
- Department of Physiology, School of Medicine, University of Patras, Asklepiou Street 1, Rio, 26504 Patras, Greece; (A.S.); (V.S.); (G.T.)
| | - Andreas Panagopoulos
- Department of Orthopedics and Traumatology, Sports Medicine Department, University Hospital of Patras, Asklepiou Street 1, Rio, 26504 Patras, Greece; (V.G.); (A.P.)
| | - Stavros Taraviras
- Department of Physiology, School of Medicine, University of Patras, Asklepiou Street 1, Rio, 26504 Patras, Greece; (A.S.); (V.S.); (G.T.)
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Kocaoglu B, Yozgatli TK, Tischer T, Calleja-Gonzalez J, Cuzzolin F, Bedi A, Seil R. Sport-specific differences in ACL injury, treatment and return to sports: Basketball. Knee Surg Sports Traumatol Arthrosc 2025. [PMID: 39749738 DOI: 10.1002/ksa.12575] [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: 10/11/2024] [Revised: 12/12/2024] [Accepted: 12/13/2024] [Indexed: 01/04/2025]
Abstract
Basketball is an intense, fast-paced game that is physically, highly demanding. Certain aspects of the game, such as the quick pivoting and cutting movements, predispose the players to serious knee injuries, including anterior cruciate ligament (ACL) tears. While an ACL tear can be a devastating condition for players, multidisciplinary management of the injury can provide the players with a reasonable chance to return to play at the pre-injury level. This article aims to review the general principles and guidelines for the management of ACL injury in basketball players. The diagnosis, surgical treatment, rehabilitation and return to sports are discussed from European and North American perspectives. With a comprehensive and multidisciplinary approach to this condition, medical professionals can provide injured basketball players with a favourable prognosis for returning to play at the pre-injury level. To return to normal life and basketball after ACL reconstruction, the proposed approach includes (1) the selection of the appropriate surgical graft and technique, (2) maintaining a healthy and persistent mental state during rehabilitation, and (3) following a scientific rehabilitation programme based on personalized recovery. LEVEL OF EVIDENCE: Level V.
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Affiliation(s)
- Baris Kocaoglu
- Acibadem Altunizade Sports Therapy and Health Unit, Istanbul, Turkey
- Department of Orthopedics and Traumatology, Acibadem University Faculty of Medicine, Istanbul, Turkey
- Turkish Basketball National Team, Istanbul, Turkey
- Euro League Players Association (ELPA), Barcelona, Spain
| | - Tahir Koray Yozgatli
- Department of Orthopedics and Traumatology, Acibadem University Faculty of Medicine, Istanbul, Turkey
| | - Thomas Tischer
- Klinik für Orthopädie und Unfallchirurgie Malteser Waldkrankenhaus St. Marien, Erlangen, Germany
- Department of Orthopedics, University Medical Center, Rostock, Germany
| | - Julio Calleja-Gonzalez
- Euro League Players Association (ELPA), Barcelona, Spain
- Department of Physical Education and Sports, Faculty of Education and Sport, University of the Basque Country (UPV/EHU), Vitoria-Gasteiz, Spain
| | - Francesco Cuzzolin
- Euro League Players Association (ELPA), Barcelona, Spain
- UCAM, Catholic University of Murcia, Murcia, Spain
| | - Asheesh Bedi
- Department of Orthopedic Surgery, University of Chicago, Chicago, Illinois, USA
- NorthShore Health System, Chicago, Illinois, USA
- National Basketball Players' Associations, Chicago, Illinois, USA
- Hospital for Special Surgery/Weill Cornell Medical Center, New York, New York, USA
| | - Romain Seil
- Division of Neurosciences and Musculoskeletal Diseases, Department of Orthopaedic Surgery, Centre Hospitalier de Luxembourg (CHL), Luxembourg, Luxembourg
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Ghali AN, Ghobrial P, Momtaz DA, Krishnakumar HN, Gonuguntla RK, Salem Y, AlSaidi A, Bartush KC, Heath DM. The Impact of Anterior Cruciate Ligament Tear on Player Performance and Longevity in La Liga League Soccer Players. J Knee Surg 2025; 38:99-108. [PMID: 39471976 DOI: 10.1055/s-0044-1791985] [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: 11/01/2024]
Abstract
Anterior cruciate ligament (ACL) rupture is among the most studied sports injuries. We investigate the impact of ACL reconstruction (ACLR) on performance and longevity in La Liga to elucidate performance parameters impacted after surgery in professional soccer players and variables impacting return-to-play (RTP).Demographic and performance data for La Liga players with ACLR between 1993 and 2020 were collected three seasons before and after injury and compared with two healthy controls. Analysis was conducted between and within ACLR and control groups. Pearson's correlation coefficients and a multiple linear regression model analyzed relationships between demographic variables and RTP.After exclusion, 23 professional soccer players were identified for the ACLR group. One year after index, ACLR had lower goals, shots on-target, assists, pass percentage, tackles, tackle success percentage, blocks, and clearances compared with control (p < 0.05). Two years after index, ACLR had lower assists, pass percentage, and tackle success percentage than control (p < 0.05). Three years after index, ACLR had fewer matches and blocks versus control (p < 0.05). Pearson's correlation showed a positive correlation between experience and RTP (p = 0.001). Multiple linear regression found RTP to increase 32.66 days for each additional year of experience (p < 0.001).With performance metrics showing significant decreases up to 2 years post-ACLR but largely recovering within 3 years of RTP, results support that soccer players undergoing ACLR eventually recover to preinjury levels of play. Players should be counseled on initial declines in performance metrics the first few years after RTP.
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Affiliation(s)
- Abdullah N Ghali
- Department of Orthopaedics, Baylor college of medicine, Houston, Texas
| | - Philip Ghobrial
- Department of Orthopaedics, Baylor college of medicine, Houston, Texas
| | - David A Momtaz
- Department of Orthopaedics, University of Miami, Miami, Florida
| | | | - Rishi K Gonuguntla
- University of Texas Health Sciences Center San Antonio, San Antonio, Texas
| | - Yousef Salem
- University of Texas Health Sciences Center San Antonio, San Antonio, Texas
| | - Amir AlSaidi
- Department of Orthopaedics, Baylor college of medicine, Houston, Texas
| | | | - David M Heath
- University of Texas Health Sciences Center San Antonio, San Antonio, Texas
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Brinkman JC, Hassebrock JD, Tummala SV, Richman EH, Haglin JM, Makovicka JL, Poon SK, Economopoulos KJ. Association Between Autograft Choice and Psychological Readiness to Return to Sport After ACL Reconstruction. Orthop J Sports Med 2025; 13:23259671241291926. [PMID: 39877422 PMCID: PMC11773525 DOI: 10.1177/23259671241291926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Accepted: 04/23/2024] [Indexed: 01/31/2025] Open
Abstract
Background It has been demonstrated that an athlete's psychological readiness contributes to one's ability to successfully return to sport (RTS) after anterior cruciate ligament (ACL) reconstruction. However, the effect of graft choice on psychological readiness is not yet understood. Purpose/Hypothesis The purpose of this study was to evaluate the association between graft choice and an athlete's psychological readiness to RTS. It was hypothesized that similar ACL-Return to Sport after Injury (ACL-RSI) scores would be achieved among patients who underwent ACL reconstruction with quadriceps autograft (QA), hamstring tendon autograft (HA), and bone-patellar tendon-bone (BTB) autograft. Study Design Cohort study; Level of evidence, 3. Methods Patients who underwent primary ACL reconstruction at a single institution between January 2017 and December 2018 were placed into separate cohorts depending on graft type (HA, BTB, or QA; n = 30 patients in each group), and the ACL-RSI, International Knee Documentation Committee subjective form, and Lysholm scores were compared between the different graft cohorts at 6 months postoperatively, at RTS, and at 2 years postoperatively. Also, the rate of patients who achieved an ACL-RSI score of ≥65 (predictive of return to preinjury sport at 2 years postoperatively) was calculated, as was the RTS rate and time. Results The QA group demonstrated significantly higher ACL-RSI scores than both the HA and BTB groups at 6 months postoperatively (P < .0001) and RTS (P = .011). The QA group also had a higher rate of achieving ≥65 on ACL-RSI than the other groups at 6 months postoperatively (P = .002) and RTS (P = .024). There was no significant difference in the RTS rate between the 3 groups, although the QA group demonstrated a significantly quicker return (QA, 8.1 months; BTB, 9.6 months; HA, 10.5 months; P < .001). Conclusion Athletes undergoing primary ACL reconstruction with QA achieved a higher mean ACL-RSI score and more often achieved a score of ≥65 at the 6-month and RTS time points compared with the HA and BTB groups. QA may afford an advantage over other grafts in terms of improved psychological readiness to RTS.
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Affiliation(s)
| | | | | | - Evan H. Richman
- Department of Orthopaedic Surgery, University of Colorado, Aurora, Colorado, USA
| | - Jack M. Haglin
- Department of Orthopaedic Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | | | - Steven K. Poon
- Department of Orthopaedic Surgery, Mayo Clinic, Phoenix, Arizona, USA
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Fukuyama Y, Murakami H, Iemitsu M. Single Nucleotide Polymorphisms and Tendon/Ligament Injuries in Athletes: A Systematic Review and Meta-analysis. Int J Sports Med 2025; 46:3-21. [PMID: 39437988 DOI: 10.1055/a-2419-4359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2024]
Abstract
This systematic review and meta-analysis aimed to identify the association between genetic polymorphisms and tendon and ligament injuries in adolescent and adult athletes of multiple competition sports. The PubMed, Web of Science, EBSCO, Cochrane Library, and MEDLINE databases were searched until July 7, 2023. Eligible articles included genetic studies on tendon and ligament injuries and comparisons between injured and non-injured athletes. This review included 31 articles, comprising 1,687 injury cases and 2,227 controls, from a meta-analysis of 12 articles. We identified 144 candidate gene polymorphisms (only single nucleotide polymorphisms were identified). The meta-analyses included vascular endothelial growth factor A (VEGFA) rs699947, collagen type I alpha 1 rs1800012, collagen type V alpha 1 rs12722, and matrix metalloproteinase 3 rs679620. The VEGFA rs699947 polymorphism showed a lower risk of injuries in athletes with the C allele ([C vs. A]: OR=0.80, 95% CI: 0.65-0.98, I 2 =3.82%, p=0.03). The risk of these injuries were not affected by other polymorphisms. In conclusion, the VEGFA rs699947 polymorphism is associated with the risk of tendon and ligament injuries in athletes. This study provides insights into genetic variations that contribute to our understanding of the risk factors for such injuries in athletes.
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Affiliation(s)
- Yumi Fukuyama
- Department of Physical Therapy, Aino University, Ibaraki, Japan
- Faculty of Sport and Health Science, Ritsumeikan University, Kusatsu, Japan
| | - Haruka Murakami
- Faculty of Sport and Health Science, Ritsumeikan University, Kusatsu, Japan
| | - Motoyuki Iemitsu
- Faculty of Sport and Health Science, Ritsumeikan University, Kusatsu, Japan
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Ismailidis P, Neopoulos G, Egloff C, Mündermann A, Halbeisen FS, Nüesch C, Appenzeller-Herzog C, Müller SA. Simultaneous patellar tendon and anterior cruciate ligament rupture: a systematic review, meta-analysis and algorithmic approach. Arch Orthop Trauma Surg 2024; 145:61. [PMID: 39694972 DOI: 10.1007/s00402-024-05676-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 10/08/2024] [Indexed: 12/20/2024]
Abstract
INTRODUCTION Isolated patellar tendon (PT) or anterior cruciate ligament (ACL) ruptures are common injuries, yet the co-occurrence of both presents a rare challenge for clinicians. The objectives of the study are to document diagnostic and therapeutic approaches, outcomes, and complications of combined PT and ACL injuries and to develop an algorithm to guide clinicians in decision-making. METHODS The systematic review und metanalysis was conducted according to the PRISMA guidelines. Studies reporting on simultaneous PT and ACL ruptures were included. Meta-analysis was performed to compare different diagnostic modalities and treatment strategies. RESULTS Thirty-six studies reporting on 56 Patients were included. 88% of patients had a concomitant injury (apart from PT and ACL) to the ipsilateral knee. Part of the diagnosis was missed in 23% of the cases. Performance of MRI significantly reduced the risk of missing a part of the injury (5% with MRI vs 69% without MRI, p < 0.001). Surgical treatment was used only for the PT in 21% of the cases and for the PT and ACL in 77% of the cases (48% one-stage, 52% two-stage surgical treatment). CONCLUSION Combined ACL and PT rupture is rare, and recognizing its full extent is crucial for successful management. Performing an MRI in PT rupture from high-energy trauma and diagnostic arthroscopy/arthrotomy when MRI is not done is essential. PT ruptures should be treated surgically. For ACL rupture, conservative and operative treatment, one- or two-stage surgery are possible based on the patient's profile and concomitant injuries. Based on the limited available literature, this systematic review provides a diagnostic and therapeutic algorithm to assist in clinical decision-making.
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Affiliation(s)
- Petros Ismailidis
- Department of Orthopaedics and Traumatology, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
- Faculty of Medicine, University of Basel, 4031, Basel, Switzerland.
- Department of Clinical Research, University of Basel, 4031, Basel, Switzerland.
- Surgical Outcome Research Center, University Hospital Basel and University of Basel, Basel, Switzerland.
| | - Georgios Neopoulos
- Department of Orthopaedics and Traumatology, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
| | - Christian Egloff
- Department of Orthopaedics and Traumatology, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
- Lower Extremity, Schulthess Klinik, Zurich, Switzerland
| | - Annegret Mündermann
- Department of Orthopaedics and Traumatology, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
- Department of Clinical Research, University of Basel, 4031, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, 4031, Basel, Switzerland
| | - Florian S Halbeisen
- Surgical Outcome Research Center, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Corina Nüesch
- Department of Orthopaedics and Traumatology, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
- Department of Clinical Research, University of Basel, 4031, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, 4031, Basel, Switzerland
- Department of Spine Surgery, University Hospital Basel, 4031, Basel, Switzerland
| | | | - Sebastian A Müller
- Faculty of Medicine, University of Basel, 4031, Basel, Switzerland
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101, Bruderholz, Switzerland
- Orthopaedic surgery, Leonardo Ortho, Münchenstein, Switzerland
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Obradovic A, Manojlovic M, Rajcic A, Jankovic S, Andric N, Ralic V, Zlicic T, Aleksic B, Ninkovic S, Veraksa A, Drid P. Males have higher psychological readiness to return to sports than females after anterior cruciate ligament reconstruction: a systematic review and meta-analysis. BMJ Open Sport Exerc Med 2024; 10:e001996. [PMID: 39720149 PMCID: PMC11667408 DOI: 10.1136/bmjsem-2024-001996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 11/05/2024] [Indexed: 12/26/2024] Open
Abstract
Objectives To examine sex differences in psychological readiness to return to sport following anterior cruciate ligament (ACL) reconstruction as well as to determine whether males and females separately fulfilled cut-off values (≥65) of psychological readiness necessary to return to sport. Information sources Web of Science, Scopus and PubMed were comprehensively searched from inception to January 2024 to identify relevant studies. Eligibility criteria Observational investigations that compared males and females with a history of ACL reconstruction concerning psychological readiness to return to sport. Risk of bias Studies were rated using the Methodological Index for Non-Randomised Studies. Included studies Only 11 reports fulfilled the eligibility criteria and were included in the quantitative analysis. A total of 2618 participants were subjected to the primary ACL reconstruction, out of 1631 males and 987 females. Psychological readiness to return to sport was evaluated approximately 9±2.9 months following surgery. Synthesis of results The main findings demonstrated that males had slightly higher psychological readiness to return to the sport than females (standardised mean difference 0.33; 95% CI 0.14 to 0.52; p=0.0007; I2=77%) after ACL surgery. In addition, the mean psychological readiness to return to the sport of males was 70.1±8.8 points and of females 65.1±8.8 points, indicating that both sexes exceeded recommendations necessary to return to sport. Conclusion Males had slightly higher psychological readiness to return to sport than females approximately 9±2.9 months after ACL reconstruction and both sexes exceeded the highlighted recommendations necessary to return to sport. PROSPERO registration number CRD42024497769: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024497769.
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Affiliation(s)
- Anja Obradovic
- Faculty of Sport and Physical Education, University of Novi Sad, Novi Sad, Serbia
| | - Marko Manojlovic
- Faculty of Sport and Physical Education, University of Novi Sad, Novi Sad, Serbia
| | - Aleksandra Rajcic
- Faculty of Sport and Physical Education, University of Novi Sad, Novi Sad, Serbia
| | - Stefan Jankovic
- Faculty of Sport and Physical Education, University of Novi Sad, Novi Sad, Serbia
| | - Nikola Andric
- Faculty of Sport and Physical Education, University of Novi Sad, Novi Sad, Serbia
| | - Vuk Ralic
- Faculty of Sport and Physical Education, University of Novi Sad, Novi Sad, Serbia
| | - Tamara Zlicic
- Faculty of Sport and Physical Education, University of Novi Sad, Novi Sad, Serbia
| | - Branko Aleksic
- Faculty of Sport and Physical Education, University of Novi Sad, Novi Sad, Serbia
| | - Srdjan Ninkovic
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Aleksander Veraksa
- Faculty of Psychology, Lomonosov Moscow State University, Moscow, Russia
| | - Patrik Drid
- Faculty of Sport and Physical Education, University of Novi Sad, Novi Sad, Serbia
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Medeiros de Queiroz JH, Silva Rodrigues CA, Scattone Silva R, Leão Peixoto Almeida G, Bezerra MA, de Oliveira RR. Verbal instructions for attentional focus influence the results of tests for return to sport after anterior cruciate ligament reconstruction. J Sports Sci 2024; 42:2343-2351. [PMID: 39632422 DOI: 10.1080/02640414.2024.2430904] [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: 06/01/2024] [Accepted: 11/09/2024] [Indexed: 12/07/2024]
Abstract
This cross-sectional study investigated the influence of attentional focus verbal instructions on test results for return to sport (RTS) after ACL-R. Sixty subjects (53 male and 7 female, age 27.52 ± 7.63 years, body mass 77.56 ± 12.41 kg, height 162.04 ± 43.90 cm, and surgery time 11.15 ± 4.55 months) were evaluated in the single hop test (SHT), 6 m timed hop test (6mTHT), and "T" agility test. Participants performed the tests following randomly determined verbal instructions that induced neutral focus (NF), internal focus (IF), and external focus (EF). EF increased hop distance in SHT compared to NF (p = 0.001, effect size = 0.57) and IF (p = 0.037, effect size = 0.57) and there was no difference between IF and NF (p = 0.418). In 6mTHT, NF and EF increase velocity compared to IF (p = 0.001, effect size = 0.49, p = 0.001, effect size = 0.49, respectively). In the "T" agility test, the NF increased velocity when compared to the EF (p = 0.001, effect size = 0.62) and the IF (p = 0.001, effect size = 0.62), without difference between IF and EF (p = 0.071). In summary, attentional focus in patients under ACL-R can influence hops and agility.
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Affiliation(s)
- Jeffeson Hildo Medeiros de Queiroz
- Tendon Research Group, Master Program in Physical Therapy and Functioning, Physical Therapy Department, Federal University of Ceara, Fortaleza, CE, Brazil
| | - Carlos Augusto Silva Rodrigues
- Knee and Sports Research Group, Master Program in Physical Therapy and Functioning, Physical Therapy Department, Federal University of Ceara, Fortaleza, CE, Brazil
| | - Rodrigo Scattone Silva
- Tendon Research Group, Post-graduate Program in Physiotherapy and Post-graduate Program in Rehabilitation Sciences, Federal University of Rio Grande do Norte, Santa Cruz, RN, Brazil
| | - Gabriel Leão Peixoto Almeida
- Knee and Sports Research Group, Master Program in Physical Therapy and Functioning, Physical Therapy Department, Federal University of Ceara, Fortaleza, CE, Brazil
| | - Márcio Almeida Bezerra
- Tendon Research Group, Master Program in Physical Therapy and Functioning, Physical Therapy Department, Federal University of Ceara, Fortaleza, CE, Brazil
| | - Rodrigo Ribeiro de Oliveira
- Tendon Research Group, Master Program in Physical Therapy and Functioning, Physical Therapy Department, Federal University of Ceara, Fortaleza, CE, Brazil
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Piussi R, Brandt E, Johansson A, Snaebjörnsson T, Thomeé R, Samuelsson K, Hamrin Senorski E. The Patient-Physiotherapist Tango: a Personalized Approach to ACL Recovery - a Qualitative Interview Study. Int J Sports Phys Ther 2024; 19:1589-1599. [PMID: 39628779 PMCID: PMC11611479 DOI: 10.26603/001c.126060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 09/21/2024] [Indexed: 12/06/2024] Open
Abstract
Background Person-centered care is a concept in healthcare that aims to promote the patient's health and adapt resources and interventions based on the patient's needs and wishes. Knowledge on what person-centered physiotherapy is for patients who rehabilitate after an anterior cruciate ligament (ACL) reconstruction, and how patients experience it within the context of sports injury rehabilitation, is lacking. Purpose The aim of this study was to explore how patients who were in a late rehabilitation stage (8-12 months) after ACL reconstruction experienced their rehabilitation from a person-centered perspective. Study Design Qualitative interview study. Methods Fourteen patients (57% females), aged 18-57, treated with ACL reconstruction, were interviewed with semi-structured interviews 8-12 months after ACL reconstruction. Interviews were recorded, transcribed and analyzed with qualitative content analysis. Results One theme: all lights on me; be seen and heard, a cornerstone for patients, supported by three main categories: 1) rehabilitation: a roller coaster of physical and psychological challenges; 2) patient involvement; 3) the physiotherapist - stronger together; emerged from the collected data. Conclusion Patients in a late rehabilitation stage (8-12 months) after ACL reconstruction experienced that the rehabilitation process was person-centered when they felt to be the focus and were allowed to participate via open and constructive communication with the physiotherapists.
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Affiliation(s)
- Ramana Piussi
- 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, Gothenburg, Sweden
| | - Ella Brandt
- Sportrehab Sports Medicine Clinic, Stampgatan 14, SE-411 01 Gothenburg, Sweden
| | - Alicia Johansson
- Sportrehab Sports Medicine Clinic, Stampgatan 14, SE-411 01 Gothenburg, Sweden
| | - Thorkell Snaebjörnsson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Roland Thomeé
- 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
- Sportrehab Sports Medicine Clinic, Stampgatan 14, SE-411 01 Gothenburg, Sweden
| | - Kristian Samuelsson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eric Hamrin Senorski
- 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, Gothenburg, Sweden
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Ashnai F, Thomeé R, Hamrin Senorski E, Beischer S. Higher isokinetic quadriceps peak force is associated with a patient-acceptable symptom-state 1 and 3 years after ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 39564974 DOI: 10.1002/ksa.12541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 09/30/2024] [Accepted: 10/19/2024] [Indexed: 11/21/2024]
Abstract
PURPOSE The main purpose was to determine cut-off values for absolute (QNm/kg) and relative (QLSI) isokinetic knee extensor (KE) strength for achieving a patient-acceptable symptom state (PASS) in the Knee injury and Osteoarthritis Outcome Score (KOOS) subscales and for different age groups to determine the association between QNm/kg and QLSI and PASS, at 1 and 3 years after an anterior cruciate ligament reconstruction (ACLR). METHODS PASS was defined as reaching cut-off values for all KOOS subscales. Data from follow-ups were extracted from a rehabilitation registry. Male and female patients were divided into two age groups based on their age at primary ACLR: 16-24 years and 25-65 years. Odds Ratios between the QNm/kg and QLSI cut-off values and achieving PASS were calculated. Receiver Operating Characteristic curves were constructed to determine the individual predictive capacity for achieving PASS of QNm/kg and of QLSI using the area under the curve (AUC). RESULTS Results from 755 and 145 patients (females = 51% and 52%; preinjury Tegner Activity level ≥6 = 82% and 74%) were used in the 1- and 3-year follow-up analyses. Reaching the cut-off values for the QNm/kg, ranging between ≥2.1 and ≥2.7, entailed between 2.09 and 5.12 times the odds of achieving PASS, across all groups at the 1-year follow-up. At the 3-year follow-up, the cut-off values of ≥3.4 and ≥2.6QNm/kg were associated with patients achieving PASS with acceptable accuracy (AUC = 0.700-0.780) in 16-41 year-old males and females. CONCLUSION At 1 year after ACLR, patients of both sexes and age groups reaching cut-off values for absolute KE strength had two to five times the odds, that were clinically relevant, to achieve PASS. Acceptable discriminative capacity was found for the absolute KE strength among male and female patients 16-24 years old, at 3 years after ACLR. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Farshad Ashnai
- Department of Orthopaedics, The Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Sportrehab Sports Medicine Clinic, Gothenburg, Sweden
| | - Roland Thomeé
- Sportrehab Sports Medicine Clinic, Gothenburg, Sweden
- Department of Health and Rehabilitation, Unit of Physiotherapy, The Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eric Hamrin Senorski
- Sportrehab Sports Medicine Clinic, Gothenburg, Sweden
- Department of Health and Rehabilitation, Unit of Physiotherapy, The Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Susanne Beischer
- Sportrehab Sports Medicine Clinic, Gothenburg, Sweden
- Department of Health and Rehabilitation, Unit of Physiotherapy, The Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Cheng R, Yao G, Dimitriou D, Jiang Z, Yang Y, Tsai TY. The 45° and 60° of sagittal femoral tunnel placement in anterior cruciate ligament reconstruction provide similar knee stability. Knee Surg Sports Traumatol Arthrosc 2024; 32:3031-3038. [PMID: 38973630 DOI: 10.1002/ksa.12341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 06/03/2024] [Accepted: 06/18/2024] [Indexed: 07/09/2024]
Abstract
PURPOSE The aim of the present study was to compare 45° and 60° of sagittal femoral tunnel angles in terms of anterior tibial translation (ATT), valgus angle and graft in situ force following anterior cruciate ligament reconstruction (ACLR). METHODS Ten porcine knees were subjected to the following loading conditions: (1) 89 N anterior tibial load at 35° (full extension), 60° and 90° of knee flexion and (2) 5 N m valgus tibial moment at 35° and 45° of knee flexion. ATT and graft in situ force of the intact anterior cruciate ligament (ACL) and ACLR were collected using a robotic universal force/moment sensor (UFS) testing system for (1) ACL intact, (2) ACL-deficient (ACLD) and (3) two different ACLR using different sagittal femoral tunnel angles (coronal 45°/sagittal 45° and coronal 45°/sagittal 60°). RESULTS During the anterior tibial load, the femoral tunnel angle of ACLR knees at coronal 45°/sagittal 45° and 60° had significantly higher ATT than that of the ACL-intact knees at 60° of knee flexion (p < 0.05). The femoral tunnel angle of ACLR knees at coronal 45°/sagittal 60° had significantly lower graft in situ force than that of the ACL-intact knees at 60° and 90° of knee flexion (p < 0.05). During the valgus tibial moment, the femoral tunnel angle of ACLR knees at coronal 45°/sagittal 45° and 60° had significantly lower graft in situ force than that of the ACL-intact knees at all knee flexions (p < 0.05). CONCLUSIONS The femoral tunnel angle of ACLR knees at coronal 45°/sagittal 45° provided similar ATT, valgus angle and graft in situ force to that of ACLR knees at coronal 45°/sagittal 60°. Therefore, both femoral tunnel angles could be used in ACLR, as the sagittal femoral tunnel angle does not appear to be relevant in post-operative knee stability. LEVEL OF EVIDENCE Not applicable.
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Affiliation(s)
- Rongshan Cheng
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center for Digital Medicine of the Ministry of Education, Shanghai, China
- Department of Orthopedics, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao, Tong University School of Medicine, Shanghai, China
| | - Gai Yao
- The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Dimitris Dimitriou
- Department of Orthopedics, University Hospital Balgrist, Zurich, Switzerland
| | - Ziang Jiang
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center for Digital Medicine of the Ministry of Education, Shanghai, China
- Department of Orthopedics, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao, Tong University School of Medicine, Shanghai, China
| | - Yangyang Yang
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center for Digital Medicine of the Ministry of Education, Shanghai, China
- Department of Orthopedics, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao, Tong University School of Medicine, Shanghai, China
| | - Tsung-Yuan Tsai
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center for Digital Medicine of the Ministry of Education, Shanghai, China
- Department of Orthopedics, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao, Tong University School of Medicine, Shanghai, China
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Tan Y, Kaldau NC, Lumban-Gaol I, Budhiparama NC, Peers K. Anterior cruciate ligament injuries in elite badminton athletes: 84% Return to sport, half return to performance. Knee Surg Sports Traumatol Arthrosc 2024; 32:2978-2998. [PMID: 38984858 DOI: 10.1002/ksa.12347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 06/03/2024] [Accepted: 06/17/2024] [Indexed: 07/11/2024]
Abstract
PURPOSE Badminton requires fast and pivoting movements, putting athletes at risk of sustaining an anterior cruciate ligament (ACL) injury. The primary purpose is to investigate the return to sport (RTS) and the return to performance (RTP) after an ACL injury in elite badminton athletes. The secondary purpose is to describe ACL injury mechanisms in elite badminton players. METHODS Athletes within the top 200 of the Badminton World Federation World Ranking who sustained an ACL injury between January 2001 and December 2021 were retrospectively included. An anonymous online survey was created in eight languages. RTS, RTP and contributing factors were analysed among athletes aiming to RTP. The injury mechanism was analysed in all participants. RESULTS Sixty-six athletes from 32 countries were included. Fifty-seven athletes (86.4%) aimed to RTP. Forty-eight out of 57 (84.2%) did RTS. Twenty-nine (50.9%) managed to successfully RTP. Forty-nine (74.2%) of ACL injuries occurred during a competition, 14 (21.2%) occured during training. Thirty-one (49.2%) occurred in the rear court backhand side and 47 (74.6%) occurred during landing after a jump. CONCLUSION Forty-eight out of 57 (84.2%) athletes managed to RTS. Half of the athletes managed to successfully RTP. Most of the ACL injuries occurred during competition, in the rear court backhand side and during landing after a jump. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Yuhan Tan
- Department of Orthopaedics, Noorderhart Ziekenhuis, Pelt, Belgium
- Department of Orthopaedics, University Hospital Brussels, Brussels, Belgium
- Department of Physical Medicine & Rehabilitation, University Hospitals Leuven, Leuven, Belgium
| | - Niels Christian Kaldau
- Department of Orthopaedic Surgery, Sports Orthopaedic Research Center Copenhagen (SORC-C), Copenhagen University Hospital, Amager-Hvidovre Hospital, Copenhagen, Denmark
| | - Imelda Lumban-Gaol
- Nicolaas Institute of Constructive Orthopaedic Research and Education Foundation for Arthroplasty and Sports Medicine, Department of Orthopaedics, Medistra Hospital, Jakarta, Indonesia
| | - Nicolaas C Budhiparama
- Nicolaas Institute of Constructive Orthopaedic Research and Education Foundation for Arthroplasty and Sports Medicine, Department of Orthopaedics, Medistra Hospital, Jakarta, Indonesia
| | - Koenraad Peers
- Department of Physical Medicine & Rehabilitation, University Hospitals Leuven, Leuven, Belgium
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Franco D, Ambrosio L, Za P, Maltese G, Russo F, Vadalà G, Papalia R, Denaro V. Effective Prevention and Rehabilitation Strategies to Mitigate Non-Contact Anterior Cruciate Ligament Injuries: A Narrative Review. APPLIED SCIENCES 2024; 14:9330. [DOI: 10.3390/app14209330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2025]
Abstract
Non-contact anterior cruciate ligament injuries (NC-ACLs) represent a significant concern in sports medicine, particularly among athletes and physically active individuals. These injuries not only result in immediate functional impairment but also predispose individuals to long-term issues such as recurrent instability and early-onset osteoarthritis. This narrative review examines the biomechanical, neuromuscular, and environmental factors that contribute to the high incidence of NC-ACLs and evaluates the effectiveness of current prevention and rehabilitation strategies. The review identifies key risk factors, including improper landing mechanics, deficits in neuromuscular control, and muscle imbalances, which are pivotal in the etiology of NC-ACLs. Prevention programs that incorporate plyometric exercises, strength training, and neuromuscular education have shown efficacy in reducing injury rates. Rehabilitation protocols that emphasize a gradual return to sport, focusing on pain management, restoration of range of motion, and progressive strengthening, are critical for successful recovery and prevention of re-injury. The evidence suggests that an integrated approach, combining prevention and rehabilitation strategies tailored to the individual, is essential for minimizing NC-ACL risk and improving outcomes in affected populations.
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Affiliation(s)
- Domenico Franco
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Luca Ambrosio
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Pierangelo Za
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Girolamo Maltese
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Fabrizio Russo
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Gianluca Vadalà
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Rocco Papalia
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Vincenzo Denaro
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
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Herzog D, Vach W, Schwamborn T, Saxer F. How Athletic Swiss Patients Experience Their Return to Sports After Anterior Cruciate Ligament Reconstruction: Results from a Retrospective Self-Assessment. Open Access J Sports Med 2024; 15:141-158. [PMID: 39415771 PMCID: PMC11481995 DOI: 10.2147/oajsm.s464765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 06/21/2024] [Indexed: 10/19/2024] Open
Abstract
Introduction Anterior cruciate ligament (ACL) ruptures are frequent injuries, especially in athletes. Return to sports after reconstruction of the ligament is a frequently debated topic and of high relevance for these patients. It is mostly achieved at 9-12 months post-surgery. However, the risk of subsequent knee injuries is high and psychological factors play an important role in the process and success of returning to sports. Little is known about patients' perception of their journey returning to sports. This study aims to fill the gap. Material and Methods The study aimed to include patients treated surgically for an ACL injury over 5 years at a specialized sports-medicine clinic. Patients were surveyed on the impact of the injury on their lives, their return to sports experience, and medical history. Results In total, 100 (of 474) patients aged 35.9 years responded. Within 5 years, 19% experienced a reoperation and 23% a new knee injury. Overall, 83% of patients returned to their main sport, 72% reached their pre-injury level. However, 45% reported at least one distinct or severe consequence of their ACL injury. The ability to return to sports had more impact on the perception of the course of treatment than the experience of new injuries or surgery. Conclusion The rate of successful return to sports was comparable to previous reports despite a higher average age in this cohort. A successful return to sports seems to be a major determinant for the perception of impact from the injury and may be more important than the avoidance of repeat trauma.
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Affiliation(s)
- Dominik Herzog
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Werner Vach
- Crossklinik Basel, Basel, Switzerland
- Basel Academy for Quality and Research in Medicine, Basel, Switzerland
| | | | - Franziska Saxer
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Basel Academy for Quality and Research in Medicine, Basel, Switzerland
- Novartis BioMedical Research, Translational Medicine, Basel, Switzerland
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44
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Harley JD, Ristow JJ, Macalena JA. Concomitant Rupture of the Anterior Cruciate Ligament and the Patellar Tendon in a High-Level Athlete: A Case Report. HSS J 2024:15563316241287751. [PMID: 39583893 PMCID: PMC11582993 DOI: 10.1177/15563316241287751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2024] [Accepted: 09/04/2024] [Indexed: 11/26/2024]
Affiliation(s)
- Jonathan D. Harley
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Jacob J. Ristow
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Jeffrey A. Macalena
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA
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Ghahremani JS, Dong HW, Watarastaporn T, Al-Khatib NA, Khalil LS, Mehran N. Defensive Performance Declines in Ultimate Fighting Championship Fighters Following Anterior Cruciate Ligament Reconstruction. Arthrosc Sports Med Rehabil 2024; 6:100961. [PMID: 39534034 PMCID: PMC11551401 DOI: 10.1016/j.asmr.2024.100961] [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: 02/09/2024] [Accepted: 06/06/2024] [Indexed: 11/16/2024] Open
Abstract
Purpose To evaluate the impact anterior cruciate ligament reconstruction (ACLR) has on strike evasion rates, strike and landing rates, win percentage, and career longevity in Ultimate Fighting Championship (UFC) fighters. Methods UFC fighters who underwent ACLR from 1993 to 2022 were matched 2:1 with uninjured controls. The percentage of each injured fighter's career that occurred before ACLR was deemed the "index percentage." Injured fighter performance pre-/post-ACLR was compared with control metrics pre-/postindex percentage. Results Of the 82 patients with documented ACL injuries identified, 48 met the inclusion criteria. Of these, 27 returned for more than 2 fights and were paired with 54 controls. UFC fighters demonstrated return-to-sport rates of 81.25% and 56.25% for at least 1 and 2 fights, respectively. On average, it took 411.85 ± 174.73 (range, 165-879) days for fighters to return. All fighters had significantly lower evasion rates against total significant strikes, distance strikes, and head strikes, postindex (P < .05 for each). ACLR fighters had significantly lower submission attempts and evasion rates against clinch strikes, ground strikes, and total strikes, postindex (P < .05 for each). Controls had a significantly lower evasion rate against leg strikes, postindex. Both groups' win percentages significantly declined (ACLR, P = .001; control, P = .012). No significant difference in total career fights was observed (P = .873). Conclusions In this study, we found that most UFC fighters who undergo ACLR return to sport for at least 1 fight; however, just over half return for at least 2 fights. There was not a significant difference in career length between fighters who returned to sport following ACLR for at least 2 fights and their controls. Defensive performance, but not offensive performance, declined significantly following ACLR. All fighters demonstrated significant declines in their win percentage as their career progressed, irrespective of ACLR. Level of Evidence Level III, retrospective comparative study.
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Affiliation(s)
- Jacob S. Ghahremani
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, U.S.A
| | - Henry W. Dong
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, U.S.A
| | - Tanya Watarastaporn
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, U.S.A
| | - Nala A. Al-Khatib
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, U.S.A
| | - Lafi S. Khalil
- OrthoMichigan McLaren-Flint & Hurley Medical Center, Flint, Michigan, U.S.A
| | - Nima Mehran
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, U.S.A
- Department of Orthopaedic Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, U.S.A
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46
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Charles S, Preston N. Osteoarthritis After Anterior Cruciate Ligament Reconstruction: A Systematic Review of Contributing Factors and Potential Treatments. Cureus 2024; 16:e71188. [PMID: 39525184 PMCID: PMC11549666 DOI: 10.7759/cureus.71188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2024] [Indexed: 11/16/2024] Open
Abstract
Anterior cruciate ligament (ACL) injuries result in abnormal knee motion and long-term joint degradation. ACL reconstruction (ACLR) is done with the aim of restoring normal knee kinematics and slowing the joint degradation process. It does appear that this inevitably happens and can be impacted by a multitude of factors. The aim of this review was to examine the factors that influence the progression of osteoarthritis (OA) after ACLR and examine possible treatments that can aid in slowing that progression. A systematic review was conducted by searching all levels of evidence for all studies in English that assessed risk factors for developing OA after ACL reconstruction, had a minimum follow-up of 10 years, and used radiographical outcomes to measure the presence of OA. Studies on trial treatments to reduce osteoarthritis after ACL reconstruction were also included. It was found that among the factors associated with an increased risk of post-ACLR OA are meniscal lesions, meniscectomy, increased age at the time of ACLR, increased time from injury to surgery, male sex, reduced range of motion, smaller thigh girth, graft complications, and failure. Additionally, in performing the ACLR, anteromedial femoral tunnel placement, higher graft tension, and following guidelines for performing anatomic ACLR have been shown to reduce the risk of OA as well. Patients should be adequately counselled on their risk pre-operatively for informed decision-making. Surgeons should also be aware of potential risk factors and how they can be mitigated.
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Affiliation(s)
- Shane Charles
- Sports and Exercise Medicine, University of South Wales, Wales, GBR
- Orthopaedics and Trauma, San Fernando General Hospital, San Fernando, TTO
| | - Nick Preston
- Department of Rehabilitation Medicine, The University of Leeds, Leeds, GBR
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Walker A, Sattler L, Heyward S, Tedesco J, Jones Z, D'Lima C, Higham C, Cuthbert S, Hing W. An 8-week physiotherapist-led return to sport group program after anterior cruciate ligament reconstruction improves measures of physical and psychological function: A case series. Musculoskelet Sci Pract 2024; 73:103149. [PMID: 39047591 DOI: 10.1016/j.msksp.2024.103149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/15/2024] [Accepted: 07/17/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Low return to competitive sport, high reinjury rates and long-term functional impairment of anterior cruciate ligament reconstruction (ACLR) present significant challenges for patients. A program that facilitates a safe return to sport (RTS) following ACLR could potentially improve outcomes. STUDY DESIGN Case Series. METHODS Sixty participants (median 20-years-old (13-36), 43 males, 18 females, median 7.5 months (4-25) post-ACLR) completed an eight-week exercise program. A battery of physical tests and patient-reported outcome measures were assessed pre and post-program. The number of participants passing RTS criteria was evaluated, and RTS rates were determined. The correlation between the ACL-RSI and measures of physical function was explored. RESULTS Improvements in all isometric strength, hop tests, running T-test, and patient reported outcome measures were seen post-program. Five (8%) participants successfully passed all RTS criteria and eighty-five percent of participants returned to their previous level of sport. The ACL-RSI and the IKDC showed correlation across all time points (pre rs = 0.49; post rs = 0.40; change r = 0.40). CONCLUSIONS Our study demonstrated improvements in all RTS criteria tests upon completing the 8-week rehabilitation program; however, few participants (8%) passed all RTS criteria. Psychological readiness is more closely related to patient-reported function than functional tests.
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Affiliation(s)
- Adam Walker
- Bond Institute of Health and Sport, Bond University, Gold Coast, Australia; Gold Coast Knee Group, Gold Coast, Australia.
| | - Larissa Sattler
- Bond Institute of Health and Sport, Bond University, Gold Coast, Australia; Gold Coast Knee Group, Gold Coast, Australia
| | - Samuel Heyward
- Bond Institute of Health and Sport, Bond University, Gold Coast, Australia
| | - Jordan Tedesco
- Bond Institute of Health and Sport, Bond University, Gold Coast, Australia
| | - Zachariah Jones
- Bond Institute of Health and Sport, Bond University, Gold Coast, Australia
| | - Corey D'Lima
- Bond Institute of Health and Sport, Bond University, Gold Coast, Australia
| | - Caroline Higham
- Bond Institute of Health and Sport, Bond University, Gold Coast, Australia
| | - Sophie Cuthbert
- Bond Institute of Health and Sport, Bond University, Gold Coast, Australia
| | - Wayne Hing
- Bond Institute of Health and Sport, Bond University, Gold Coast, Australia
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Torre G, Vasta S, Rocchi J, Papalia R, Paolo Mariani P. Autograft Choice and Jumping Performance After Anterior Cruciate Ligament Reconstruction: A Comparative Study on Professional Athletes. Orthop J Sports Med 2024; 12:23259671241278690. [PMID: 39479182 PMCID: PMC11523165 DOI: 10.1177/23259671241278690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 04/04/2024] [Indexed: 11/02/2024] Open
Abstract
Background The extensor apparatus of the knee is of paramount importance in generating the torque needed for a countermovement jump (CMJ), especially in jumping athletes. In anterior cruciate ligament reconstruction (ACLR) procedures, graft harvesting from the extensor apparatus may dramatically affect extensor strength and jumping performance. Hypothesis The focused jump training of professional jumping athletes would increase the likelihood of restoring jumping performance after ACLR, despite the graft choice (autologous bone-patellar tendon-bone [BPTB] or hamstring [HS] tendon). Study Design Cohort study; Level of evidence, 3. Methods A retrospective evaluation of prospectively collected data was carried out. Only professional athletes were included, and all surgical procedures were performed by a single experienced surgeon. Data collection considered the type of surgery, sports activity, and functional evaluation at 3 months after surgery. From the functional evaluation, data on single-leg hop (SLH) test, triple hop (TH) test, and CMJ were extracted. Limb symmetry index (LSI) for maximal voluntary isometric contraction of the quadriceps and for each of the jumping tests was calculated. Multiple analysis of covariance (ANCOVA) models were used to assess mean differences among groups for the LSI in CMJ, SLH, and TH and estimate the effect of confounders. Results From a subsequent series of 208 athletes, 44 professional athletes were included for data collection. Of these, 26 were male and 18 were female. A jumping sport (basketball, volleyball) was played by 17 athletes, while a running sport (soccer, judo, rugby, tennis, ski) was performed by 27 athletes. The mean time from injury to surgery was 17.8 ± 14.5 days. At 90 days from surgery, the overall mean LSI for CMJ was 85.3% ± 8.9%, for SLH was 92.2% ± 6.4%, and for TH was 90.8% ± 6.1%. When ANCOVA was fitted using the interaction term with BPTB autograft and jumping sport, a nonsignificant effect on LSI for CMJ (P = .56), SLH (P = .72), and TH (P = .98) was observed. Conclusion The results of the present investigation on professional athletes showed that no difference occurred within the study cohort in overall jumping performance between jumping and running athletes undergoing ACLR either with BPTB or with HS tendon grafts. Although some evidence suggests that quadriceps strength may be dramatically affected by the harvesting of BPTB, the overall performance of the jump was not compromised.
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Affiliation(s)
- Guglielmo Torre
- Villa Stuart Sport Clinic, FIFA Medical Centre of Excellence, Rome, Italy
- Foro Italico University, Rome, Italy
| | - Sebastiano Vasta
- Foro Italico University, Rome, Italy
- Campus Bio-Medico University of Rome, Rome, Italy
| | - Jacopo Rocchi
- Villa Stuart Sport Clinic, FIFA Medical Centre of Excellence, Rome, Italy
| | | | - Pier Paolo Mariani
- Villa Stuart Sport Clinic, FIFA Medical Centre of Excellence, Rome, Italy
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Brown CL, Worts PR, Dewig DR, Rolle GA, Ormsbee MJ. Return to Play After an Anterior Cruciate Ligament Reconstruction in the Collegiate Athlete: A Systematic Review Evaluating Return to Play Proportions and Associated Factors. J Orthop Sports Phys Ther 2024; 54:625-633. [PMID: 39348216 DOI: 10.2519/jospt.2024.12483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/02/2024]
Abstract
OBJECTIVE: To estimate anterior cruciate ligament reconstruction (ACLR) return-to-play (RTP) factors and proportions across all National Collegiate Athletics Association (NCAA) sports. DESIGN: Systematic review with prognosis and etiology components. LITERATURE SEARCH: Two independent reviewers searched PubMed, Cochrane Library, and Embase databases using terms related to RTP, ACLR, and NCAA for articles published up to June 30, 2023. STUDY SELECTION CRITERIA: Articles were included if RTP proportions or factors affecting RTP were reported and if the study population included NCAA collegiate athletes recovering from an ACLR. DATA SYNTHESIS: The proportion represents the total number of athletes who returned to play after ACLR over the total number of ACLR athletes from each cohort. The cumulative proportion represents the aggregated total from each included study. When eligibility information was available (ie, athletes in their final year of eligibility), RTP proportions were adjusted. The Newcastle-Ottawa Scale (NOS) was used to assess the study quality and scored by 2 raters. RESULTS: Nine studies were included. RTP criteria varied across the studies. Proportions of RTP ranged from 69% to 92%, with a cumulative RTP proportion after ACLR of 84% (628/745). The primary factors associated with the proportion of RTP were scholarship status, competitive eligibility remaining, depth chart position, and surgical graft type. CONCLUSIONS: The cumulative proportion of RTP was 84% and was associated with patient-specific and operative factors. Psychological and functional factors were not routinely reported, and rehabilitation protocols were unknown. Data were not explicitly available for any athletes outside of Division I. The criteria for RTP after ACLR varied. J Orthop Sports Phys Ther 2024;54(10):1-9. Epub 10 September 2024. https://doi.org/10.2519/jospt.2024.12483.
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Rips L, Koovit T, Luik M, Saar H, Kuik R, Kartus JT, Rahu M. In the medium term, more than half of males report kinesiophobia after anterior cruciate ligament reconstruction. J ISAKOS 2024; 9:100309. [PMID: 39159822 DOI: 10.1016/j.jisako.2024.100309] [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: 12/12/2023] [Revised: 08/01/2024] [Accepted: 08/10/2024] [Indexed: 08/21/2024]
Abstract
OBJECTIVES Anterior cruciate ligament rupture is a serious trauma with long-term consequences for the patient. Psychological and physiological factors may negatively affect patient recovery after anterior cruciate ligament reconstruction (ACLR), and development of kinesiophobia is possible. The aim of this study was to examine the presence of kinesiophobia and lower-leg muscle strength recovery in both sexes after ACLR. METHODS 140 ACLR patients agreed to participate in the study. Kinesiophobia was assessed using the Tampa Scale of Kinesiophobia (TSK). The Knee injury and Osteoarthritis Outcome Score (KOOS), Oxford Knee Score (OKS) and Tegner Activity Scale (TAS) were used for patient-related outcome measurements. In both legs quadriceps and hamstring muscle strength at 60°/s and 180°/s were measured with an isokinetic dynamometer. For dynamic balance and leg function, the Y-balance test and single-leg hop test were used. RESULTS 100 (71%) males and 40 (29%) females-mean age 32.5 (±8.3)-were examined 5.5 (±1.25) years after ACLR. 68/140 patients (48.6%) reported a TSK kinesiophobia score equal to or higher than 37 points: 54/100 (54%) males and 14/40 (35%) females (p = 0.04). Patients with kinesiophobia had significantly lower KOOS values (p < 0.001). In terms of the TAS no significant differences were found between those with or without kinesiophobia. Knee strength deficiency at 180°/sec and 60°/sec was significantly higher in the kinesiophobia group in knee extension in males (p = 0.009) and knee flexion in females (p = 0.001). Normalized body weight isokinetic average peak torque strength tests were significantly better in males compared to females in both groups (p < 0.001). CONCLUSION Both sexes reported high rates of kinesiophobia, but males are at higher risk of developing kinesiophobia than females in the medium term after ACLR. Furthermore, patients with kinesiophobia have significantly lower total KOOS scores, and females were significantly weaker than males in knee flexion and extension according to normalized body weight muscle strength tests. Also, a longer time from injury to surgery increases the risk of kinesiophobia in females. LEVEL OF EVIDENCE Level IV. TYPE OF STUDY Retrospective case series study. CLINICAL TRIAL REGISTRATION Trial registration in ClinicalTrials.gov. Identifier: NCT05762809.
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Affiliation(s)
- Leho Rips
- Sports Medicine and Rehabilitation Clinic, Tartu University Hospital, Puusepa 1(a), 50406 Tartu, Estonia; Department of Sports Medicine and Rehabilitation, Institute of Clinical Medicine, Faculty of Medicine, University of Tartu, Ülikooli 8, 50090 Tartu, Estonia.
| | - Tauno Koovit
- Sports Medicine and Rehabilitation Clinic, Tartu University Hospital, Puusepa 1(a), 50406 Tartu, Estonia
| | - Mihkel Luik
- Sports Medicine and Rehabilitation Clinic, Tartu University Hospital, Puusepa 1(a), 50406 Tartu, Estonia
| | - Helena Saar
- Sports Medicine and Rehabilitation Clinic, Tartu University Hospital, Puusepa 1(a), 50406 Tartu, Estonia
| | - Rein Kuik
- Sports Medicine and Rehabilitation Clinic, Tartu University Hospital, Puusepa 1(a), 50406 Tartu, Estonia
| | - Jüri-Toomas Kartus
- Sports Medicine and Rehabilitation Clinic, Tartu University Hospital, Puusepa 1(a), 50406 Tartu, Estonia; Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Box 100, 405 30, Gothenburg, Sweden
| | - Madis Rahu
- Sports Medicine and Rehabilitation Clinic, Tartu University Hospital, Puusepa 1(a), 50406 Tartu, Estonia; Department of Sports Medicine and Rehabilitation, Institute of Clinical Medicine, Faculty of Medicine, University of Tartu, Ülikooli 8, 50090 Tartu, Estonia
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