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Dauty M, Geffroy L, Chalopin A, Menu P, Grondin J, Hirardot T, Crenn V, Fouasson-Chailloux A. Quadriceps muscle strength of adolescents recovers faster than those of adults after anterior cruciate ligament reconstruction using hamstring graft. J ISAKOS 2025; 12:100901. [PMID: 40360132 DOI: 10.1016/j.jisako.2025.100901] [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: 02/10/2025] [Revised: 04/11/2025] [Accepted: 05/07/2025] [Indexed: 05/15/2025]
Abstract
OBJECTIVES Knee muscle strength recovery after anterior cruciate ligament reconstruction is usually evaluated using isokinetic limb symmetry index to help take the decision to allow return to the previous sport. However, the role of age on knee strength recovery is not well known. So, we aimed to compare the isokinetic knee muscle strength recovery according to age at 4 and 7 months after anterior cruciate ligament reconstruction using hamstring graft. METHODS From a historical cohort (2018-2023) of patients who completed isokinetic monitoring at 4 and 7 months after anterior cruciate ligament reconstruction using hamstring graft, two groups were compared according to age: ≤19 and > 20 years old. The quadriceps and hamstring limb symmetry indexes were studied as the main parameters. A multivariate analysis was realized to assess the weight of potential inter-subject explanatory parameters on knee strength evolution. RESULTS Two hundred fifty-three adolescents were compared with 247 adults. The adolescent quadriceps symmetry index at 60°/s was significantly higher than that of adults (79% vs 72% and 88% vs 82% at 4 and 7 months of follow-up, respectively). The hamstring symmetry index was not statistically significantly different. No inter-subject explanatory parameters were found after the multivariate analysis. CONCLUSION Knee strength recovers faster in adolescents than in adults after anterior cruciate ligament reconstruction using hamstring graft. This result should be carefully considered because adolescents could be exposed to return to sport too early, while the risk of graft rupture is still high, if strength cutoff is only considered. LEVEL EVIDENCE III.
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Affiliation(s)
- Marc Dauty
- Nantes Université, Médecine Physique et Réadaptation Locomotrice et Respiratoire, Médecine du sport, CHU Nantes, 44093 Nantes, France; Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, ONIRIS, Nantes Université, 44042 Nantes, France; Institut Régional de Médecine du Sport (IRMS) des Pays de Loire, 44093 Nantes, France
| | - Loïc Geffroy
- Nantes Université, Médecine Physique et Réadaptation Locomotrice et Respiratoire, Médecine du sport, CHU Nantes, 44093 Nantes, France; Santé Atlantique, Chirurgie Orthopédie Pédiatrique, Avenue Claude Bernard, 44800 Saint-Herblain, France
| | - Antoine Chalopin
- Nantes Université, Chirurgie Infantile, CHU Nantes, 44093 Nantes, France
| | - Pierre Menu
- Nantes Université, Médecine Physique et Réadaptation Locomotrice et Respiratoire, Médecine du sport, CHU Nantes, 44093 Nantes, France; Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, ONIRIS, Nantes Université, 44042 Nantes, France; Institut Régional de Médecine du Sport (IRMS) des Pays de Loire, 44093 Nantes, France
| | - Jérôme Grondin
- Nantes Université, Médecine Physique et Réadaptation Locomotrice et Respiratoire, Médecine du sport, CHU Nantes, 44093 Nantes, France; Institut Régional de Médecine du Sport (IRMS) des Pays de Loire, 44093 Nantes, France
| | - Thomas Hirardot
- Nantes Université, Médecine Physique et Réadaptation Locomotrice et Respiratoire, Médecine du sport, CHU Nantes, 44093 Nantes, France; Institut Régional de Médecine du Sport (IRMS) des Pays de Loire, 44093 Nantes, France
| | - Vincent Crenn
- Nantes Université, Clinique Chirurgicale Orthopédique et Traumatologique, CHU Nantes, 44093 Nantes, France
| | - Alban Fouasson-Chailloux
- Nantes Université, Médecine Physique et Réadaptation Locomotrice et Respiratoire, Médecine du sport, CHU Nantes, 44093 Nantes, France; Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, ONIRIS, Nantes Université, 44042 Nantes, France; Institut Régional de Médecine du Sport (IRMS) des Pays de Loire, 44093 Nantes, France.
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Yildiz M. Bibliometric Analysis of Studies on The Rehabilitation of Disabled Athletes Through Visual Mapping. J Sport Rehabil 2025; 34:387-395. [PMID: 39591961 DOI: 10.1123/jsr.2024-0112] [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: 03/18/2024] [Revised: 07/07/2024] [Accepted: 09/02/2024] [Indexed: 11/28/2024]
Abstract
CONTEXT The rehabilitation of disabled athletes is a critical area of research aimed at improving athletes' performance and well-being. This bibliometric analysis examines scientific studies related to the rehabilitation of disabled athletes, focusing on trends, authors, publications and interdisciplinary collaborations. OBJECTIVE This study seeks to provide quantitative and qualitative insights into the trends, interdisciplinary collaborations, and significant contributions in the rehabilitation of disabled athletes. DESIGN Bibliometric analysis of 660 scientific publications related to the rehabilitation of disabled athletes, from 1975 to 2023. SETTING The analysis reveals that research in this field is multidisciplinary, encompassing sports, medicine, rehabilitation and education. Studies focused on disabled athletes and their rehabilitation. INTERVENTION Rehabilitation plays a vital role in disabled athletes' lives, aiding in injury recovery and enhancing overall health and performance. RESULTS The United States leads in research output. Collaborative networks among authors are evident, indicating joint research efforts. Identification of research trends, prominent authors Bartosz Molik and Natalia Morgulec-Adamowicz), collaborative networks and common keywords (e.g., adaptive sports, disability, rehabilitation). Keywords such as adaptive sports, disability and rehabilitation are frequently mentioned, reflecting the focus of research. CONCLUSIONS The rehabilitation of disabled athletes is a growing field with significant contributions from researchers worldwide. Collaborative efforts and interdisciplinary approaches are essential for advancing knowledge and improving the lives of disabled athletes.
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Affiliation(s)
- Muhammed Yildiz
- Vocational School of Health Services, Artvin Çoruh University, Artvin, Turkey
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Mengis N, Höher J, Ellermann A, Eberle C, Hartner C, Keller M, Rippke JN, Sprenger N, Stein T, Stoffels T, Egloff C, Niederer D. A Guideline for Validated Return-to-Sport Testing in Everyday Clinical Practice: A Focused Review on the Validity, Reliability, and Feasibility of Tests Estimating the Risk of Reinjury After ACL Reconstruction. Orthop J Sports Med 2025; 13:23259671251317208. [PMID: 40342351 PMCID: PMC12056336 DOI: 10.1177/23259671251317208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Accepted: 06/24/2024] [Indexed: 05/11/2025] Open
Abstract
Background Information derived from functional return-to-sport (RTS) tests after primary anterior cruciate ligament (ACL) reconstruction (ACLR) can have a significant impact on the risk reduction of ACL reruptures. However, due to space, time, and financial limitations, few clinicians utilize objective data to assess their patients' functional abilities after ACLR. Purpose To identify validated and feasible RTS tests that could reliably estimate the risk of reinjury after ACLR in everyday clinical practice beyond the highly sophisticated laboratory setting. Study Design Systematic review; Level of evidence, 4. Methods A focused review was performed by experts of the committees for Ligament Injuries and Prevention/Rehabilitation of the German Knee Society. RTS functional tests, their reinjury prognostic values (if known), their reliabilities, and their implementation capacities were extracted from the original studies on the described RTS test setup, as well as from studies on potential test alternatives. These alternatives were required to be less resource-consuming yet still validated and thus able to be implemented into everyday practice. All tests were categorized according to their relevant target objective: isokinetic or isometric strength, functional (hopping and jumping) ability, or self-reported readiness. Results In the final analysis, 19 studies involving 7513 patients were included. From these, a total of 21 RTS tests were retrieved, and 13 tests were included. For strength testing, 2 dynamic tests and 1 static test were found to be eligible. Functional ability was represented by 8 different jump, hop, and agility tests. Tests for self-reported readiness included the ACL-Return to Sport after Injury scale and the Knee injury and Osteoarthritis Outcome Score Sport and Recreation subscore. Alternative tests included the 8-repetition maximum test, handheld/portable dynamometer, single-leg vertical (countermovement) hop with inertial sensor or smartphone app, and the drop jump with knee displacement or normalized knee distance measurement. Conclusion For most of the strength and functional abilities assessed by RTS tests, validated and less resource-consuming alternatives do exist. Therapists and clinicians working in nonlaboratory settings may find it helpful to select from a menu of established RTS tests and test alternatives for each relevant target objective, depending on their individual requirements.
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Affiliation(s)
- Natalie Mengis
- Department of Sports Medicine, ARCUS Kliniken, Pforzheim, Baden-Württemberg, Germany
- University Department of Orthopedic Surgery and Traumatology, Kantonsspital Baselland, Bruderholz, Switzerland
- Department of Clinical Research, Research Group Michael T. Hirschmann, Regenerative Medicine & Bio-mechanics, University of Basel, Basel, Switzerland
| | | | - Andree Ellermann
- Department of Sports Medicine, ARCUS Kliniken, Pforzheim, Baden-Württemberg, Germany
| | - Christian Eberle
- Department of Sports Medicine, ARCUS Kliniken, Pforzheim, Baden-Württemberg, Germany
| | - Christian Hartner
- rehamed Therapie und Prävention in Pforzheim GmbH, Pforzheim, Germany
| | | | - Jules-Nikolaus Rippke
- Department of Sports Medicine, ARCUS Kliniken, Pforzheim, Baden-Württemberg, Germany
- University Department of Orthopedic Surgery and Traumatology, Kantonsspital Baselland, Bruderholz, Switzerland
- Department of Clinical Research, Research Group Michael T. Hirschmann, Regenerative Medicine & Bio-mechanics, University of Basel, Basel, Switzerland
| | | | - Thomas Stein
- SPORTHOLOGICUM Frankfurt am Main, Frankfurt am Main, Germany
| | | | - Christian Egloff
- Department of Orthopedic and Trauma Surgery, University Hospital, Basel, Switzerland
| | - Daniel Niederer
- Department of Sports Medicine and Exercise Physiology, Institute of Occupational, Social and Environmental Medicine, Goethe University Frankfurt, Frankfurt am Main, Germany
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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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Abuljadail S, Albotuaiba AO, Almarri AS, Alhamam AK, Almulhim AK. Return to Sport Following Anterior Cruciate Ligament Reconstruction: A Cross-Sectional Study in Saudi Arabia. Cureus 2025; 17:e82965. [PMID: 40416260 PMCID: PMC12103728 DOI: 10.7759/cureus.82965] [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] [Accepted: 04/24/2025] [Indexed: 05/27/2025] Open
Abstract
Introduction The anterior cruciate ligament (ACL) is essential for knee stability, and its injury significantly impacts athletic performance. Anterior cruciate ligament reconstruction (ACLR) is the standard treatment for active individuals, yet many fail to return to sport (RTS) due to factors like pain and kinesiophobia. This study explores these barriers in the Saudi Arabian population. Methodology This is a cross-sectional study using an online questionnaire targeting ACLR patients across five Saudi hospitals between 2017 and 2023. Tools included are the International Knee Documentation Committee's (IKDC) scale and the Tampa Scale for Kinesiophobia (TSK-11) score. Data was analyzed using IBM SPSS Statistics software, version 29.0.0 (IBM Corp., Armonk, NY). Results Our study included 84 participants undergoing ACL reconstruction. Most were aged between 18 and 25 years (n=35, 41.7%), male (n=75, 89.3%), and employed (n=65, 77.4%). Only 44.0% (n=37) returned to their pre-injury level of sport. Moderate fear of re-injury was common (n=67, 79.8%), and fear significantly correlated with lower IKDC scores (r = -0.410, p < 0.001). Participants with minimal fear had the highest IKDC score (81.01 ± 9.47, p < 0.001). Functional limitation was significantly associated with RTS (p < 0.001); none with moderate/severe limitations returned. Lower pain scores (1.77 vs. 4.35, p = 0.005), lower TSK-11 scores (15.77 vs. 22.90, p < 0.001), and higher knee function (81.01 vs. 63.02, p < 0.001) were significantly linked to RTS. Height > 180 cm was also significantly associated with RTS (p = 0.011). Conclusion Our findings show that returning to sport after ACLR is strongly influenced by functional ability, pain severity, and fear of re-injury. Psychological readiness, particularly kinesiophobia, plays a critical role. Addressing both physical limitations and mental barriers is essential to improve RTS outcomes in post-ACLR patients.
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Affiliation(s)
| | | | - Ali S Almarri
- College of Medicine, King Faisal University, Al Ahsa, SAU
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Alanazi R, Kashoo FZ, Alrashdi N, Alanazi S, Shaik AR, Sirajudeen MS, Alenazi A, Nambi G, Dover G, Alanazi AD. Cultural Adaptation and Validation of the Athlete Fear-Avoidance Questionnaire in Arabic: Preliminary Analysis of Fear-Avoidance in ACL-Reconstructed Recreational Players. Orthop J Sports Med 2025; 13:23259671251322776. [PMID: 40190690 PMCID: PMC11970100 DOI: 10.1177/23259671251322776] [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: 09/18/2024] [Accepted: 10/24/2024] [Indexed: 04/09/2025] Open
Abstract
Background The Athlete Fear-Avoidance Questionnaire (AFAQ) is a validated instrument that measures athletes' fear and avoidance behaviors after an injury, particularly regarding their sporting activities. Purpose This study aimed to adapt and validate the AFAQ for Arabic-speaking recreational players (AFAQ-Arabic) after anterior cruciate ligament reconstruction (ACLR). Study Design Cohort study; level of evidence: 3. Methods The AFAQ underwent translation and cross-cultural adaptation according to the Beaton guidelines. A total of 104 male recreational players who had undergone ACLR completed the AFAQ-Arabic, the Fear-Avoidance Belief Questionnaire (FABQ), and the Numerical Pain Scale (NPS). To assess test-retest reliability, a subset of 38 recreational players were asked to complete the AFAQ-Arabic twice, 1 week apart. Statistical tests were conducted to test the internal consistency, reliability, and convergent validity of the AFAQ-Arabic. Results The AFAQ-Arabic demonstrated high internal consistency (Cronbach alpha, 0.854) and excellent test-retest reliability (intraclass correlation coefficient, 0.885) (95% CI, 0.784-0.942; P < .001). Minimal floor (4.8% scoring the minimum) and ceiling effects (1% scoring the maximum) were observed. Convergent validity showed significant positive weak correlations between the AFAQ-Arabic and (1) the FABQ-Physical Activity (r = 0.340; P < .01), (2) the FABQ-Work (r = 0.272; P < .01), and (3) the NPS (r = 0.383; P < .01). Cross-cultural adaptation of the AFAQ-Arabic revealed linguistic and cultural relevance. Conclusion Our study demonstrated that the AFAQ-Arabic was a reliable and valid tool for assessing fear avoidance in Arabic-speaking recreational players after ACLR. Future studies are needed to measure athlete fear-avoidance in injured Arabic-speaking athletes to understand its psychological aspects in rehabilitation and potentially aid in tailored interventions for improving outcomes.
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Affiliation(s)
- Rami Alanazi
- Department of Physical Therapy and Rehabilitation, King Khaled Hospital, Al-Majma’ah, Saudi Arabia
| | - Faizan Zaffar Kashoo
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, AL-Majmaah, Saudi Arabia
| | - Naif Alrashdi
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, AL-Majmaah, Saudi Arabia
| | - Sultan Alanazi
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, AL-Majmaah, Saudi Arabia
| | - Abdul Rahim Shaik
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, AL-Majmaah, Saudi Arabia
| | - Mohamed Sherif Sirajudeen
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, AL-Majmaah, Saudi Arabia
| | - Aqeel Alenazi
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al Kharj, Saudi Arabia
| | - Gopal Nambi
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al Kharj, Saudi Arabia
| | - Geoffrey Dover
- Department of Exercise Science, Concordia University, Montreal, Quebec, Canada
| | - Ahmad Dhahawi Alanazi
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, AL-Majmaah, Saudi Arabia
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Mesnard G, Fournier G, Cance N, Magnussen RA, Lustig S, Servien E. Isokinetic Testing After Anterior Cruciate Ligament Injury Showed a Greater Hamstrings/Quadriceps Ratio at 240°/S Over 6 Months From Injury but No Difference of Limb Symmetry Index. Arthrosc Sports Med Rehabil 2025; 7:101063. [PMID: 40297093 PMCID: PMC12034048 DOI: 10.1016/j.asmr.2024.101063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2024] [Accepted: 12/01/2024] [Indexed: 04/30/2025] Open
Abstract
Purpose To assess preoperative quadriceps and hamstring strength at various time points after anterior cruciate ligament (ACL) injury but before ACL reconstruction. Methods Patients who underwent isokinetic muscle strength testing before planned ACL reconstruction were included. Patients were placed in 1 of the following 3 groups on the basis of time from injury to testing: <3 months, 3 to 6 months, and 6 to 12 months. Among these 3 groups, hamstring and quadriceps limb symmetry index (LSI) and hamstring/quadriceps (H/Q) ratios were compared. A total of 100 patients were included (<3 months [n = 55]; 3-6 months [n = 31]; and 6-12 months [n = 14]). Results There were no significant differences between patients in the 3 groups in regards to age, body mass index, or flexion range of motion, but there was a greater proportion of female patients in the 6 to 12 month group than the other groups. No significant differences in quadriceps or hamstring strength were noted among the 3 groups. H/Q ratio was significantly greater in the 6 to 12 month group than the less than 3 months and 3 to 6 months groups, with concentric testing at 240°/s. No correlation was found between patient sex and LSI or H/Q ratios. Conclusions Patients who underwent isokinetic muscle strength testing 6 to 12 months after ACL injury had a greater H/Q ratio at 240°/s than those who were testing within 6 months of injury. No differences in hamstring or quadriceps LSI were noted on the basis of time. Clinical Relevance An understanding of the factors that influence preoperative isokinetic muscle strength testing (including time from injury to surgery) is important, given associations noted between preoperative strength and postoperative strength recovery after ACL reconstruction.
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Affiliation(s)
- Guillaume Mesnard
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
| | - Gaspard Fournier
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
| | - Nicolas Cance
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
| | - Robert A. Magnussen
- Department of Orthopaedics, The Ohio State University, Columbus, Ohio, U.S.A
- OSU Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio, U.S.A
| | - Sébastien Lustig
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
- Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, F69622, Lyon, France
| | - Elvire Servien
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
- LIBM - EA 7424, Interuniversity Laboratory of Biology of Mobility, Claude Bernard Lyon 1 University, Lyon, France
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Abdelraouf OR, Abdel-Aziem AA, Alkhamees NH, Ibrahim ZM, Elhosiny MA, Ibrahim SE, Elborady AA. The Arabic Version of Injury-Psychological Readiness to Return to Sport Scale: Translation and Psychometric Validation. MEDICINA (KAUNAS, LITHUANIA) 2025; 61:506. [PMID: 40142317 PMCID: PMC11943973 DOI: 10.3390/medicina61030506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/31/2024] [Revised: 02/27/2025] [Accepted: 03/13/2025] [Indexed: 03/28/2025]
Abstract
Background and Objectives: It is crucial to consider not only the physical variables but also the athlete's psychological condition prior to making the decision to return to sport (RTS). It is unfortunate that there is currently no universal questionnaire available in Arabic to determine whether an athlete is ready to return to sports. So, this cross-cultural validation study was carried out to translate and validate the Injury-Psychological Readiness to Return to Sport Scale (I-PRRS) into the Arabic language. Materials and Methods: One hundred twenty athletes with lower extremity injuries (95 males and 25 females) completed the Arabic I-PRRS twice with a one-week time interval. An additional 50 athletes, comprising 40 males and 10 females, also participated in the study by completing the questionnaire during their initial visit to a physical therapist. Floor and ceiling effects, internal consistency, reliability, discriminate validity, convergent validity, and factor construct were analyzed. Results: The I-PRRS was translated into Arabic with no floor or ceiling effects. It had good internal consistency (0.84) and excellent test-retest reliability (ICC 0.88, 95% CI 0.73-0.95) where the lower bound of 95% CI indicated at least good reliability. The SEM was 1.14, and the MDC was 3.27 points. Athletes who were cleared to RTS demonstrated significant differences in their responses compared with those who were visiting their physical therapist for the first time. These differences were significant across all individual items, as well as in the total scores of the assessment (p < 0.001). There was a significant moderate correlation between overall scores on the I-PRRS and the Tampa Scale of Kinesiophobia (TSK) (rs = 0.69, p < 0.05). Conclusions: The Arabic version of the I-PRRS demonstrated good reliability and validity, making it a suitable tool for evaluating psychological readiness to RTS among injured athletes in Arabic-speaking populations.
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Affiliation(s)
- Osama R. Abdelraouf
- Physical Therapy Program, Batterjee Medical College, Jeddah 21442, Saudi Arabia;
| | - Amr A. Abdel-Aziem
- Department of Biomechanics, Faculty of Physical Therapy, Cairo University, Giza 12611, Egypt; (A.A.A.-A.); (A.A.E.)
- Department of Physical Therapy, College of Applied Medical Science, Taif University, Taif 21944, Saudi Arabia
| | - Nouf H. Alkhamees
- Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia; (N.H.A.); (Z.M.I.)
| | - Zizi M. Ibrahim
- Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia; (N.H.A.); (Z.M.I.)
| | - Mohamed A. Elhosiny
- Physical Therapy Program, Batterjee Medical College, Jeddah 21442, Saudi Arabia;
| | - Shaza E. Ibrahim
- Physical Therapy Department, Saudi German Hospital, Jeddah 21461, Saudi Arabia;
| | - Amal A. Elborady
- Department of Biomechanics, Faculty of Physical Therapy, Cairo University, Giza 12611, Egypt; (A.A.A.-A.); (A.A.E.)
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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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Dwyer T, Gordey E, Ajrawat P, Lameire DL, Theodoropoulos J, Ogilvie-Harris D, Faulkner G, Sabiston C, Chahal J. Accelerometer-Assisted Physical Activity Outcomes During the First Year of Recovery After Anterior Cruciate Ligament Reconstruction: A Prospective Cohort Pilot Study. Orthopedics 2025; 48:e62-e68. [PMID: 39879626 DOI: 10.3928/01477447-20250123-02] [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: 01/31/2025]
Abstract
BACKGROUND Wearable activity-measurement devices are increasingly popular among the public, but there is little information regarding their use among patients undergoing sports medicine procedures. The purpose of this study was to compare accelerometer-measured data with traditional patient-reported measures and to determine the trajectory of physical activity from before surgery to 1 year after anterior cruciate ligament reconstruction. MATERIALS AND METHODS Adult patients undergoing primary anterior cruciate ligament reconstruction were enrolled in this prospective cohort pilot study. The Tegner activity scale, Marx activity scale, International Physical Activity Questionnaire Short Form (IPAQ-SF), Knee injury and Osteoarthritis Outcome Score (KOOS), and EuroQoL-5D were administered preoperatively and 3, 6, and 12 months postoperatively. At these intervals, each patient was asked to wear an accelerometer for 7 consecutive days. Time spent in moderate-to-vigorous physical activity (MVPA min/wk), metabolic equivalents of physical activity, and average daily steps were calculated from the accelerometer output and correlated with patient-reported measures. RESULTS Twenty-eight patients were included in this study. Of the 28 patients, 20 remained, and at the 12-month analysis, 18 patients were analyzed. There were significant improvements in Tegner activity scale score, KOOS symptoms, sports/recreation, and quality of life subscales, and IPAQSF MVPA min/wk at final follow-up. All accelerometer-based outcomes had improvements at 3, 6, and 12 months. CONCLUSION The accelerometer may be a useful tool for understanding patients' activity levels at different time points during their recovery and for providing tangible targets for patients to achieve at least an average recovery. [Orthopedics. 2025;48(2):e62-e68.].
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11
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Park SB, Lee YS. Anterior Cruciate Ligament Allograft Reconstruction in Females Can Produce Outcomes Comparable to Those of Autografts in Male Counterparts. J Knee Surg 2025; 38:170-179. [PMID: 39448053 DOI: 10.1055/a-2451-6685] [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: 10/26/2024]
Abstract
There are unique anatomical and geometric risk factors that contribute to higher injury rates of the anterior cruciate ligament (ACL) in women. Allografts are an important alternative option for female patients.Patients who underwent primary ACL reconstruction were retrospectively evaluated. The case group comprised female patients with ACL allograft reconstruction, and the control group comprised male patients with ACL reconstruction. Functional and clinical evaluations were based on the pre- and postoperative Cybex test, Lysholm score, International Knee Documentation Committee subjective and objective measurement criteria, and Tegner Activity Scale questionnaires. Radiological comparisons were performed using the femorotibial angle (FTA), posterior tibial slope (PTS), and intercondylar notch width (INW). The roof inclination angle (RIA) was assessed using magnetic resonance imaging.The two groups (female [44] and male [88]) had an average follow-up period of 57.9 ± 19.3 months and average ages of 36.5 ± 10.9 and 35.2 ± 11.7 years, respectively. Functional and clinical outcomes showed no differences between the groups, except that the return to the preinjury activity level was higher in the female group (95% vs. 77%, p < 0.001). The female group showed larger FTA and PTS and smaller INW and RIA than those of the male group (p < 0.001, 0.008, <0.001, and 0.035, respectively).Female ACL allograft reconstruction showed comparable outcomes to those of their male counterparts, and the return to preinjury activity levels was significantly higher in women. However, women showed lower activity levels and were more vulnerable to geometric risk factors than their male counterparts.
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Affiliation(s)
- Sung Bae Park
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Yong Seuk Lee
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
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12
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Lisee C, Baez S, Bjornsen E, Thoma L, Blackburn T, Spang JT, Creighton RA, Kamath G, Hu J, Pietrosimone B. Investigating the Impact of Preoperative Kinesiophobia and Pain on Postoperative Gait Biomechanics Following Anterior Cruciate Ligament Injury. Orthop J Sports Med 2025; 13:23259671241301376. [PMID: 40034608 PMCID: PMC11872735 DOI: 10.1177/23259671241301376] [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: 03/26/2024] [Accepted: 05/06/2024] [Indexed: 03/05/2025] Open
Abstract
Background Aberrant gait biomechanics-ie, lower knee abduction moment (KAM) impulse- are linked to the development of posttraumatic osteoarthritis after anterior cruciate ligament (ACL) injury and ACL reconstruction (ACLR). There is a clinical need to identify modifiable factors, such as kinesiophobia and pain, that may contribute to aberrant gait development after ACLR to advance multimodal rehabilitation strategies. Purpose/Hypothesis This study aimed to determine associations between preoperative kinesiophobia and pain and gait biomechanics linked to posttraumatic osteoarthritis development at 2 and 4 months after ACLR. We hypothesized that worse preoperative kinesiophobia and pain would be associated with lower KAM impulses in the ACLR limb but not the uninjured limb at 2 and 4 months after ACLR. Study Design Cohort study; Level of evidence, 2. Methods Patients within 6 weeks of ACL injury and planning to undergo ACLR with bone-patellar tendon-bone autografts were recruited for the study. Preoperatively, participants completed the Tampa Scale of Kinesiophobia (TSK-11) and Knee injury and Osteoarthritis Outcome Score Pain (KOOS Pain) subscale surveys to assess kinesiophobia (ie, psychological component to pain) and knee pain, respectively. Participants returned at 2 and 4 months after ACLR to complete a 3-dimensional gait biomechanics analysis. KAM impulses during the stance phase were calculated (N*m*s/N*m) for both limbs. Associations of preoperative TSK-11 and KOOS Pain scores with KAM impulses in ACLR and uninjured limbs were analyzed using separate linear regressions. Results A total of 36 participants (58% women; mean age, 21.4 ± 4.31 years; body mass index, 24.1 ± 3.59 kg/m2 ) completed 3 study visits. Higher preoperative kinesiophobia was associated with lower KAM impulses in the ACLR limb (R 2 = 0.14; P = .02) but not the uninjured limb (R 2 = 0.01; P = .58) at 4 months after ACLR. Preoperative KOOS Pain scores were not associated with KAM impulses in the ACLR and uninjured limbs at 2 and 4 months after ACLR (ΔR 2 range, <0.01-0.02; P range = .53-.90). Conclusion Preoperative kinesiophobia, but not pain, was weakly associated with lower KAM impulses during early to midphases of clinical recovery at 4 months after ACLR.
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Affiliation(s)
- Caroline Lisee
- Department of Kinesiology, University of Georgia, Athens, Georgia, USA
| | - Shelby Baez
- Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Elizabeth Bjornsen
- Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Louise Thoma
- Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Troy Blackburn
- Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jeffrey T. Spang
- Department of Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - R. Alexander Creighton
- Department of Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ganesh Kamath
- Department of Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jessica Hu
- UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Brian Pietrosimone
- Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Issaoui W, Dergaa I, Ghouili H, El Omri A, Guelmami N, Chomier P, Ghrairi M, Ben Saad H, Moalla W. A comparative analysis of autograft choices of anterior cruciate ligament reconstruction and their effects on muscle strength and joint biomechanics. Front Sports Act Living 2025; 6:1444465. [PMID: 39981267 PMCID: PMC11841387 DOI: 10.3389/fspor.2024.1444465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Accepted: 12/18/2024] [Indexed: 02/22/2025] Open
Abstract
Introduction Anterior cruciate ligament reconstruction (ACLR) is crucial to restore knee stability and function after ACL injuries, especially in physically active individuals. Despite advances in surgical techniques and rehabilitation protocols, the choice of autograft has a significant impact on postoperative recovery, particularly on muscle strength and joint biomechanics. In this study, the effects of four autografts are investigated: Iliotibial band (ITB), combined ITB and hamstring tendon (ITB + HT), hamstring tendon (HT) and bone-tendon-bone (BTB) on quadriceps and hamstring peak torque (QPT and HPT) recovery and hamstring to quadriceps ratio (H:Q) to assess knee stability and function. Methods Forty-two active males (mean ± standard deviation of age: 31.5 ± 6.1 years, height: 177 ± 6 cm, weight: 76 ± 11 kg, body mass index: 24.5 ± 2.2 kg/m²) with primary ACL ruptures were allocated to the four graft groups (ITB: n = 16, ITB + HT: n = 12, HT: n = 7, BTB: n = 7) and underwent a standardized rehabilitation protocol. Quadriceps and hamstring peak torque (QPT and HPT, respectively) as indicators of isokinetic muscle strength were assessed both postoperatively and follow-up after approximately six months (mean 6.29 ± 1.70 months). Results Significant differences in QPT and HPT recovery between the healthy and injured legs were found in all graft groups (P < 0.001). The BTB group showed the largest QPT deficit between healthy and injured legs (Δ = 133.4 Nm, Cohen's d = 8.05) and HPT deficit (Δ = 41.1 Nm, Cohen's d = 4.01). In contrast, the ITB + HT group showed the smallest deficits in QPT (Δ = 22.5 Nm, Cohen's d = 0.73) and HPT (Δ = 13.5 Nm, Cohen's d = 1.21). The BTB group also showed the largest deviation in H:Q ratios (Δ = -0.23, Cohen's d = 2.70), while the HT group showed a more balanced recovery with smaller significant deficits in H:Q ratios (Δ = -0.07, Cohen's d = 0.46). Conclusion The BTB graft showed the most pronounced variations in QPT and HPT between healthy and injured legs in the short term, indicating the importance of longitudinally monitoring knee stability to determine the best autograft choice for ACLR. While all graft types contribute to muscle strength recovery, the HT graft may provide advantages in balancing muscle strength and potentially enhancing knee stability.
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Affiliation(s)
- Wiem Issaoui
- High Institute of Sport and Physical Education, University of Sfax, Sfax, Tunisia
- Health Medical Services (HMS) FIFA Medical Centre of Excellence Dubai, Dubai, United Arab, Emirates
| | - Ismail Dergaa
- Research Unit “Sport Sciences, Health and Movement”, Higher Institute of Sports and Physical Education of Kef, University of Jendouba, El Kef, Tunisia
- Department of Preventative Health, Primary Health Care Corporation (PHCC), Doha, Qatar
- Departement of Biological Sciences, High Institute of Sport and Physical Education Ksar Saïd, University of Manouba, Manouba, Tunisia
| | - Hatem Ghouili
- Research Unit “Sport Sciences, Health and Movement”, Higher Institute of Sports and Physical Education of Kef, University of Jendouba, El Kef, Tunisia
| | | | - Noomen Guelmami
- Research Unit “Sport Sciences, Health and Movement”, Higher Institute of Sports and Physical Education of Kef, University of Jendouba, El Kef, Tunisia
| | - Philippe Chomier
- Health Medical Services (HMS) FIFA Medical Centre of Excellence Dubai, Dubai, United Arab, Emirates
| | - Mourad Ghrairi
- Health Medical Services (HMS) FIFA Medical Centre of Excellence Dubai, Dubai, United Arab, Emirates
| | - Helmi Ben Saad
- Service of Physiology and Functional Explorations, Farhat Hached Hospital, University of Sousse, Sousse, Tunisia
- Research Laboratory LR12SP09 “Heart Failure”, Farhat Hached Hospital, University of Sousse, Sousse, Tunisia
- Laboratory of Physiology, Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
| | - Wassim Moalla
- High Institute of Sport and Physical Education, University of Sfax, Sfax, Tunisia
- Research Laboratory Education, Motricité, Sport et Santé (EM2S) LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
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14
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Dwyer T, Ajrawat P, Lameire DL, Betsch M, Whelan D, Shahrokhi S, Theodoropoulos J, Hoit G, Chahal J. The Minimum Patient Acceptable Symptom State for the ACL-Return to Sport after Injury Scale Among Patients Treated With Anterior Cruciate Ligament Reconstruction. Orthopedics 2025; 48:20-24. [PMID: 39312746 DOI: 10.3928/01477447-20240918-04] [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: 09/25/2024]
Abstract
BACKGROUND Despite most patients reporting optimal knee function after anterior cruciate ligament reconstruction (ACLR), not all return to their pre-injury level of sport, often due to psychological factors. The ACL-Return to Sport after Injury Scale (ACL-RSI) was developed to measure the emotions, confidence in performance, and risk appraisal among athletes returning to sport. The purpose of this study was to determine the Patient Acceptable Symptom State (PASS) threshold for the ACL-RSI in patients undergoing ACLR. MATERIALS AND METHODS Patients with an ACL injury that required surgical reconstruction were included in this prospective study. All patients underwent ACLR with a bone-patellar tendon-bone autograft and completed the ACL-RSI 12 months postoperatively. An anchor-based approach was used to generate a receiver operating characteristic curve and establish the PASS threshold. Multivariable regression analyses were used to evaluate the effect of age, sex, and baseline score on likelihood of achieving PASS. RESULTS A total of 113 patients (37% female) with a mean age of 28.1±8.2 years and a mean body mass index of 24.7±3.5 kg/m2 were included. At 12 months postoperatively, the threshold value for the PASS of the ACL-RSI was 40 (robust area under the curve: 0.89; sensitivity: 81%; specificity: 85%). Baseline score, sex, and age had no significant influence on achieving PASS at 12 months postoperatively. CONCLUSION In a group of patients undergoing ACLR with bone-patellar tendon-bone autograft, the PASS threshold value was 40 for the ACL-RSI at 12 months postoperatively. The PASS value for the ACL-RSI established from this study can be useful for designing future clinical trials. [Orthopedics. 2025;48(1):20-24.].
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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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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: 2] [Impact Index Per Article: 2.0] [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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Hållén I, Kvist J, Forssblad M, Sandon A. Return to Soccer After Anterior Cruciate Ligament Reconstruction: An Outcome or a Decision? Orthop J Sports Med 2024; 12:23259671241295834. [PMID: 39697607 PMCID: PMC11653463 DOI: 10.1177/23259671241295834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2024] [Accepted: 09/17/2024] [Indexed: 12/20/2024] Open
Abstract
Background The return-to-sports rate is often used as an outcome measure after anterior cruciate ligament (ACL) reconstruction (ACLR). Although most soccer players want to return to sports after their ACL injury, up to 40% do not believe they will return to soccer after their ACL injury. Purpose To investigate whether self-reported presurgical beliefs regarding return to soccer correspond to registered official match participation after ACLR. Study Design Cohort study; Level of evidence, 2. Methods Included were soccer players with a primary unilateral ACL injury who were ≥15 years at the time of ACLR and who had completed a presurgical question about their future sports participation beliefs. ACLR surgical data were extracted from the Swedish National Knee Ligament Registry, and game participation data were extracted from the Swedish Football Association's administrative data system. Results A total of 959 soccer players (617 [64%] male and 342 [36%] female) were included. The follow-up time after ACLR ranged from 18 months to 5.5 years. Of 720 soccer players (75%) who believed that they would return to play (RTP), 462 (64%) players actually did. Of the players who believed that they would not RTP, 181 (76%) did not. Presurgical beliefs predicted RTP (odds ratio [OR], 5.59; P < .001). Younger age at the time of ACLR favored RTP, where 61% of the players aged 15-20 years had RTP (OR, 3.85; P < .001). At the top competitive level, 84% of the players RTP compared to 14% at the recreational level. Players active at higher levels were more likely to believe that they would RTP, and they also actually did so (OR, 33.06; P < .001). Overall, 67% of players followed their presurgical intention to return to soccer. Conclusion The findings indicated that presurgical beliefs, age, and level of play helped to predict the actual RTP of soccer players after ACLR.
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Affiliation(s)
- Isabelle Hållén
- Aleris Sports Medicine and Ortopedi Sabbatsberg, Stockholm, Sweden
| | - Joanna Kvist
- Department of Health, Medicine and Caring Sciences, Division of Physiotherapy, Linköping University, Linköping, Sweden
- Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Forssblad
- Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden
| | - Alexander Sandon
- Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden
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Akbari Aghdam H, Shahrokh SG, Ahmadi O, Rostami K, Najafi MM, Sadeghian A, Hosseini Z, Anaraki KT. Evaluation of the Relative Frequency of Preinjury Activity Recovery in Anterior Cruciate Ligament Replacement Patients: A Cohort Study. Adv Biomed Res 2024; 13:117. [PMID: 39717237 PMCID: PMC11665178 DOI: 10.4103/abr.abr_281_23] [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: 08/02/2023] [Revised: 01/13/2024] [Accepted: 01/13/2024] [Indexed: 12/25/2024] Open
Abstract
Background Anterior cruciate ligament (ACL) injury has an incidence of 0.05-0.08 per thousand. An inappropriate treatment plan could lead to articular cartilage damage and early knee osteoarthritis. Some surgical reconstruction techniques use different graft types; all of them try to restore the patient's preinjury activity levels. The current study aims to evaluate the efficacy of ACL reconstruction (ACLR) using an autologous hamstring tendon. Materials and Methods This is a retrospective one-center cohort study performed on consecutive patients with an ACL injury who underwent ACLR using semitendinosus and gracilis autograft. The postsurgical activity and fear were measured using Marx scale and Tampa scale of kinesophobia, respectively, during a follow-up of 18 months. Results From a total of 76 patients included in our study, 40.8% were female. The mean age of the participants was 26.25-year-old. Five patients from those with kinesophobia (12.5%) and 34 patients from those with no-kinesophobia (94%) returned to the preinjury activity level (P value < 0.001). Marx scale six months after the surgery was significantly lower than the score before the surgery, but as expected, it improved during the 18-month follow-up. Conclusion The current study showed that kinesophobia reduces the rate of return to preinjury levels. Maybe, overcoming this fear will help these patients to reach better results. However, we suggest implementing further trials in larger sample sizes before reaching a solid conclusion.
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Affiliation(s)
- Hossein Akbari Aghdam
- Department of Orthopedic Surgery, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyedeh Ghazal Shahrokh
- Department of Orthopedic Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfehan, Iran
| | - Omid Ahmadi
- Department of Emergency Medicine, School of Medicine, Isfehan University of Medical Sciences, Isfehan, Iran
| | - Koushan Rostami
- Yazd University of Medical Sciences, School of Medicine, Yazd Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mohammad M. Najafi
- Department of Orthopedic Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfehan, Iran
| | - Amirhossein Sadeghian
- Department of Orthopedic Surgery, School of Medicine, Zabol University of Medical Sciences Sistan and Baluchestan Province, Iran
| | - Zahra Hosseini
- Department of Orthopedic Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfehan, Iran
| | - Kasra Talebi Anaraki
- Department of Orthopedic Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfehan, Iran
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García-Rodríguez P, Pecci J, Vázquez-González S, Pareja-Galeano H. Acute and Chronic Effects of Blood Flow Restriction Training in Physically Active Patients With Anterior Cruciate Ligament Reconstruction: A Systematic Review. Sports Health 2024; 16:820-828. [PMID: 37946502 PMCID: PMC11346237 DOI: 10.1177/19417381231208636] [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: 11/12/2023] Open
Abstract
CONTEXT Muscle atrophy and loss of knee function are common findings after anterior cruciate ligament (ACL) reconstruction. Rehabilitation through blood flow restriction (BFR) has gained clinical relevance when combined with low loads to improve these disorders in recent years. OBJECTIVE To evaluate the rehabilitation effectiveness of ACL reconstruction with the use of BFR on pain, functionality, strength, and muscle mass in physically active people. DATA SOURCES A search of PubMed, Web of Science, and MEDLINE was performed on March 31, 2023, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. STUDY SELECTION Randomized clinical trials with active adults who underwent ACL surgery were included. They had to compare conventional treatments with the use of BFR, reporting values of pain, functionality, strength, or cross-sectional area (CSA). Articles whose participants presented concomitant injuries and whose intervention combined the use of BFR with treatments other than resistance training were excluded. STUDY DESIGN Systematic review. LEVEL OF EVIDENCE Level 2. DATA EXTRACTION Study design, population, cuff pressure, and main outcomes including strength, quadriceps CSA, pain, and functionality. RESULTS Six studies out of a total of 389 were included (152 participants; 90 men and 62 women). These included studies showed no differences on CSA or strength when comparing BFR training with high loads exercise. BFR has demonstrated improvements in knee functionality and pain compared with other interventions such as immobilization or high loads training. CONCLUSION The use of low loads combined with BFR improves pain, strength, functionality, and CSA. In addition, knee pain reduction and functionality are greater with BFR compared with the use of high loads or immobilization.
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Affiliation(s)
- Pere García-Rodríguez
- Faculty of Sports Sciences and Physiotherapy, Universidad Europea de Madrid, Madrid, Spain
| | - Javier Pecci
- Department of Physical Education and Sport, University of Seville, Seville, Spain
| | - Sergio Vázquez-González
- Faculty of Sports Sciences and Physiotherapy, Universidad Europea de Madrid, Madrid, Spain
- Rehabilitación Premium Madrid Clinic, Madrid, Spain
| | - Helios Pareja-Galeano
- Department of Physical Education, Sport and Human Movement, Universidad Autónoma de Madrid, Madrid, Spain
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20
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Wenning M, Sofack GN, Zöller D, Mauch M, Heitner AH, Paul J, Zahn P, Ritzmann R. Predicting the Recovery of Isokinetic Knee Strength 6 Months After Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2024; 12:23259671241264845. [PMID: 39247527 PMCID: PMC11375688 DOI: 10.1177/23259671241264845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/02/2024] [Indexed: 09/10/2024] Open
Abstract
Background The limb symmetry index (LSI) is a metric of strength restoration. It is key to successfully return to sports after anterior cruciate ligament (ACL) reconstruction. The threshold for return to sports is generally considered an LSI of ≥85%. Purpose To develop a statistical model for predicting the recovery of knee extension and flexion strength (with LSI ≥85%) at 6 months after ACL reconstruction. Study Design Case-control study; Level of evidence: 3. Methods Patients who underwent arthroscopic ACL reconstruction between November 2015 and December 2020 were included. The patients were classified into 2 groups: "pass" if the LSI at 6 months postoperatively was ≥85% and "fail" if the LSI was <85%. Factors in 25 categories with 74 levels, including patient characteristics, periarticular procedures, intra-articular lesions and treatment, and perioperative management, were collected. A multivariable logistic regression combined with backward variable elimination was used to determine the predictive parameters for recovery of knee extension and flexion strength. Results A total of 948 patients were included. Graft site, preoperative isokinetic strength, treatment of meniscal injury, and injured side (left vs right) were identified as general predictors for both knee extension and flexion strength. For knee extension strength, age at injury and partial weightbearing duration were identified as additional predictors. For knee flexion strength, type of meniscal injury, surgeon volume, cartilage procedures, and periarticular procedures were identified as additional predictors. The Nagelkerke R 2 of the final model was 0.178, and the c-statistic was 0.716 (95% CI, 0.676-0.754). The Hosmer-Lemeshow test indicated good calibration (P = .879). Conclusion Several factors including preoperative isokinetic strength, treatment of meniscal injuries, left vs. right side and graft site were found to predict recovery of ≥85% LSI in knee extension and flexion strength. Despite the numerous factors that were analyzed, the predictive power was moderate (c-statistic = 0.716), indicating there were other nonincluded factors that significantly influence strength performance at 6 months postoperatively.
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Affiliation(s)
- Markus Wenning
- Department of Orthopaedic and Trauma Surgery, University Medical Center, Faculty of Medicine, University of Freiburg, Germany
- Orthopaedic Surgery, BDH Klinik Waldkirch, Waldkirch, Germany
| | - Ghislain N Sofack
- Institute of Medical Biometry and Statistics, Faculty of Medicine, University of Freiburg, Germany
| | - Daniela Zöller
- Institute of Medical Biometry and Statistics, Faculty of Medicine, University of Freiburg, Germany
| | - Marlene Mauch
- Praxisklinik Rennbahn, Basel, Switzerland
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | | | | | - Peter Zahn
- Department of Orthopaedic and Trauma Surgery, University Medical Center, Faculty of Medicine, University of Freiburg, Germany
| | - Ramona Ritzmann
- Praxisklinik Rennbahn, Basel, Switzerland
- Department of Sport and Sport Science, University of Freiburg, Germany
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21
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Giacomazzo Q, Picot B, Chamu T, Samozino P, Pairot de Fontenay B. Impaired Symmetry in Single-Leg Vertical Jump and Drop Jump Performance 7 Months After ACL Reconstruction. Orthop J Sports Med 2024; 12:23259671241263794. [PMID: 39157022 PMCID: PMC11328232 DOI: 10.1177/23259671241263794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 02/12/2024] [Indexed: 08/20/2024] Open
Abstract
Background Anterior cruciate ligament reconstruction (ACLR) continues to be associated with a variable rate of return to sports and a concerning rate of further anterior cruciate ligament injury. Persistent functional deficits may explain these results and support the need to keep exploring lower limb functional indexes, especially during vertical jumping. This would help improve rehabilitation through the return-to-sports continuum and improve postoperative outcomes. Hypothesis Vertical jumping performance indexes are impaired among patients 7 months after ACLR. Study Design Cross-sectional study; Level of evidence, 3. Methods A total of 202 patients who underwent ACLR and 50 healthy participants performed single-leg vertical jump (SLVJ) and single-leg drop jump (SLDJ) testing. Jump height (H) as well as reactive strength index (RSI) were assessed and the limb symmetry index (LSI) of each parameter was compared between both groups. Vertical jumping indexes were also compared between healthy participants and the injured and contralateral legs of ACLR patients. Frequency analysis (chi-square test) of participants exhibiting an LSI >90% for each parameter was calculated in both groups. The level of association between SLVJ-H, SLDJ-H, and SLDJ-RSI was evaluated using the Pearson coefficient (r). Results At 6.6 ± 0.7 months (mean ± SD) postoperatively, participants after ACLR exhibited poorer LSI than the control group for all parameters (79.1 ± 14.8 vs 93.9 ± 4.5, 77.3 ± 14.6 vs 93.4 ± 5.2, and 71.9 ± 17.4 vs 93.4 ± 3.8; all P < .001; for the SLVJ-H, SLDJ-H, and SLDJ-RSI, respectively). Vertical jumping performance was lower on both injured and contralateral legs compared with healthy participants (all P < .001). Only 27%, 25%, and 16% of the ACLR patients exhibited an LSI >90% for the SLVJ-H, SLDJ-H, and SLDJ-RSI, respectively, in comparison with 80%, 72%, and 86% in the control group. Moderate correlations were observed between SLDJ-H and SLVJ-H (r = 0.494; P < .001) as well as between SLDJ-RSI and SLVJ-H (r = 0.488; P < .001) in the ACLR group. Conclusion Vertical jumping indexes (both symmetry and absolute values) were highly impaired 7 months after ACLR. Deficits were more marked for reactive strength ability. Clinicians should focus on restoring vertical jumping abilities to improve functional performance after ACLR.
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Affiliation(s)
| | - Brice Picot
- Univ Savoie Mont Blanc, Laboratory Interuniversity of Human Movement Sciences, Chambéry, France
- French Society of Sports Physical Therapy (SFMKS Lab), Asnières-sur-Oise, France
| | - Thomas Chamu
- Centre de kinésithérapie du sport, Lyon Ortho Clinic, Lyon, France
| | - Pierre Samozino
- Univ Savoie Mont Blanc, Laboratory Interuniversity of Human Movement Sciences, Chambéry, France
| | - Benoit Pairot de Fontenay
- French Society of Sports Physical Therapy (SFMKS Lab), Asnières-sur-Oise, France
- Interuniversity Laboratory of Human Movement Biology, Claude Bernard University Lyon 1, Villeurbanne, France
- Ramsay Santé, Clinique de la Sauvegarde, Lyon, France. P.S. and B.P.F. contributed equally to this article and also share last authorship
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22
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Cederström N, Ageberg E, Granér S. Lived experiences of physical therapists treating traumatic knee injury using integrated psychological training (MOTIFS): a qualitative interview study. Physiother Theory Pract 2024; 40:1522-1536. [PMID: 36779818 DOI: 10.1080/09593985.2023.2176729] [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: 06/12/2022] [Revised: 01/31/2023] [Accepted: 01/31/2023] [Indexed: 02/14/2023]
Abstract
BACKGROUND The novel Motor Imagery to Facilitate Sensorimotor Re-Learning (MOTIFS) training model, which began development in 2018, integrates psychological training into physical rehabilitation in knee-injured people. OBJECTIVE This qualitative interview study aims to understand, interpret, and describe how physical therapists perceive using the MOTIFS Model. METHODS One-on-one semi-structured interviews were conducted with six physical therapists familiar with the MOTIFS model and eight with experience with care-as-usual training only, analyzed using Interpretive Phenomenological Analysis. RESULTS Two major themes were generated in the MOTIFS group: 1) "MOTIFS increases psychological focus during rehabilitation training"; and 2) "Care-as-Usual training is mainly physical, and lacks the necessary psychological focus." Physical therapists perceived structured methods of addressing psychological factors, such as using imagery to influence patients' motivation, fear, and preparation for return to activity. Three major themes were generated in the Care-as-Usual group: 1) "Rehabilitation is mainly to restore physical function"; 2) "Rehabilitation training includes a biopsychosocial interaction"; and 3) "Psychological factors are important to address, but strategies are lacking." CONCLUSION Physical therapists perceive MOTIFS as a method of consciously shifting perspective toward an increased focus on psychological factors in knee-injury rehabilitation. Results indicate that a training model with integrated psychological strategies to create more holistic rehabilitation may be beneficial.
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Affiliation(s)
| | - Eva Ageberg
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Simon Granér
- Department of Psychology, Lund University, Lund, Sweden
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23
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Stitelmann A, Allet L, Armand S, Tscholl P. Reliability and Validity of Temporal Parameters during the Side Hop Test in Patients after Anterior Cruciate Ligament Reconstruction. J Clin Med 2024; 13:3407. [PMID: 38929938 PMCID: PMC11204192 DOI: 10.3390/jcm13123407] [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: 05/08/2024] [Revised: 05/26/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024] Open
Abstract
Background: The side hop test (SHT) measures the number of jumps performed over 30 s. Although this measure has demonstrated its value in clinical practice, the temporal parameters of the SHT allow for a deeper analysis of the execution strategy. The aim of this study is to assess the reliability and construct validity of contact time parameters during the SHT recorded by a video analysis system in anterior cruciate ligament reconstructed (ACLR) patients. Methods: We investigated the reliability (intra-rater, standard error of measurement (SEM), and minimum detectable change (MDC)), discriminant validity (operated (OP) versus non-operated (NOP) side), and convergent validity (relationship with strength and psychological readiness) of SHT contact time parameters, number of valid hops and limb symmetry index (LSI) in 38 ACLR patients. Contact time parameters are presented as mean, standard deviation (SD), and coefficient of variation (CV) of contact time. Results: Intra-tester reliability was good to excellent for all contact time parameters. For discriminant validity, the mean and SD contact times of the OP leg were significantly longer than those of the NOP leg, although the difference was smaller than the SEM and MDC values. The number of valid jumps and CV contact time parameters were not significantly different. Isokinetic quadriceps strength (60°/s) was strongly correlated with mean contact time for both legs. However, psychological readiness was not correlated with any of the contact time parameters. Conclusions: Temporal parameters of the SHT measured on video analysis are valid and reliable parameters to assess the performance strategy of the SHT. The results should be interpreted with caution regarding the SEM and MDC values. Further studies are needed to measure criterion validity, inter-rater reliability, and responsiveness.
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Affiliation(s)
- Anna Stitelmann
- Department of Orthopedic Surgery and Traumatology of the Musculoskeletal System, Geneva University Hospitals, 1205 Geneva, Switzerland
- Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, 1202 Geneva, Switzerland
| | - Lara Allet
- Wallis School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, 1950 Sion, Switzerland
| | - Stéphane Armand
- Kinesiology Laboratory, Geneva University Hospitals and University of Geneva, 1205 Geneva, Switzerland
| | - Philippe Tscholl
- Department of Orthopedic Surgery and Traumatology of the Musculoskeletal System, Geneva University Hospitals, 1205 Geneva, Switzerland
- ReFORM IOC Research Centre for Prevention of Injury and Protection of Athlete Health, 4000 Liège, Belgium
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24
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Triana J, Rao N, Buldo-Licciardi M, Lott A, Rynecki ND, Eskenazi J, Alaia MJ, Jazrawi LM, Strauss EJ, Campbell KA. Kinesiophobia and Pain Catastrophizing Leads to Decreased Return to Sport Following Autologous Chondrocyte Implantation but Does Not Affect Return to Work. Cartilage 2024; 15:130-138. [PMID: 37815311 PMCID: PMC11368903 DOI: 10.1177/19476035231183256] [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: 02/23/2023] [Revised: 05/12/2023] [Accepted: 05/28/2023] [Indexed: 10/11/2023] Open
Abstract
OBJECTIVE To evaluate the effect of fear of reinjury on return to sport (RTS), return to work (RTW), and clinical outcomes following autologous chondrocyte implantation (ACI). DESIGN A retrospective review of patients who underwent ACI with a minimum of 2 years in clinical follow-up was conducted. Patient-reported outcomes collected included the Visual Analog Scale (VAS) and Knee Injury and Osteoarthritis Outcome Score (KOOS). Kinesiophobia and pain catastrophizing was assessed using the Tampa Scale of Kinesiophobia-11 (TSK-11) and Pain Catastrophizing Scale (PCS), respectively. Patients were surveyed on their RTS and RTW status. RESULTS Fifty-seven patients (50.9% female) were included in our analysis. Twenty-two (38.6%) patients did not RTS. Of the 35 patients (61.4%) who returned, nearly half (48.6%) returned at a lower level of play. TSK-11 (P = 0.003), PCS (P = 0.001), and VAS pain scores (P < 0.001) were significantly greater in patients that did not RTS than in those who returned. All KOOS subscores analyzed were significantly lower (P < 0.001) in patients that did not RTS than in those who returned at the same level or higher. Of the 44 (77.2%) patients previously employed, 97.7% returned to work. Increasing TSK-11 scores were associated with lower odds of returning to sport (P = 0.003). CONCLUSION Fear of reinjury decreases the likelihood that patients will return to sport after ACI. Patients that do not return to sport report significantly greater levels of fear of reinjury and pain catastrophizing and lower clinical knee outcomes. Nearly all patients were able to return to work after surgery. LEVEL OF EVIDENCE IV case series.
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Affiliation(s)
- Jairo Triana
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Naina Rao
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Michael Buldo-Licciardi
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Ariana Lott
- Department of Orthopedic Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Nicole D Rynecki
- Department of Orthopedic Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Jordan Eskenazi
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Michael J Alaia
- Department of Orthopedic Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Laith M Jazrawi
- Department of Orthopedic Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Eric J Strauss
- Department of Orthopedic Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Kirk A Campbell
- Department of Orthopedic Surgery, NYU Grossman School of Medicine, New York, NY, USA
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25
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O'Dowd DP, Stanley J, Rosenfeldt MP, Walsh S, Twaddle B, De Ruiter L, Crua E, Monk AP, Walsh S. Reduction in re-rupture rates following implementation of return-to-sport testing after anterior cruciate ligament reconstruction in 313 patients with a mean follow-up of 50 months. J ISAKOS 2024; 9:264-271. [PMID: 38218452 DOI: 10.1016/j.jisako.2024.01.005] [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: 08/28/2023] [Revised: 12/18/2023] [Accepted: 01/08/2024] [Indexed: 01/15/2024]
Abstract
OBJECTIVES The objective of this study was to assess the mid-term effectiveness of a return to sport (RTS) test in relation to preventing anterior cruciate ligament (ACL) re-rupture and contralateral ACL injury following ACL reconstruction (ACLR). Furthermore, this study aimed to assess the timing of passing a, RTS-test after surgery, and the effect age has on RTS outcomes. METHODS Patients undergoing ACLR between August 2014 and December 2018 took an RTS-test following rehabilitation. The RTS-test consisted of the Anterior Cruciate Ligament Return to Sport After Injury Scale, a single-leg hop, a single-leg triple hop, a single-leg triple cross-over hop, a box-drop vertical jump down, a single-leg 4-rep max-incline leg press, and a modified agility T test. RTS-passing criteria were ≥90% limb symmetry index in addition to defined takeoff and landing parameters. Mid-term review assessed sporting level, ACL re-injury, and contralateral ACL injury. RESULTS A total of 352 patients underwent RTS-testing, following ACLR with 313 (89%) contactable at follow-up, a mean of 50 months (standard deviation: 11.41, range: 28-76) after surgery. The re-rupture rate was 6.6% after passing the RTS-test and 10.3% following failure (p = 0.24), representing a 36% reduction. Contralateral ACL injury rate after surgery was 6% and was 19% lower in those passing the RTS test. The mean age of patients passing their first RTS-test was significantly higher than that of those who failed (p = 0.0027). Re-ruptures in those who passed the RTS test first time occurred late (>34 months), compared to those who failed first time, which all occurred early (<33 months) (p = 0.0015). The mean age of re-rupture was significantly less than those who did not sustain a re-rupture (p = 0.025). CONCLUSION Passing a RTS-test following ACLR reduces ACL re-rupture by 36.21% and contralateral ACL injury by 19.15% at mid-term follow-up. Younger patients are more likely to fail a RTS-test and are at higher risk of contralateral ACL rupture. LEVEL III EVIDENCE
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Affiliation(s)
- D P O'Dowd
- Unisports Sports Medicine, Auckland, 1072, New Zealand.
| | - J Stanley
- Unisports Sports Medicine, Auckland, 1072, New Zealand
| | | | - Sa Walsh
- Unisports Sports Medicine, Auckland, 1072, New Zealand
| | - B Twaddle
- Unisports Sports Medicine, Auckland, 1072, New Zealand
| | - L De Ruiter
- Unisports Sports Medicine, Auckland, 1072, New Zealand
| | - E Crua
- Unisports Sports Medicine, Auckland, 1072, New Zealand
| | - A P Monk
- Unisports Sports Medicine, Auckland, 1072, New Zealand
| | - S Walsh
- Unisports Sports Medicine, Auckland, 1072, New Zealand
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Herring SA, Putukian M, Kibler WB, LeClere L, Boyajian-O'Neill L, Day MA, Franks RR, Indelicato P, Matuszak J, Miller TL, O'Connor F, Poddar S, Svoboda SJ, Zaremski JL. Team Physician Consensus Statement: Return to Sport/Return to Play and the Team Physician: A Team Physician Consensus Statement-2023 Update. Curr Sports Med Rep 2024; 23:183-191. [PMID: 38709944 DOI: 10.1249/jsr.0000000000001169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Affiliation(s)
- Stanley A Herring
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | | | - W Ben Kibler
- Shoulder Center of Kentucky, Lexington Clinic, Lexington KY
| | - Lance LeClere
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | | | | | | | - Peter Indelicato
- Department of Orthopedic Surgery and Sports Medicine, College of Medicine, University of Florida, Gainesville, FL
| | | | - Timothy L Miller
- Department of Orthopaedic Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Fran O'Connor
- Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Sourav Poddar
- Primary Sports Medicine, University of Colorado School of Medicine, Denver, CO
| | | | - Jason L Zaremski
- Department of Physical Medicine & Rehabilitation, University of Florida Health, Gainesville, FL
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27
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Herring SA, Putukian M, Kibler WB, Leclere L, Boyajian-O'Neill L, Day MA, Franks RR, Indelicato P, Matuszak J, Miller TL, O'Connor F, Poddar S, Svoboda SJ, Zaremski JL. Team Physician Consensus Statement: Return to Sport/Return to Play and the Team Physician: A Team Physician Consensus Statement-2023 Update. Med Sci Sports Exerc 2024; 56:767-775. [PMID: 38616326 DOI: 10.1249/mss.0000000000003371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Affiliation(s)
- Stanley A Herring
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | | | - W Ben Kibler
- Shoulder Center of Kentucky, Lexington Clinic, Lexington KY
| | - Lance Leclere
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | | | | | | | - Peter Indelicato
- Department of Orthopedic Surgery and Sports Medicine, College of Medicine, University of Florida, Gainesville, FL
| | | | - Timothy L Miller
- Department of Orthopaedic Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Fran O'Connor
- Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Sourav Poddar
- Primary Sports Medicine, University of Colorado School of Medicine, Denver, CO
| | | | - Jason L Zaremski
- Department of Physical Medicine & Rehabilitation, University of Florida Health, Gainesville, FL
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28
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Hopper HM, Bruce Leicht AS, Thompson XD, Gwathmey FW, Miller MD, Werner BC, Brockmeier SF, Diduch DR, Hart JM. The effect of factors from different time points on psychological readiness following ACL reconstruction. Phys Ther Sport 2024; 67:161-166. [PMID: 38823214 DOI: 10.1016/j.ptsp.2024.05.002] [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: 09/01/2023] [Revised: 05/18/2024] [Accepted: 05/19/2024] [Indexed: 06/03/2024]
Abstract
OBJECTIVE The purpose of this study was to examine factors correlated with psychological readiness to return to activity after ACLR. DESIGN cross sectional study. SETTING controlled laboratory. PARTICIPANTS 164 patients (82 M/82 F, 22.5 ± 8.9yr, 171.6 ± 11.0 cm, 77.4 ± 18.6 kg, 8.6 ± 3.4 months post-ACLR) participated in this study after a primary, isolated, and uncomplicated ACLR. MAIN OUTCOME MEASURES ACL Return to Sport Index (ACL-RSI). RESULTS ACL-RSI scores demonstrated a weak positive correlation with activity level at the time of injury and a fair positive correlation with activity level at the time of post-operative testing (p-values: 0.004, <0.001). ACL-RSI scores showed a statistically significant fair negative correlation with pain and a moderate negative correlation with kinesiophobia during rehabilitation (p-values: <0.001, <0.001). There was no statistical significance between ACL-RSI and the surgical variables (p-value range: 0.10-0.61). CONCLUSIONS Outcomes from testing during postoperative rehabilitation were most correlated with psychological readiness to return to activity after ACLR. Increased pain and kinesiophobia were associated with a decreased psychological readiness. Increased activity level prior to injury and activity level at the time of testing during rehabilitation were both correlated with increased psychological readiness. Psychological readiness to return to activity may need to be customized based on potentially modifiable patient-specific factors during the post-operative rehabilitation.
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Affiliation(s)
- Haleigh M Hopper
- University of Virginia, Department of Kinesiology, Charlottesville, VA, USA.
| | | | - Xavier D Thompson
- University of Virginia, Department of Kinesiology, Charlottesville, VA, USA
| | - F Winston Gwathmey
- University of Virginia, Department of Orthopaedic Surgery, Charlottesville, VA, USA
| | - Mark D Miller
- University of Virginia, Department of Orthopaedic Surgery, Charlottesville, VA, USA
| | - Brian C Werner
- University of Virginia, Department of Orthopaedic Surgery, Charlottesville, VA, USA
| | - Stephen F Brockmeier
- University of Virginia, Department of Orthopaedic Surgery, Charlottesville, VA, USA
| | - David R Diduch
- University of Virginia, Department of Orthopaedic Surgery, Charlottesville, VA, USA
| | - Joseph M Hart
- University of North Carolina, Department of Orthopaedics, Chapel Hill, NC, USA
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Zink GP, Zwolski CM, Thomas SM, Paterno MV, Schmitt LC. The Influence of Strength and Sport Exposure on Psychological Readiness After ACL Reconstruction. Sports Health 2024; 16:239-246. [PMID: 38288482 PMCID: PMC10916781 DOI: 10.1177/19417381231223522] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Among young athletes returning to sport after anterior cruciate ligament reconstruction (ACLR), the extent to which psychological readiness is influenced by factors beyond the psychological domain is largely unknown. HYPOTHESIS Young athletes with recent sport exposure and higher quadriceps strength will demonstrate higher psychological readiness within 8 weeks of medical clearance to return to sport (RTS) after ACLR. STUDY DESIGN Cross-sectional study. LEVEL OF EVIDENCE Level 3. METHODS A total of 38 young athletes after primary ACLR completed testing within 8 weeks of medical clearance to RTS. All participants completed isometric knee extension strength testing, in addition to the ACL Return to Sport after Injury (ACL-RSI) questionnaire. Athletes who participated in sport between time of medical clearance to RTS and date of study enrollment were categorized as SPORT-YES. Those who had not yet participated in sports were categorized as SPORT-NO. Multiple linear regression analyses were used to determine differences in ACL-RSI scores based on quadriceps strength and sport exposure status, while adjusting for age and sex. RESULTS Of the 38 participants, 20 (52.6%) were categorized as SPORT-YES. The regression model estimating overall ACL-RSI score (P < 0.01, adjusted R2 = 0.389) included significant independent contributions from age, sex, and sport exposure variables (age: P = 0.01, β [95% CI] = -2.01 [-3.54, -0.48]; sex (male): P = 0.02, β [95% CI] = 12.50 [2.36, 22.64]; strength: P = 0.51, β [95% CI] = -2.47 [-10.07,5.13]; sport exposure: P < 0.01, β [95% CI] = 12.89 [3.58, 22.19]). CONCLUSION In partial accordance with our hypothesis, recent sport exposure was significantly associated with higher ACL-RSI scores among young athletes in the weeks after medical clearance to RTS after ACLR, while quadriceps strength was not. CLINICAL RELEVANCE Future prospective work is needed to determine the existence and direction of causal relationships between exposure to sport environment and psychological readiness among young athletes after ACLR.
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Affiliation(s)
- Griffin P Zink
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio
- Department of Physical Therapy, Bon Secours Mercy Health Orthopaedic and Sports Medicine, Cincinnati, Ohio
| | - Christin M Zwolski
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio
- Division of Occupational Therapy and Physical Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Staci M Thomas
- Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Mark V Paterno
- Division of Occupational Therapy and Physical Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Laura C Schmitt
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio
- Jameson Crane Sports Medicine Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
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Sheean AJ, DeFoor MT, Spindler KP, Arner JW, Athiviraham A, Bedi A, DeFroda S, Ernat JJ, Frangiamore SJ, Nuelle CW, Sheean AJ, Spindler KP, Bedi A. The Psychology of ACL Injury, Treatment, and Recovery: Current Concepts and Future Directions. Sports Health 2024:19417381241226896. [PMID: 38374636 DOI: 10.1177/19417381241226896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024] Open
Abstract
CONTEXT Interest in the relationship between psychology and the outcomes of anterior cruciate ligament (ACL) reconstruction (ACLR) continues to grow as variable rates of return to preinjury level of activity continue to be observed. EVIDENCE ACQUISITION Articles were collected from peer-reviewed sources available on PubMed using a combination of search terms, including psychology, resilience, mental health, recovery, and anterior cruciate ligament reconstruction. Further evaluation of the included bibliographies were used to expand the evidence. STUDY DESIGN Clinical review. LEVEL OF EVIDENCE Level 4. RESULTS General mental health and wellbeing, in addition to a host of unique psychological traits (self-efficacy, resilience, psychological readiness and distress, pain catastrophizing, locus of control, and kinesiophobia) have been demonstrated convincingly to affect treatment outcomes. Moreover, compelling evidence suggests that a number of these traits may be modifiable. Although the effect of resilience on outcomes of orthopaedic surgical procedures has been studied extensively, there is very limited information linking this unique psychological trait to the outcomes of ACLR. Similarly, the available information related to other parameters, such as pain catastrophizing, is limited with respect to the existence of adequately sized cohorts capable of accommodating more rigorous and compelling analyses. A better understanding of the specific mechanisms through which psychological traits influence outcomes can inform future interventions intended to improve rates of return to preinjury level of activity after ACLR. CONCLUSION The impact of psychology on patients' responses to ACL injury and treatment represents a promising avenue for improving low rates of return to preinjury activity levels among certain cohorts. Future research into these areas should focus on specific effects of targeted interventions on known, modifiable risk factors that commonly contribute to suboptimal clinical outcomes. STRENGTH-OF-RECOMMENDATION TAXONOMY (SORT) B.
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Affiliation(s)
| | | | | | - Justin W Arner
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - Asheesh Bedi
- NorthShore University Health System, Skokie, Illinois
| | | | | | | | | | | | | | - Asheesh Bedi
- NorthShore University Health System, Skokie, Illinois
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Laboute E, James-Belin E, Ucay O, Caubere A, Verhaeghe E. Prospective study of functional outcomes and return to sports after anterior cruciate ligament reconstruction in the knee. INTERNATIONAL ORTHOPAEDICS 2024; 48:455-463. [PMID: 37700201 PMCID: PMC10799780 DOI: 10.1007/s00264-023-05973-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 09/03/2023] [Indexed: 09/14/2023]
Abstract
PURPOSE Individual factors of low rates of return to sport after anterior cruciate ligament (ACL) reconstruction were unclear. We evaluated the impact of various individual factors after ACL reconstruction for return to sport in athletes. METHODS A prospective study was performed in 1274 athletes, who had undergone ACL autograft reconstruction. Individual factors survey about return to sport was performed during the second year after surgery. Athlete responses were analyzed with a multivariate logistic model adjusted for baseline patient characteristics and an adjusted Cox model. RESULTS Younger age and involvement in higher-level sporting activities were associated with a significantly higher frequency and a significantly shorter time to return to sport (running, training, competition; p = 0.001 to 0.028). Men returned to sport more rapidly than women, for both training (p = 0.007) and competition (p = 0.042). Although there was no difference to return to sport between hamstring (HT) and patellar tendon (PT) autograft. We note that MacFL surgery (Mac Intosh modified with intra- and extra-articular autografts used the tensor fasciae latae muscle) was associated with a higher frequency (p = 0.03) and rapidity (p = 0.025) of return to training than HT. Sports people practicing no weight-bearing sports returned to training (p < 0.001) and competition (p < 0.001) more rapidly than other sports people. By contrast, the practicing pivoting sports with contact started running again sooner (p < 0.001). CONCLUSION Younger age, male sex, higher level of sports, sportspeople practicing no weight-bearing sports, and MacFL surgery reduce time to return to sport after ACL reconstruction.
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Affiliation(s)
- E Laboute
- C.E.R.S., Groupe Ramsay Santé, 83 Av Maréchal de Lattre de Tassigny, 40130, Capbreton, France.
| | - E James-Belin
- C.E.R.S., Groupe Ramsay Santé, 83 Av Maréchal de Lattre de Tassigny, 40130, Capbreton, France
| | - O Ucay
- C.E.R.S., Groupe Ramsay Santé, 83 Av Maréchal de Lattre de Tassigny, 40130, Capbreton, France
| | - A Caubere
- Service de Chirurgie Orthopédique Et Traumatologie, Hôpital d'Instruction Des Armées Sainte-Anne, 2, Bd Sainte Anne, BP 600, 83800, Cedex 9, Toulon, France
| | - E Verhaeghe
- C.E.R.S., Groupe Ramsay Santé, 83 Av Maréchal de Lattre de Tassigny, 40130, Capbreton, France
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Aregger FC, Kreuzer S, Häckel S, Bigdon SF, Tinner C, Erbach G, Deml MC, Albers CE. Return to sports/activity level after 360° thoracolumbar fusion after burst fractures in young patients. BRAIN & SPINE 2024; 4:102762. [PMID: 38510642 PMCID: PMC10951747 DOI: 10.1016/j.bas.2024.102762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/16/2024] [Accepted: 01/22/2024] [Indexed: 03/22/2024]
Abstract
Introduction Traumatic thoracolumbar burst fractures are the most common spinal injuries and the proper treatment is controversial. In central Europe in particular, these fractures are often treated with minimally invasive anterior-posterior reduction and fusion, whereas a conservative approach is preferred in the USA. Independent of the treatment strategy, no data exists regarding the outcome related to return to activity level/sport. Research question The aim of this study was to evaluate the return to sports and activity levels after 360° fusion in patients with thoracolumbar burst fractures without neurological deficits. Methods Between January 2013 and December 2022, 46 patients aged 18 to 40 years underwent partial or complete vertebral body replacement in the thoracolumbar region due to traumatic burst fractures without neurologic deficit as an isolated injury. Patients were contacted retrospectively by phone calls to assess their activities using a modified version of the Tegner activity scale at different time points: Before trauma, 3, 6, and 12 months post-surgery. Results After applying exclusion criteria, data collection was complete for 28 patients. The median modified Tegner activity scale was 5.4 before sustaining the fracture, declined to 2.9 at three months post-trauma, improved to 4.2 at six months, and reached 5.0 at 12 months. The majority (83%) of patients achieved their pre-accident activity level within 12 months. No significant differences were observed between patients with partial or complete corpectomy. Conclusion This is the first study assessing return to sports/physical activity based on the modified Tegner scale in young patients undergoing 360° fusion for spinal burst fractures. The majority of patients (83%) return to the pre-injury activity level within 12 months after surgery.
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Affiliation(s)
- Fabian Cedric Aregger
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University Hospital Bern, University Bern, Bern, Switzerland
| | - Sebastian Kreuzer
- Department of Orthopaedic Surgery and Traumatology, Spital Thun, Thun, Switzerland
| | - Sonja Häckel
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University Hospital Bern, University Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Switzerland
| | - Sebastian Frederick Bigdon
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University Hospital Bern, University Bern, Bern, Switzerland
| | - Christian Tinner
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University Hospital Bern, University Bern, Bern, Switzerland
| | - Georg Erbach
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University Hospital Bern, University Bern, Bern, Switzerland
| | - Moritz Caspar Deml
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University Hospital Bern, University Bern, Bern, Switzerland
| | - Christoph Emanuel Albers
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University Hospital Bern, University Bern, Bern, Switzerland
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Faleide AGH, Inderhaug E. It is time to target psychological readiness (or lack of readiness) in return to sports after Anterior Cruciate Ligament tears. J Exp Orthop 2023; 10:94. [PMID: 37728618 PMCID: PMC10511393 DOI: 10.1186/s40634-023-00657-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/06/2023] [Indexed: 09/21/2023] Open
Abstract
Functional recovery has for long been the focus of rehabilitation after an Anterior Cruciate Ligament (ACL) injury. It is now increasingly recognized that more attention should be given to patients` mental recovery, their psychological readiness for returning to sport, after such an injury. Within this relatively new field of science, clinicians need clarity on when and how psychological factors should be monitored and how inexpedient psychological responses may be addressed during rehabilitation. In this Expert Opinion suggestions on how targeting psychological readiness may improve rehabilitation and return-to-sport evaluations are made based on current evidence-and issues in need of further clarification are addressed.
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Affiliation(s)
- Anne Gro Heyn Faleide
- Haraldsplass Deaconess Hospital, Ulriksdal 8, 5009, Bergen, Norway.
- The University of Bergen, Bergen, Norway.
| | - Eivind Inderhaug
- Haraldsplass Deaconess Hospital, Ulriksdal 8, 5009, Bergen, Norway
- The University of Bergen, Bergen, Norway
- Haukeland University Hospital, Bergen, Norway
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卢 晓, 余 洋, 谢 冰, 王 国, 杨 腾, 熊 波, 刘 津, 李 彦. [Establishment of anterior cruciate ligament reconstruction model in cynomolgus monkey with autogenous hamstring tendon transplantation]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2023; 37:862-867. [PMID: 37460184 PMCID: PMC10352513 DOI: 10.7507/1002-1892.202303103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/29/2023] [Accepted: 05/29/2023] [Indexed: 07/20/2023]
Abstract
Objective To investigate the feasibility of establishing an anterior cruciate ligament (ACL) reconstruction model using hamstring tendon autograft in cynomolgus monkeys. Methods Twelve healthy adult male cynomolgus monkeys, weighing 8-13 kg, were randomly divided into two groups ( n=6). In the experimental group, the ACL reconstruction model of the right lower limb was prepared by using a single bundle of hamstring tendon, and the ACL of the right lower limb was only cut off in the control group. The survival of animals in the two groups was observed after operation. Before operation and at 3, 6, and 12 months after operation, the knee range of motion, thigh circumference, and calf circumference of the two groups were measured; the anterior tibial translation D-value (ATTD) was measured by Ligs joint ligament digital body examination instrument under the loads of 13-20 N, respectively. At the same time, the experimental group underwent MRI examination to observe the graft morphology and the signal/ noise quotient (SNQ) was caculated. Results All animals survived to the end of the experiment. In the experimental group, the knee range of motion, thigh circumference, and calf circumference decreased first and then gradually increased after operation; the above indexes were significantly lower at 3 and 6 months after operation than before operation ( P<0.05), and no significant difference was found between pre-operation and 12 months after operation ( P>0.05). In the control group, there was no significant change in knee range of motion after operation, showing no significant difference between pre- and post-operation ( P>0.05), but the thigh circumference and calf circumference gradually significantly decreased with time ( P<0.05), and the difference was significant when compared with those before operation ( P<0.05). At 6 and 12 months after operation, the thigh circumference and calf circumference were significantly larger in the experimental group than in the control group ( P<0.05). At 3 and 6 months after operation, the knee range of motion was significantly smaller in the experimental group than in the control group ( P<0.05). Under the loading condition of 13-20 N, the ATTD in the experimental group increased first and then decreased after operation; and the ATTD significantly increased at 3, 6 months after operation when compared with the value before operation ( P<0.05). But there was no significant difference between the pre-operation and 12 months after operation ( P>0.05). There was no significant change in ATTD in the control group at 3, 6, and 12 months after operation ( P>0.05), and which were significantly higher than those before operation ( P<0.05). At each time point after operation, the ATTD was significantly smaller in the experimental group than in the control group under the same load ( P<0.05). The MRI examination of the experimental group showed that the ACL boundary gradually became clear after reconstruction and was covered by the synovial membrane. The SNQ at each time point after operation was significantly higher than that before operation, but gradually decreased with time, and the differences between time points were significant ( P<0.05). Conclusion The ACL reconstruction model in cynomolgus monkey with autogenous hamstring tendon transplantation was successfully established.
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Affiliation(s)
- 晓君 卢
- 昆明医科大学第一附属医院运动医学科（昆明 650032）Department of Sports Medicine, First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650032, P. R. China
| | - 洋 余
- 昆明医科大学第一附属医院运动医学科（昆明 650032）Department of Sports Medicine, First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650032, P. R. China
| | - 冰 谢
- 昆明医科大学第一附属医院运动医学科（昆明 650032）Department of Sports Medicine, First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650032, P. R. China
| | - 国梁 王
- 昆明医科大学第一附属医院运动医学科（昆明 650032）Department of Sports Medicine, First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650032, P. R. China
| | - 腾云 杨
- 昆明医科大学第一附属医院运动医学科（昆明 650032）Department of Sports Medicine, First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650032, P. R. China
| | - 波涵 熊
- 昆明医科大学第一附属医院运动医学科（昆明 650032）Department of Sports Medicine, First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650032, P. R. China
| | - 津瑞 刘
- 昆明医科大学第一附属医院运动医学科（昆明 650032）Department of Sports Medicine, First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650032, P. R. China
| | - 彦林 李
- 昆明医科大学第一附属医院运动医学科（昆明 650032）Department of Sports Medicine, First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650032, P. R. China
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Wang YJ, Zhang JC, Zhang YZ, Liu YH. Assessment of functional prognosis of anterior cruciate ligament reconstruction in athletes based on a body shape index. World J Clin Cases 2023; 11:4567-4578. [PMID: 37469737 PMCID: PMC10353512 DOI: 10.12998/wjcc.v11.i19.4567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 05/21/2023] [Accepted: 05/24/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND A healthy body shape is essential to maintain athletes’ sports level. At present, little is known about the effect of athletes’ body shape on anterior cruciate ligament reconstruction (ACLR). Moreover, the relationship between body shape and variables such as knee joint function after operation and return to the field has not been well studied.
AIM To verify the relationship between a body shape index (ABSI) and the functional prognosis of the knee after ACLR in athletes with ACL injuries.
METHODS We reviewed 76 athletes with unilateral ACL ruptures who underwent ACLR surgery in the First Hospital of Shanxi Medical University between 2017 and 2020, with a follow-up period of more than 24 mo. First, all populations were divided into a High-ABSI group (ABSI > 0.835, n = 38) and a Low-ABSI group (ABSI < 0.835, n = 38) based on the arithmetic median (0.835) of ABSI values. The primary exposure factor was ABSI, and the outcome indicators were knee function scores as well as postoperative complications. The correlation between ABSI and postoperative knee function scores and postoperative complications after ACLR were analyzed using multifactorial logistic regression.
RESULTS The preoperative knee function scores of the two groups were similar. The surgery and postoperative rehabilitation exercises, range of motion (ROM) compliance rate, Lysholm score, and Knee Injury and Osteoarthritis Outcome Score of the two groups gradually increased, whereas the quadriceps atrophy index gradually decreased. The knee function scores were higher in the Low-ABSI group than in the High-ABSI group at the 24-mo postoperative follow-up (P < 0.05). In multifactorial logistic regression, ABSI was a risk factor of low knee joint function score after surgery, specifically low ROM scores (odds ratio [OR] = 1.31, 95% confidence interval [CI] [1.10-1.44]; P < 0.001), low quadriceps atrophy index (OR = 1.11, 95%CI [0.97-1.29]; P < 0.05), low Lysholm scores (OR = 2.34, 95%CI [1.78-2.94]; P < 0.001), low symptoms (OR = 1.14, 95%CI [1.02-1.34]; P < 0.05), low activity of daily living (OR = 1.34, 95%CI [1.18-1.65]; P < 0.05), low sports (OR = 2.47, 95%CI [1.78-2.84]; P < 0.001), and low quality of life (OR = 3.34, 95%CI [2.88-3.94]; P < 0.001). ABSI was also a risk factor for deep vein thrombosis of the lower limb (OR = 2.14, 95%CI [1.88-2.36], P < 0.05] and ACL recurrent rupture (OR = 1.24, 95%CI [0.98-1.44], P < 0.05) after ACLR.
CONCLUSION ABSI is a risk factor for the poor prognosis of knee function in ACL athletes after ACLR, and the risk of poor knee function after ACLR, deep vein thrombosis of lower limb, and ACL recurrent rupture gradually increases with the rise of ABSI.
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Affiliation(s)
- Yun-Jun Wang
- Institutes of Biomedical Sciences, Shanxi University, Taiyuan 030006, Shanxi Province, China
| | - Jun-Chang Zhang
- Department of Orthopedics, First Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
| | - Yu-Ze Zhang
- Institutes of Biomedical Sciences, Shanxi University, Taiyuan 030006, Shanxi Province, China
| | - Ying-Hai Liu
- Institutes of Biomedical Sciences, Shanxi University, Taiyuan 030006, Shanxi Province, China
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Sheean AJ, Jin Y, Huston LJ, Brophy RH, Cox CL, Flanigan DC, Jones MH, Kaeding CC, Magnussen RA, Marx RG, Matava MJ, McCarty EC, Parker RD, Wolcott ML, Wolf BR, Wright RW, Spindler KP. Predictors of Return to Activity at 2 Years After Anterior Cruciate Ligament Reconstruction Among Patients With High Preinjury Marx Activity Scores: A MOON Prospective Cohort Study. Am J Sports Med 2023; 51:2313-2323. [PMID: 37724692 DOI: 10.1177/03635465231172769] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
BACKGROUND Predictors of return to activity after anterior cruciate ligament reconstruction (ACLR) among patients with relatively high preinjury activity levels remain poorly understood. PURPOSE/HYPOTHESIS The purpose of this study was to identify predictors of return to preinjury levels of activity after ACLR, defined as achieving a Marx activity score within 2 points of the preinjury value, among patients with Marx activity scores of 12 to 16 who had been prospectively enrolled in the Multicenter Orthopaedic Outcomes Network (MOON) cohort. We hypothesized that age, sex, preinjury activity level, meniscal injuries and/or procedures, and concurrent articular cartilage injuries would predict return to preinjury activity levels at 2 years after ACLR. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS All unilateral ACLR procedures from 2002 to 2008 performed in patients enrolled in the MOON, with preinjury Marx activity scores ranging from 12 to 16, were evaluated with a specific focus on return to preinjury activity levels at 2 years postoperatively. Return to activity was defined as a Marx activity score within 2 points of the preinjury value. The proportion of patients able to return to preinjury activity levels was calculated, and multivariable modeling was performed to identify risk factors for patients' inability to return to preinjury activity levels. RESULTS A total of 1188 patients were included in the final analysis. The median preinjury Marx activity score was 16 (interquartile range, 12-16). Overall, 466 patients (39.2%) were able to return to preinjury levels of activity, and 722 patients (60.8%) were not able to return to preinjury levels of activity. Female sex, smoking at the time of ACLR, fewer years of education, lower 36-Item Short Form Health Survey Mental Component Summary scores, and higher preinjury Marx activity scores were predictive of patients' inability to return to preinjury activity levels. Graft type, revision ACLR, the presence of medial and/or lateral meniscal injuries, a history of meniscal surgery, the presence of articular cartilage injuries, a history of articular cartilage treatment, and the presence of high-grade knee laxity were not predictive of a patient's ability to return to preinjury activity level. CONCLUSION At 2 years after ACLR, most patients with high preinjury Marx activity scores did not return to their preinjury level of activity. The higher the preinjury Marx activity score that a patient reported at the time of enrollment, the less likely he/she was able to return to preinjury activity level. Smoking and lower mental health at the time of ACLR were the only modifiable risk factors in this cohort that predicted an inability to return to preinjury activity levels. Continued effort and investigation are required to maximize functional recovery after ACLR in patients with high preinjury levels of activity.
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Affiliation(s)
- Andrew J Sheean
- San Antonio Military Medical Center, San Antonio, Texas, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA, and Cleveland Clinic, Cleveland, Ohio, USA
| | - Yuxuan Jin
- Cleveland Clinic, Cleveland, Ohio, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA, and Cleveland Clinic, Cleveland, Ohio, USA
| | - Laura J Huston
- Vanderbilt University, Nashville, Tennessee, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA, and Cleveland Clinic, Cleveland, Ohio, USA
| | - Robert H Brophy
- Washington University in St Louis, St Louis, Missouri, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA, and Cleveland Clinic, Cleveland, Ohio, USA
| | - Charles L Cox
- Vanderbilt University, Nashville, Tennessee, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA, and Cleveland Clinic, Cleveland, Ohio, USA
| | - David C Flanigan
- The Ohio State University, Columbus, Ohio, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA, and Cleveland Clinic, Cleveland, Ohio, USA
| | - Morgan H Jones
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA, and Cleveland Clinic, Cleveland, Ohio, USA
| | - Christopher C Kaeding
- The Ohio State University, Columbus, Ohio, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA, and Cleveland Clinic, Cleveland, Ohio, USA
| | - Robert A Magnussen
- The Ohio State University, Columbus, Ohio, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA, and Cleveland Clinic, Cleveland, Ohio, USA
| | - Robert G Marx
- Hospital for Special Surgery, New York, New York, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA, and Cleveland Clinic, Cleveland, Ohio, USA
| | - Matthew J Matava
- Washington University in St Louis, St Louis, Missouri, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA, and Cleveland Clinic, Cleveland, Ohio, USA
| | - Eric C McCarty
- University of Colorado, Denver, Colorado, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA, and Cleveland Clinic, Cleveland, Ohio, USA
| | - Richard D Parker
- Cleveland Clinic, Cleveland, Ohio, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA, and Cleveland Clinic, Cleveland, Ohio, USA
| | - Michelle L Wolcott
- University of Colorado, Denver, Colorado, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA, and Cleveland Clinic, Cleveland, Ohio, USA
| | - Brian R Wolf
- University of Iowa, Iowa City, Iowa, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA, and Cleveland Clinic, Cleveland, Ohio, USA
| | - Rick W Wright
- Vanderbilt University, Nashville, Tennessee, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA, and Cleveland Clinic, Cleveland, Ohio, USA
| | - Kurt P Spindler
- Cleveland Clinic, Cleveland, Ohio, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA, and Cleveland Clinic, Cleveland, Ohio, USA
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Kocak UZ, Knurr KA, Cobian DG, Heiderscheit BC. Beyond peak torque: Longitudinal analysis of angle-specific isokinetic knee torques in collegiate athletes post-ACLR. Phys Ther Sport 2023; 61:11-19. [PMID: 36841117 PMCID: PMC10330311 DOI: 10.1016/j.ptsp.2023.02.004] [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: 11/22/2022] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 02/18/2023]
Abstract
OBJECTIVES To investigate changes in angle-specific knee extensor torque between limbs from 4 to 12 months post-anterior cruciate ligament reconstruction(ACLR) in Division I collegiate athletes at two different isokinetic velocities. DESIGN Case-series study. SETTING Laboratory-based. PARTICIPANTS Isokinetic knee flexion and extension assessments of 17 athletes (11 female) at 4, 8, and 12 months after ACLR with bone-patellar tendon-bone autograft were evaluated. MAIN OUTCOME MEASURES Angle-specific curve analyses were performed using statistical parametric mapping for torque data obtained between 14 and 101° at 60°/s and 240°/s velocities. RESULTS At 60°/s, knee extensor torque of the operated limb increased between 4 and 8 months (18-101°,p < 0.001), 4 and 12 months (28-101°,p < 0.001), and 8 and 12 months post-surgery (62-70°,p = 0.002, and 79-90°,p < 0.001). Knee extensor torque was lower in the operated limb compared to the non-operated limb at 4 (47-97°,p < 0.001) and 8 months (65-90°,p < 0.001) for 60°/s, at 4 (21-89°,p < 0.001) and 8 months (50-77°,p < 0.001) for 240°/s, with no between-limb differences at 12 months post-ACLR for both velocities. CONCLUSIONS Operated limb knee extensor torque increased throughout the majority of knee range of motion from 4 to 12 months post-ACLR at both isokinetic velocities, while non-operated limb torque only improved through a reduced arc of motion in greater knee flexion angles.
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Affiliation(s)
- Umut Z Kocak
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkiye; Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI, USA; Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI, USA.
| | - Keith A Knurr
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI, USA; Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI, USA
| | - Daniel G Cobian
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI, USA; Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI, USA
| | - Bryan C Heiderscheit
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI, USA; Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI, USA
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Pascual-Leone N, Mackie AT, Gross PW, Kelly AM, Green DW, Fabricant PD. Higher Grit Scores Are Associated With Earlier Increases in Knee Flexion Following Anterior Cruciate Ligament Reconstruction With Meniscus Repair in Pediatric Patients. J Pediatr Orthop 2023; 43:193-197. [PMID: 36728260 DOI: 10.1097/bpo.0000000000002353] [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: 02/03/2023]
Abstract
BACKGROUND The Grit Scale is used to measure grit, defined by Duckworth and colleagues as the disposition to show perseverance and passion for long-term goals. It has been shown that psychological factors like motivation, coachability, and coping with adversity are correlated with faster readiness for return to sport (RTS) in patients undergoing anterior cruciate ligament reconstruction (ACLR). This study investigates the association between pediatric patients' baseline grit scores and; preoperative Patient-reported Outcomes Measurement Information System (PROMIS) Pain scores and the recovery of range of motion (ROM) after ACLR. The investigators hypothesized that higher preoperative grit scores would predict lower preoperative pain scores and earlier return of knee ROM in patients undergoing ACLR. METHODS This is a retrospective cohort study. Pediatric patients who underwent primary ACLR were assigned the pediatric Grit Scale. Patients were subdivided by meniscal procedures due to differences in postoperative protocols. ACLR alone or with meniscectomy (ACLR ± meniscectomy) were grouped together and ACLR with meniscal repair (ACLR + meniscus repair) represented the other cohort. Patients above the 50th grit percentile were considered "high grit". Patients below the 50th percentile were considered "low grit". Baseline PROMIS pain intensity and interference were collected. ROM was compared by grit cohort using the Mann-Whitney U test with a significance threshold of P ≤ 0.05. RESULTS A total of 58 patients undergoing ACLR were analyzed: 20 ACLR ± meniscectomy and 38 ACLR + meniscus repair. The mean age was 15.0 ± 2.1 years with 41.4% of participants identifying as females. No significant difference was noted between baseline PROMIS pain intensity and interference and grit score ( P = 0.82, P = 0.91, respectively). Three months postoperatively, for those in the ACLR + meniscus repair cohort, low grit ROM was 130 degrees (interquartile range = 10 degrees), whereas high grit ROM was 135 degrees (interquartile range = 8 degrees) ( P = 0.006). CONCLUSIONS This study found no differences in pain scores at presentation between grit cohorts but found that patients with grit scores below the 50th percentile undergoing ACLR + meniscus repair have 5 degrees less total ROM at 3 months compared with those with high grit scores. Quicker ROM recovery in patients with high grit may be a leading indicator of these patients' likelihood to achieve other postoperative milestones and meet criteria for RTS more quickly; the relationship between grit and readiness for RTS should be further investigated. LEVEL OF EVIDENCE Level IV; retrospective cohort study.
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Affiliation(s)
- Nicolas Pascual-Leone
- Hospital for Special Surgery, New York, NY
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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39
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Cui H, Cao Z, Wang S, Zhang H, Chen Z, Wu X, Zhao Y, Qie S, Li W. Surface electromyography characteristics of patients with anterior cruciate ligament injury in different rehabilitation phases. Front Physiol 2023; 14:1116452. [PMID: 37051018 PMCID: PMC10083235 DOI: 10.3389/fphys.2023.1116452] [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: 12/05/2022] [Accepted: 03/13/2023] [Indexed: 03/29/2023] Open
Abstract
Background: Anterior cruciate ligament reconstruction (ACLR) is a common treatment for anterior cruciate ligament (ACL) injury. However, after ACLR, a significant proportion of patients do not return to pre-injury levels. Research on muscle function during movement has important implications in rehabilitation. Methods: Sixty patients with unilateral ACL injury were recruited for this study and assigned into three groups: group A, individuals with an ACL injury before 6 months; group B, individuals with ACLR from 6 months to 1 year; and group C, individuals with ACLR 1 year later. Surface electromyography (SEMG) signals were collected from the bilateral rectus femoris (RF), vastus medialis (VM), vastus lateralis (VL), biceps femoris (BF), and semitendinosus (ST). The tasks performed during the experiment included straight leg raising (SLR) training at 30°, SLR training at 60°, ankle dorsiflexion, walking, and fast walking. Results: In the maximum muscle strength test, the affected side of the BF in group A (199.4 ± 177.12) was significantly larger than in group B (53.91 ± 36.61, p = 0.02) and group C (75.08 ± 59.7, p = 0.023). In the walking test, the contralateral side of the RF in group B (347.53 ± 518.88) was significantly greater than that in group C (139.28 ± 173.78, p = 0.029). In the SLR training (60°) test, the contralateral side of the RF in group C (165.37 ± 183.06) was significantly larger than that in group A (115.09 ± 62.47, p = 0.023) and smaller than that in group B (226.21 ± 237.17, p = 0.046); In the ankle dorsiflexion training test, the contralateral side of the RF in group B (80.37 ± 87.9) was significantly larger than that in group C (45.61 ± 37.93, p = 0.046). Conclusion: This study showed the EMG characteristics of patients with ACL injury helped to determine which muscle requires more training and which exercise model would be best suited for intervention.
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Affiliation(s)
- Hongxing Cui
- Department of Rehabilitation, Binzhou Medical University Hospital, Binzhou, Shandong, China
| | - Zhijie Cao
- Department of Rehabilitation, Binzhou Medical University Hospital, Binzhou, Shandong, China
| | - Shanshan Wang
- Department of Rehabilitation, Binzhou Medical University Hospital, Binzhou, Shandong, China
| | - Hao Zhang
- School of Rehabilitation Medicine, Binzhou Medical University, Yantai, Shandong, China
| | - Ze Chen
- School of Rehabilitation Medicine, Binzhou Medical University, Yantai, Shandong, China
| | - Xipeng Wu
- School of Rehabilitation Medicine, Binzhou Medical University, Yantai, Shandong, China
| | - Yixuan Zhao
- School of Rehabilitation Medicine, Binzhou Medical University, Yantai, Shandong, China
| | - Shuyan Qie
- Department of Rehabilitation, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Wei Li
- Department of Rehabilitation, Binzhou Medical University Hospital, Binzhou, Shandong, China
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Graham MC, Reeves KA, Johnson DL, Noehren B. Relationship Between Quadriceps Strength and Knee Joint Power During Jumping After ACLR. Orthop J Sports Med 2023; 11:23259671231150938. [PMID: 37025125 PMCID: PMC10071200 DOI: 10.1177/23259671231150938] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 11/02/2022] [Indexed: 04/08/2023] Open
Abstract
Background Knee joint power is significantly impaired during the propulsive phase of jumping after anterior cruciate ligament reconstruction (ACLR); however, it is currently unknown how quadriceps strength influences knee joint power. Purpose To (1) evaluate the relationship between quadriceps strength, joint power, and the percentage contribution of the hip, knee, and ankle joints to total limb power during the propulsive phase of jumping and (2) establish a quadriceps strength cutoff value for maximizing the likelihood of having knee joint power characteristics similar to healthy participants. Study Design Cross-sectional study; Level of evidence, 3. Methods A total of 75 participants were included in this study-40 patients who underwent ACLR 6 months before (18 females; mean age, 19.3 ± 5.7 years) and 35 healthy controls (HC) (20 females; mean age, 21.5 ± 4.5 years). Participants performed a drop vertical jump and underwent isometric quadriceps strength testing. The peak joint power was calculated as the product of the internal joint moment and joint angular velocity. Pearson product-moment correlations were used to assess the relationship between quadriceps strength and knee joint power. Paired samples t tests were used to quantify differences between limbs. Receiver operating characteristic (ROC) curve analysis was used to determine a quadriceps strength cutoff. Results The involved limbs of the ACLR cohort (INV) had significantly lower peak knee joint power and percentage contribution from the knee joint during jumping compared with the uninvolved limbs (NON) and limbs of the controls (INV, 2.5 ± 1.2 W/kg; NON, 4.4 ± 1.5 W/kg; HC, 4.3 ± 1.7 W/kg [P < .0001]). Quadriceps strength was associated with knee joint power in involved limbs and limbs of controls (INV, r = 0.50; HC, r = 0.60). A quadriceps strength cutoff value of 2.07 N·m/kg had an area under the ROC curve of 0.842, indicating good predictive accuracy. Conclusion Athletes at 6 months after ACLR demonstrated knee-avoidant jumping mechanics and had significant reductions in knee joint power on the involved limb. A quadriceps strength cutoff value of 2.07 N·m/kg can help predict which athletes will display knee joint power characteristics similar to those of healthy controls.
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Affiliation(s)
- Megan C. Graham
- Department of Physical Therapy, University of Kentucky, Lexington,
Kentucky, USA
| | - Kelsey A. Reeves
- Department of Orthopaedic Surgery and Sports Medicine, University of
Kentucky, Lexington, Kentucky, USA
| | - Darren L. Johnson
- Department of Physical Therapy, University of Kentucky, Lexington,
Kentucky, USA
| | - Brian Noehren
- Department of Physical Therapy, University of Kentucky, Lexington,
Kentucky, USA
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The Evaluation of Asymmetry in Isokinetic and Electromyographic Activity (sEMG) of the Knee Flexor and Extensor Muscles in Football Players after ACL Rupture Reconstruction and in the Athletes following Mild Lower-Limb Injuries. J Clin Med 2023; 12:jcm12031144. [PMID: 36769792 PMCID: PMC9917777 DOI: 10.3390/jcm12031144] [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: 01/09/2023] [Revised: 01/23/2023] [Accepted: 01/30/2023] [Indexed: 02/04/2023] Open
Abstract
This study was aimed at evaluating knee stabilizer (quadriceps and hamstring) muscle strength and the medio-lateral symmetry of hamstring fatigue in football players after ACL reconstruction and with mild lower extremity injuries. The study comprised 65 professional football players who were divided into three groups: Group 1 (n = 24; 22.7 ± 3.6 years; 175 ± 4 cm; 77.3 ± 7.6 kg) after ACL reconstruction, Group 2 (n = 21; 20.5 ± 3.7 years; 177 ± 6 cm; 74.3 ± 9.1 kg) with mild lower-limb injuries (grade 1 muscle strains) and Group 3 (n = 20; 23.1 ± 2.8 years; 178 ± 6 cm; 75.8 ± 8.8 kg) without injuries in the past 3 years. The concentric isokinetic test (10 knee flexions and extensions at 60, 180 and 300°/s with a 30 s interval for rest) was performed on both limbs. Fatigue symmetry between the medial and lateral hamstrings was measured with sEMG during 60 s of isometric contractions. In comparison to the other groups, the injured leg demonstrated significantly lower values of peak torque for the quadriceps (G1-G2 = 48%, 38%, 14%; G1-G3 = 49%, 25%, 14%) and hamstring muscles (G1-G2 = 36%, 35%, 18%; G1-G3 = 64%, 28%, 17%) as well as lower values of hamstring muscle work (G1-G2 = 262 J, 157 J; G1-G3 = 219 J, 179 J) and power (G1-G2 = 34 W; 11 W; G1-G3 = 29 W, 12 W). No significant differences were noted in strength between Groups 2 and 3. The significantly higher fatigue of the BF compared to the SEM muscle was seen in Group 1 for the involved (mean difference = 0.12) and uninvolved limbs (mean difference = -0.10), but in Group 2, a non-significant trend towards asymmetry was also noted. No asymmetry in hamstring muscle fatigue was determined in Group 3. The results of our study allow us to indicate that active football players who previously met the RTS criteria, had deficits in lower-limb muscle performance 2-3 years after reconstruction, which could lead to ACL re-injury. This observation is potentially of importance because these deficits may not be subjectively reported by such athletes and also may not be visible in regular orthopedic and physiotherapeutic assessment.
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Examining the Effects of Mirror Therapy on Psychological Readiness and Perception of Pain in ACL-Injured Female Football Players. J Funct Morphol Kinesiol 2022; 7:jfmk7040113. [PMID: 36547659 PMCID: PMC9788338 DOI: 10.3390/jfmk7040113] [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: 11/22/2022] [Revised: 12/08/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
Virtual reality-guided imagery (VRGI) and mirror therapy (MT) have been used in isolation to treat patients suffering from different injuries. However, no attempts have been made to understand the effects of combined VRGI and MT added to conventional physical therapy, and no information exists regarding perceptual responses to these rehabilitation strategies in female football players. Thus, this study aimed to examine the effect of MT added to conventional rehabilitation on psychological readiness and perception of pain in ACL-injured female football players. Thirty ACL-injured female football players competing in the 2nd and 3rd Italian tier who underwent an ACL rehabilitation program from the same clinic participated in this study. Players were randomly distributed in an MT group (n = 15) and a CON group (n = 15). All participants reported their perception of pain on a VAS before and after the interventions and their psychological readiness to return to sport after ACL injury and reconstruction surgery on the ACL-RSI scale after the intervention. An independent-sample t-test was performed to assess between-group differences in post-intervention ACL-RSI, and a further independent-sample t-test to assume non-significant differences between VAS values before the intervention. A two-way repeated-measures analysis of variance was used to test the null hypothesis of no different change in VAS over time between groups. After the intervention, the MT group perceived largely greater psychological readiness (p < 0.01). MT and CON groups experienced a large reduction in VAS after the intervention (p < 0.001). However, a small time × group interaction was observed (p = 0.023). MT reported a greater perception of the psychological readiness of the soccer players and a lower perception of pain than those who performed conventional therapy.
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Marok E, Soundy A. The effect of kinesiophobia on functional outcomes following anterior cruciate ligament reconstruction surgery: an integrated literature review. Disabil Rehabil 2022; 44:7378-7389. [PMID: 34822258 DOI: 10.1080/09638288.2021.1998665] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE Evaluate the effect of kinesiophobia on functional outcomes following anterior cruciate ligament reconstruction (ACLR). MATERIALS AND METHODS A three-phase, integrated mixed-methods review of observational and qualitative studies was undertaken. (1) Systematic search of studies with participants over 12 years old, following ACLR and focusing on kinesiophobia, using the Tampa Scale of Kinesiophobia (TSK) for observational studies. Exclusion criteria included ipsilateral knee surgery and the involvement of elite athletes. (2) Critical appraisal for both design types was undertaken. (3) Synthesis occurred in five stages. Results were reported as a relationship between the TSK and other functional outcome measures. Finally, qualitative results were integrated to explain the results. RESULTS Twenty-four studies (1174 participants) were included with no exclusion based on the quality appraisal. Six themes were identified: (1) return to sport (RTS); (2) activities of daily living; (3) knee-related quality of life; (4) gait; (5) reinjury; and (6) knee disability and physical function. The highest strength of evidence was the negative association between increased TSK scores and both decreased activity levels and RTS. CONCLUSIONS Kinesiophobia affects a range of functional outcomes. Further research is required to identify screening tools and interventions for patients with kinesiophobia.IMPLICATIONS FOR REHABILITATIONKinesiophobia affects the effectiveness of rehabilitation following anterior cruciate ligament reconstruction, therefore addressing kinesiophobia both pre- and post-ACLR is important to optimise rehabilitation.Validated screening tools are required to identify kinesiophobia in individuals early to allow appropriate rehabilitation.Physiotherapists need to use a range of physiotherapeutic techniques, such as motor imagery and prehabilitation to assist individuals to overcome their kinesiophobia and improve their functional outcomes post-ACLR.
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Affiliation(s)
- Ellie Marok
- Physiotherapy Department, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Andrew Soundy
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
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Muacevic A, Adler JR, Moros G, Mylonas D, Kouzelis A, Gliatis J. Isokinetic Muscle Strength and Knee Function in Anatomical Anterior Cruciate Ligament Reconstruction With Hamstring Autografts: A Prospective Randomized Comparative Study Between Suspensory and Expandable Femoral Fixation in Male Patients. Cureus 2022; 14:e32482. [PMID: 36644094 PMCID: PMC9836015 DOI: 10.7759/cureus.32482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2022] [Indexed: 12/15/2022] Open
Abstract
Background Clinical performance, anterior knee stability, and isokinetic strength after anterior cruciate ligament (ACL) reconstruction with hamstring autografts are mainly influenced by graft selection, femoral tunnel preparation, and type of femoral fixation. Expandable femoral fixation devices are expected to provide a stronger initial fixation with circular graft compression, a blind-ended tunnel in the femur with less enlargement, and a theoretical double-band ACL equivalent through graft rotation. This study aimed to evaluate isokinetic strength and functional capacity after ACL reconstruction with hamstring tendons using two different anatomical femoral fixation techniques (expandable vs fixed-looped button). Methodology A total of 48 male patients with ACL deficient knees were randomized to two different femoral fixation groups, namely, the expandable (AperFix) and the standard cortical (Button) group. The primary outcome measures were isokinetic hamstrings and quadriceps strength capabilities and the hamstrings/quadriceps ratio at 60 degrees/second (°/s) and 180°/s using a Cybex before and at three, six, nine, 12, and 24 months after surgery. Secondary measurements were anteroposterior knee stability at two years (using KT-1000 arthrometer) and the functional outcome using the International Knee Documentation Committee (IKDC 2000) form, the Tegner activity scale, and the Lysholm knee score. Data were compared using a paired t-test and analysis of variance, with a p < 0.05 level of significance. Results Most patients regained the 60°/s quadriceps strength between three and 12 months (62.5% for the Button group vs. 50% for the AperFix group), as well as the 180°/s strength (79.17% vs 70.83%); however, at the 24-month evaluation, seven (29.17%) patients in the Button group and five (20.83%) in the AperFix group had significant deficits. The 60°/s flexor strength was regained in the first six months in 19 (79.17%) patients in the Button group and in 16 (66.7%) patients in the AperFix group, whereas the percentages for the 180°/s strength were 79.17% and 75%, respectively. Beyond the 24-month evaluation, only three (12.5%) patients in the Button group and four (16.67%) in the AperFix group had significant flexor deficits. Regarding the H/Q ratio, at 60°/s, the mean recovery time was six and 7.5 months for the Button and AperFix groups, respectively, whereas 15 and 12 patients, respectively, did not recover during the two-year duration. At 180°/s, a mean recovery time of six months was needed for the button group, and nine patients did not recover two years later. For the AperFix group, nine months were needed, and 12 patients did not recover in two years. Clinical performance and anterior knee stability showed no statistically significant differences between groups. Conclusions Although there were no significant differences in clinical performance, knee stability, and isokinetic strength testing between expandable and cortical button femoral fixation groups, return to play was doubtful at two years postoperatively.
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Gomez-Espejo V, Olmedilla A, Abenza-Cano L, Garcia-Mas A, Ortega E. Psychological readiness to return to sports practice and risk of recurrence: Case studies. Front Psychol 2022; 13:905816. [PMID: 36211933 PMCID: PMC9540195 DOI: 10.3389/fpsyg.2022.905816] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 07/22/2022] [Indexed: 11/29/2022] Open
Abstract
Returning to sport after the sports injury is a difficult decision because it's multicausal and the fact that a rash decision can result in numerous negative consequences. Given the importance of psychological variables for the correct rehabilitation of the injured athlete and his or her optimal return to sports practice, there seems to be little information on this subject. In this sense, the objective is to determine the relationship between the subjective psychological disposition of the athlete in the process of Return to Play (RTP) with the type of mood profile and his mental health. This is based on the fact that each athlete evaluates his or her recovery differently and has different levels of anxiety, depression, and stress. For this purpose, four athletes participated in the study. Two males and two females from the sports of indoor soccer and soccer, who had just returned to sports after a moderate or severe injury. The average age was 24.25 years. Various measurements were taken after practices and after matches, to assess mood, psychological readiness, anxiety, stress, and depression. The results confirm Morgan's iceberg profile and the influence that subjective psychological perceptions and assessed emotional states have on athletes' incorporation into their sports practice with a guarantee of success.
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Affiliation(s)
| | - Aurelio Olmedilla
- Department of Personality, Evaluation and Psychological Treatment, University of Murcia, Murcia, Spain
| | | | - Alejandro Garcia-Mas
- Grupo de Investigación en Ciencias de la Actividad Fisica (GICAFE) (Research Group of Sports Sciences), University of the Balearic Islands, Palma de Mallorca, Spain
| | - Enrique Ortega
- Department of Physical Activity and Sport, Campus of Excellence Mare Nostrum, University of Murcia, Murcia, Spain
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Bakhsh HR, Metikala S, Billy GG, Vairo GL. Association Between Self-Reported Kinesiophobia and Single-Leg Hop for Distance in Patients With ACL Reconstruction: A Systematic Review. Sports Health 2022; 14:674-680. [PMID: 34651507 PMCID: PMC9460087 DOI: 10.1177/19417381211049357] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
CONTEXT Psychological readiness is a significant factor in determining successful return to sport (RTS) and physical activities after anterior cruciate ligament (ACL) reconstruction. Knowing the influence of kinesiophobia on physical tests that are used to guide RTS, such as the single-leg hop for distance (SLHD), would contribute to advancing clinical practice. OBJECTIVE To investigate the association between kinesiophobia and SLHD performance in patients after ACL reconstruction. DATA SOURCES A comprehensive search strategy entailed surveying 6 databases for relevant articles published from January 2009 to March 2021. STUDY SELECTION Articles published in English that were a minimum of level 3 evidence describing kinesiophobia, as measured by the Tampa Scale for Kinesiophobia, and related to SLHD performance in patients after ACL reconstruction. STUDY DESIGN Systematic review. LEVEL OF EVIDENCE Level 3. DATA EXTRACTION Study characteristics, sample population demographics, instrument(s), or approach(s) used to assess kinesiophobia and SLHD performance, and corresponding results. RESULTS A total of 152 potential studies were identified, 106 studies underwent screening, 40 were reviewed in full, and 7 studies were included. Meta-analysis could not be performed because of differences in experimental design among studies and instances of missing outcome data. Currently, moderate evidence indicates patients with ACL reconstruction that exhibit less kinesiophobia perform better on the SLHD test. CONCLUSION The outcomes of this review propose that sports health practitioners consider the influence of kinesiophobia on SLHD performance as a criterion for RTS and physical activities in patients after ACL reconstruction. Higher quality studies are necessary to establish the extent of association between these variables.
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Affiliation(s)
- Hadeel R. Bakhsh
- Department of Rehabilitation, College
of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University,
Riyadh, Saudi Arabia
| | - Sreenivasulu Metikala
- Department of Orthopaedic Surgery,
Virginia Commonwealth University Medical Center, Richmond, Virginia
| | - Gregory G. Billy
- Department of Orthopaedics &
Rehabilitation, College of Medicine, Pennsylvania State University, University Park,
Pennsylvania
| | - Giampietro L. Vairo
- Department of Orthopaedics &
Rehabilitation, College of Medicine, Pennsylvania State University, University Park,
Pennsylvania
- Department of Kinesiology, College of
Health and Human Development, Pennsylvania State University, University Park,
Pennsylvania
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Raizah A, Alhefzi A, Alshubruqi AAM, Hoban MAMA, Ahmad I, Ahmad F. Perceived Kinesiophobia and Its Association with Return to Sports Activity Following Anterior Cruciate Ligament Reconstruction Surgery: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191710776. [PMID: 36078492 PMCID: PMC9518115 DOI: 10.3390/ijerph191710776] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/20/2022] [Accepted: 08/24/2022] [Indexed: 06/10/2023]
Abstract
Background: The knee joint is one of the most important joints in terms of its functions of providing great stability, movement and weight bearing. Among the contributors to knee joint stability, there is the anterior cruciate ligament (ACL). Kinesiophobia is said to be the fear of movement or the fear of re-injury. Kinesiophobia is the most extreme form of fear of movement, and it is defined as an excessive, irrational, and debilitating fear of physical movement and activity resulting from a feeling of vulnerability to painful injury or re-injury. Aim: To estimate the prevalence and effect of kinesiophobia among patients with ACL reconstruction in the Aseer region, in southern Saudi Arabia. Methodology: A descriptive cross-sectional approach was used involving those patients who underwent ACL reconstruction surgery in Aseer Central Hospital during the period of October 2017 to October 2019. The Tampa Scale for Kinesiophobia (TSK) and ACL-Return to Sport after Injury (ACL-RSI) scale were used to determine kinesiophobia and the readiness to return to sport after ACL injury or reconstructive surgery. Result: The research included 130 ACL reconstruction patients with ages ranging from 18 to 45 years with a mean age of 27.2 + 7.5 years. More than 97% of the participants were males. In 67.7% of the cases, the right leg was affected. A total of 10.8% of the patients recorded a low level of kinesiophobia, while only 6.9% recorded a high level. Conclusions: In conclusion, the study revealed that among patients who underwent ACL reconstruction, kinesiophobia was at a moderate level. Kinesiophobia was recorded more among middle-aged patients who waited a long time from the onset of injury until the ACL reconstruction surgery time.
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Affiliation(s)
- Abdullah Raizah
- Department of Orthopedics, College of Medicine, King Khalid University, Abha 62529, Saudi Arabia
| | - Ali Alhefzi
- Department of Orthopedics, College of Medicine, King Khalid University, Abha 62529, Saudi Arabia
| | | | | | - Irshad Ahmad
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 62529, Saudi Arabia
| | - Fuzail Ahmad
- College of Applied Sciences, AlMareefa University, Riyadh 13713, Saudi Arabia
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Abstract
PURPOSE OF REVIEW The purpose of this review is to discuss treatment options, rehabilitation protocols, return-to-play criteria, and expected outcomes after non-operative and operative treatment of anterior cruciate ligament (ACL) tears among an athletic population. RECENT FINDINGS Non-operative treatment may be a viable option for some athletes with an ACL tears but can be difficult to predict "copers," and those that resume to sports return at lower performance level and/or less intense activities. Most studies assessing function after ACL reconstruction demonstrate favorable outcomes using patient-reported outcome studies. However, return-to-play and graft re-rupture rates vary substantially based on patient characteristics and level and type of athletic activity. Grafts used to reconstruct ACL produce similar objective outcomes and favorable patient-reported outcomes but have variable re-rupture rates depending on study and differ largely on morbidity associated with graft harvest. Various treatment methods including non-operative and operative techniques have been demonstrated to be efficacious in returning athletes to athletic activity depending on patient age and level of activity. Adherence to fundamental rehabilitation principles and accepted return-to-play guidelines can optimize outcomes and limit re-injury to the injured or contralateral limb.
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Tim-Yun Ong M, Fu SC, Mok SW, Franco-Obregón A, Lok-Sze Yam S, Shu-Hang Yung P. Persistent quadriceps muscle atrophy after anterior cruciate ligament reconstruction is associated with alterations in exercise-induced myokine production. Asia Pac J Sports Med Arthrosc Rehabil Technol 2022; 29:35-42. [PMID: 35847192 PMCID: PMC9263390 DOI: 10.1016/j.asmart.2022.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 04/05/2022] [Accepted: 05/18/2022] [Indexed: 01/03/2023] Open
Abstract
Purpose Persistent quadriceps muscle atrophy is observed in a subset of patients following anterior cruciate ligament reconstruction (ACLR) despite the completion of comprehensive rehabilitation. Critically, quadriceps muscle atrophy correlates with muscle weakness and quadriceps strength deficits. The aim of this study was to examine the effect of resistance exercise on myokine levels and muscle atrophy status in ACLR patients with persistent quadriceps muscle atrophy. Methods Sixteen participants between the ages of 18–39 with a Tegner score of >6 and who had undergone ACLR with hamstring graft were recruited for the study. Quadriceps muscle thicknesses were ascertained by ultrasonography and isokinetic strength assessments were made prior to commencing a single bout of resistance exercise training (RET). Blood samples were taken before and after RET and assayed for myokine expression. Self-reported activity level and knee function questionnaires were completed and recorded. Results Clustering by quadriceps muscle size measurements created a non-atrophy group of 9 subjects and an atrophy group of 7 subjects. There were no significant between-group differences in anthropometric measurements, time post operation and knee function questionnaires, but the atrophic group comprised of patients with lower pre-injury sporting levels. The atrophy group exhibited significant lower side-to-side muscle thickness ratios and a decreasing trend in quadriceps strength deficits. Serum brain-derived neurotrophic factor (BDNF) was up-regulated in response to RET in non-atrophy group, but a negative fold change was detected in the atrophy group. Conclusion The dysregulation in myokines plays an important role in patients failing to regain muscle mass after ACLR leading to persistent quadriceps muscle atrophy, which may potentiate greater strength deficits and poor functional recovery.
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Affiliation(s)
- Michael Tim-Yun Ong
- Department of Orthopaedics & Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.,Lui Che Woo Institute of Innovative Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Sai-Chuen Fu
- Department of Orthopaedics & Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.,Lui Che Woo Institute of Innovative Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Sze-Wing Mok
- Department of Orthopaedics & Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.,Lui Che Woo Institute of Innovative Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Alfredo Franco-Obregón
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,BioIonic Currents Electromagnetic Pulsing Systems (BICEPS) Laboratory, National University of Singapore, Singapore.,Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Institute for Health Innovation and Technology, iHealthtech, National University of Singapore, Singapore
| | - Stacy Lok-Sze Yam
- Department of Orthopaedics & Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.,Lui Che Woo Institute of Innovative Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Patrick Shu-Hang Yung
- Department of Orthopaedics & Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.,Lui Che Woo Institute of Innovative Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
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Huang J, Xu Y, Xuan R, Baker JS, Gu Y. A Mixed Comparison of Interventions for Kinesiophobia in Individuals With Musculoskeletal Pain: Systematic Review and Network Meta-Analysis. Front Psychol 2022; 13:886015. [PMID: 35846681 PMCID: PMC9277051 DOI: 10.3389/fpsyg.2022.886015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/30/2022] [Indexed: 11/28/2022] Open
Abstract
Objective This systematic review aims to make a mixed comparison of interventions for kinesiophobia and individuals with musculoskeletal pain. Methods A comprehensive search strategy was conducted in the database of PubMed, MEDLINE, and Web of Science with the inclusion criteria: (1) randomized controlled design; (2) patients with musculoskeletal pain as participants; (3) treatments protocols of kinesiophobia as interventions or comparisons; (4) the score of Tampa Scale Kinesiophobia (TSK) as outcome measures. A network meta-analysis was used to synthesize the data after checking the model consistency. The risk of bias was assessed by the Cochrane Collaboration Risk of Bias Assessment Tool. Results Thirty-one studies were included in this review after a comprehensive search strategy with a low risk of bias and good consistency. According to the results of the network meta-analysis, a multi-modal treatment protocol had the highest probability to become the best choice in dealing with kinesiophobia caused by musculoskeletal pain, whereas psychological treatment protocols also showed a potentially positive effect on musculoskeletal pain-induced kinesiophobia. Conclusion Multi-modal protocols could be recommended as the preferred option when dealing with kinesiophobia caused by musculoskeletal pain. However, it is still worth mentioning that there are also potentially positive therapeutic effects of psychological interventions. Since the concept of kinesiophobia is based on the fear-avoidance model, the psychological mechanism should be paid enough attention to during treatment. Registration Number CRD42021286450.
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Affiliation(s)
- Jialu Huang
- Faculty of Sports Science, Ningbo University, Ningbo, China
| | - Yining Xu
- Faculty of Sports Science, Ningbo University, Ningbo, China
| | - Rongrong Xuan
- The Affiliated Hospital of Medical School of Ningbo University, Ningbo, China
| | - Julien S. Baker
- Department of Sport and Physical Education, Hong Kong Baptist University, Kowloon, Hong Kong SAR, China
| | - Yaodong Gu
- Faculty of Sports Science, Ningbo University, Ningbo, China
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