Dataset Information

Superior 2-Year Functional Outcomes Among Young Female Athletes After ACL Reconstruction in 10 Return-to-Sport Training Sessions: Comparison of ACL-SPORTS Randomized Controlled Trial With Delaware-Oslo and MOON Cohorts.

ABSTRACT: Background:Outcomes after anterior cruciate ligament reconstruction (ACLR) are not uniformly good and are worse among young female athletes. Developing better rehabilitation and return-to-sport training programs and evaluating their outcomes are essential. Purpose:(1) Test the effect of strength, agility, plyometric, and secondary prevention (SAPP) exercises with and without perturbation training (SAPP + PERT) on strength, hops, function, activity levels, and return-to-sport rates in young female athletes 1 and 2 years after ACLR and (2) compare 2-year functional outcomes and activity levels among young female athletes in the Anterior Cruciate Ligament Specialized Post-Operative Return-to-Sports (ACL-SPORTS) trial to homogeneous cohorts who completed criterion-based postoperative rehabilitation alone (Multicenter Orthopaedic Outcomes Network [MOON]) and in combination with extended preoperative rehabilitation (Delaware-Oslo). Study Design:Randomized controlled trial, Level of evidence, 1; and cohort study, Level of evidence, 3. Methods:A total of 40 level 1 and level 2 female athletes were enrolled after postoperative impairment resolution 3 to 9 months after primary ACLR. Participants were randomized to 10 SAPP or SAPP + PERT sessions and were tested 1 and 2 years after ACLR on quadriceps strength, hop tests, functional outcomes, and return-to-sport rates. Participants were then compared with homogeneous cohorts of young (<25 years) female athletes who completed criterion-based postoperative rehabilitation alone (MOON) and in combination with extended preoperative rehabilitation (Delaware-Oslo) on 2-year functional outcomes. Results:No significant or meaningful differences were found between SAPP and SAPP + PERT, so groups were collapsed for comparison with the other cohorts. At 2-year follow-up, ACL-SPORTS had the highest scores (P < .01) on the Marx activity rating scale (ACL-SPORTS, 13.5 ± 3.3; Delaware-Oslo, 12.5 ± 2.7; MOON, 10.6 ± 5.1); International Knee Documentation Committee Subjective Knee Evaluation Form (96 ± 7, 92 ± 9, and 84 ± 14, respectively); and Knee injury and Osteoarthritis Outcome Score (KOOS) subscales for Pain (98 ± 4, 94 ± 9, and 90 ± 10, respectively), Symptoms (94 ± 6, 90 ± 9, and 83 ± 14, respectively), Activities of Daily Living (100 ± 1, 99 ± 4, and 96 ± 7, respectively), Sports and Recreation (94 ± 8, 86 ± 15, and 82 ± 17, respectively), and Quality of Life (89 ± 14, 78 ± 18, and 76 ± 19, respectively). The Patient Acceptable Symptom State threshold on the KOOS-Sports and Recreation was achieved by 100% of the ACL-SPORTS cohort compared with 90% of Delaware-Oslo and 78% of MOON (P = .011). Conclusion:Although perturbation training provided no added benefit, 10 sessions of return-to-sport training, compared with criterion-based postoperative rehabilitation alone, yielded statistically significant and clinically meaningfully higher 2-year functional outcomes among young, high-level female athletes after ACLR. Registration:NCT01773317 (ClinicalTrials.gov identifier).

SUBMITTER: Capin JJ

PROVIDER: S-EPMC6676263 | biostudies-literature | 2019 Aug

REPOSITORIES: biostudies-literature

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Superior 2-Year Functional Outcomes Among Young Female Athletes After ACL Reconstruction in 10 Return-to-Sport Training Sessions: Comparison of ACL-SPORTS Randomized Controlled Trial With Delaware-Oslo and MOON Cohorts.

Capin Jacob J JJ Failla Mathew M Zarzycki Ryan R Dix Celeste C Johnson Jessica L JL Smith Angela H AH Risberg May Arna MA Huston Laura J LJ Spindler Kurt P KP Snyder-Mackler Lynn L

Orthopaedic journal of sports medicine 20190801 8

<h4>Background</h4>Outcomes after anterior cruciate ligament reconstruction (ACLR) are not uniformly good and are worse among young female athletes. Developing better rehabilitation and return-to-sport training programs and evaluating their outcomes are essential.<h4>Purpose</h4>(1) Test the effect of strength, agility, plyometric, and secondary prevention (SAPP) exercises with and without perturbation training (SAPP + PERT) on strength, hops, function, activity levels, and return-to-sport rates ...[more]

PMID: 31413963

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Project description:BACKGROUND:Rehabilitation before anterior cruciate ligament (ACL) reconstruction (ACLR) is effective at improving postoperative outcomes at least in the short term. Less is known about the effects of preoperative rehabilitation on functional outcomes and return-to-sport (RTS) rates 2 years after reconstruction. PURPOSE/HYPOTHESIS:The purpose of this study was to compare functional outcomes 2 years after ACLR in a cohort that underwent additional preoperative rehabilitation, including progressive strengthening and neuromuscular training after impairments were resolved, compared with a nonexperimental cohort. We hypothesized that the cohort treated with extended preoperative rehabilitation would have superior functional outcomes 2 years after ACLR. STUDY DESIGN:Cohort study; Level of evidence, 3. METHODS:This study compared outcomes after an ACL rupture in an international cohort (Delaware-Oslo ACL Cohort [DOC]) treated with extended preoperative rehabilitation, including neuromuscular training, to data from the Multicenter Orthopaedic Outcomes Network (MOON) cohort, which did not undergo extended preoperative rehabilitation. Inclusion and exclusion criteria from the DOC were applied to the MOON database to extract a homogeneous sample for comparison. Patients achieved knee impairment resolution before ACLR, and postoperative rehabilitation followed each cohort's respective criterion-based protocol. Patients completed the International Knee Documentation Committee (IKDC) subjective knee form and Knee injury and Osteoarthritis Outcome Score (KOOS) at enrollment and again 2 years after ACLR. RTS rates were calculated for each cohort at 2 years. RESULTS:After adjusting for baseline IKDC and KOOS scores, the DOC patients showed significant and clinically meaningful differences in IKDC and KOOS scores 2 years after ACLR. There was a significantly higher (P < .001) percentage of DOC patients returning to preinjury sports (72%) compared with those in the MOON cohort (63%). CONCLUSION:The cohort treated with additional preoperative rehabilitation consisting of progressive strengthening and neuromuscular training, followed by a criterion-based postoperative rehabilitation program, had greater functional outcomes and RTS rates 2 years after ACLR. Preoperative rehabilitation should be considered as an addition to the standard of care to maximize functional outcomes after ACLR.

Project description:While there are many opinions about the expected knee function, sports participation, and risk of knee reinjury following nonsurgical treatment of injuries of the anterior cruciate ligament (ACL), there is a lack of knowledge about the clinical course following nonsurgical treatment compared with that after surgical treatment.This prospective cohort study included 143 patients with an ACL injury. Isokinetic knee extension and flexion strength and patient-reported knee function as recorded on the International Knee Documentation Committee (IKDC) 2000 form were collected at baseline, six weeks, and two years. Sports participation was reported monthly for two years with use of an online activity survey. Knee reinjuries were reported at the follow-up evaluations and in a monthly online survey. Repeated analysis of variance (ANOVA), generalized estimating equation (GEE) models, and Cox regression analysis were used to analyze group differences in functional outcomes, sports participation, and knee reinjuries, respectively.The surgically treated patients (n = 100) were significantly younger, more likely to participate in level-I sports, and less likely to participate in level-II sports prior to injury than the nonsurgically treated patients (n = 43). There were no significant group-by-time effects on functional outcome. The crude analysis showed that surgically treated patients were more likely to sustain a knee reinjury and to participate in level-I sports in the second year of the follow-up period. After propensity score adjustment, these differences were nonsignificant; however, the nonsurgically treated patients were significantly more likely to participate in level-II sports during the first year of the follow-up period and in level-III sports over the two years. After two years, 30% of all patients had an extensor strength deficit, 31% had a flexor strength deficit, 20% had patient-reported knee function below the normal range, and 20% had experienced knee reinjury.There were few differences between the clinical courses following nonsurgical and surgical treatment of ACL injury in this prospective cohort study. Regardless of treatment course, a considerable number of patients did not fully recover following the ACL injury, and future work should focus on improving the outcomes for these patients.Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Project description:Purpose of reviewBecause of the epidemiological incidence of anterior cruciate ligament (ACL) injuries, the high reinjury rates that occur when returning back to sports, the actual number of patients that return to the same premorbid level of competition, the high incidence of osteoarthritis at 5-10-year follow-ups, and the effects on the long-term health of the knee and the quality of life for the patient, individualizing the return to sports after ACL reconstruction (ACL-R) is critical. However, one of the challenging but unsolved dilemmas is what criteria and clinical decision making should be used to return an athlete back to sports following an ACL-R. This article describes an example of a functional testing algorithm (FTA) as one method for clinical decision making based on quantitative and qualitative testing and assessment utilized to make informed decisions to return an athlete to their sports safely and without compromised performance. The methods were a review of the best current evidence to support a FTA.Recent findingsIn order to evaluate all the complicated domains of the clinical decision making for individualizing the return to sports after ACL-R, numerous assessments need to be performed including the biopsychosocial concepts, impairment testing, strength and power testing, functional testing, and patient-reported outcomes (PROs). The optimum criteria to use for individualizing the return to sports after ACL-R remain elusive. However, since this decision needs to be made on a regular basis with the safety and performance factors of the patient involved, this FTA provides one method of quantitatively and qualitatively making the decisions. Admittedly, there is no predictive validity of this system, but it does provide practical guidelines to facilitate the clinical decision making process for return to sports. The clinical decision to return an athlete back into competition has significant implications ranging from the safety of the athlete, to performance factors and actual litigation issues. By using a multifactorial FTA, such as the one described, provides quantitative and qualitatively criteria to make an informed decision in the best interests of the athlete.

Project description:BackgroundPerformance measures such as strength, jump height/length, and change of direction (CoD) time during anterior cruciate ligament (ACL) rehabilitation have been used to determine readiness to return to play and identify those who may be at risk of rerupture. However, athletes may reach these criteria despite ongoing biomechanical deficits when performing these tests. Combining return-to-play criteria with an assessment of movement through 3-dimensional (3D) biomechanics in male field sports athletes to identify risk factors for ACL rerupture has not been explored previously.PurposeTo prospectively examine differences in strength, jump, and CoD performance and movement using 3D biomechanics in a cohort of male athletes playing level 1 sports (ie, multidirectional field sports that involve landing, pivoting, or CoD) between those who reinjured the reconstructed ACL (RI group) and those with no reinjury (NRI group) after 2 years of follow-up and to examine the ability of these differences to predict reinjury.Study designCohort study; Level of evidence, 2.MethodsAfter primary ACL reconstruction (ACLR), 1045 male athletes were recruited and underwent testing 9 months after surgery including isokinetic strength, jump, and CoD performance measures as well as patient-reported outcomes and 3D biomechanical analyses. Participants were followed up after 2 years regarding ACL reinjury status. Differences were determined between the RI and NRI groups in patient-reported outcomes, performance measures, and 3D biomechanics on the ACLR side and symmetry between limbs. The ability of these measures to predict ACL reinjury was determined through logistic regression.ResultsNo differences were identified in strength and performance measures on the ACLR side or in symmetry. Biomechanical analysis indicated differences on the ACLR side primarily in the sagittal plane for the double-leg drop jump (effect size, 0.59-0.64) and greater asymmetry primarily in the frontal plane during unplanned CoD (effect size, 0.61-0.69) in the RI group. While these biomechanical test results were different between groups, multivariate regression modeling demonstrated limited ability (area under the curve, 0.67 and 0.75, respectively) to prospectively predict ACL reinjury.ConclusionCommonly reported return-to-play strength, jump, and timed CoD performance measures did not differ between the RI and NRI groups. Differences in movement based on biomechanical measures during double-leg drop jump and unplanned CoD were identified, although they had limited ability to predict reinjury. Targeting these variables during rehabilitation may reduce reinjury risk in male athletes returning to level 1 sports after ACLR.RegistrationNCT02771548 (ClinicalTrials.gov identifier).

Dataset Information

Superior 2-Year Functional Outcomes Among Young Female Athletes After ACL Reconstruction in 10 Return-to-Sport Training Sessions: Comparison of ACL-SPORTS Randomized Controlled Trial With Delaware-Oslo and MOON Cohorts.

Publications

Superior 2-Year Functional Outcomes Among Young Female Athletes After ACL Reconstruction in 10 Return-to-Sport Training Sessions: Comparison of ACL-SPORTS Randomized Controlled Trial With Delaware-Oslo and MOON Cohorts.

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