Limited evidence for return to sport testing after ACL reconstruction in children and adolescents under 16?years: a scoping review.
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ABSTRACT:
SUBMITTER: Dietvorst M
PROVIDER: S-EPMC7561621 | biostudies-literature | 2020 Oct
REPOSITORIES: biostudies-literature
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Limited evidence for return to sport testing after ACL reconstruction in children and adolescents under 16 years: a scoping review.
Dietvorst Martijn M Brzoskowski Maarten H MH van der Steen Marieke M Delvaux Eugenie E Janssen Rob P A RPA Van Melick Nicky N
Journal of experimental orthopaedics 20201015 1
Specific return to sport criteria for children and adolescents after anterior cruciate ligament injury and reconstruction are unknown. The aim of this scoping review is to provide an overview of current tests regarding return to sport for children and adolescents. This scoping review was performed according to the PRISMA statement. A systematic search was performed on PubMed and EMBASE. The inclusion criteria were diagnostic and prognostic studies evaluating tests regarding return to sport after ...[more]
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Project description:ContextUp to 90% of pediatric athletes return to sport (RTS) after anterior cruciate ligament reconstruction (ACL-R); however, <50% RTS at the same level and second ACL injury rates are up to 32%.Objectives(1) Determine which physical and patient-reported outcome measures guide clinical decision-making on RTS in pediatric athletes after ACL-R and (2) present a framework with insights from cognitive and neurophysiological domains to enhance rehabilitation outcomes.Data sourcesPubMed, CINAHL, Embrase, and Cochrane library databases and gray literature.Study selectionData on pediatric (<18 years) ACL-R patients, RTS, tests, and decision-making were reported in 1214 studies. Two authors independently reviewed titles and abstract, excluding 962 studies. Gray literature and cross-reference checking resulted in 7 extra studies for full-text screening of 259 studies. Final data extraction was from 63 eligible studies.Study designScoping review.Level of evidenceLevel 4.Data extractionDetails on study population, aims, methodology, intervention, outcome measures, and important results were collected in a data chart.ResultsStudies included 4456 patients (mean age, 14 years). Quadriceps and hamstring strength (n = 25), knee ligament arthrometer (n = 24), and hop tests (n = 22) were the most-reported physical outcome measures guiding RTS in <30% of studies with cutoff scores of limb symmetry index (LSI) ≥85% or arthrometer difference <3 mm. There were 19 different patient-reported outcome measures, most often reporting the International Knee Documentation Committee (IKDC) (n = 24), Lysholm (n = 23), and Tegner (n = 15) scales. Only for the IKDC was a cutoff value of 85% reported.ConclusionRTS clearance in pediatric ACL-R patients is not based on clear criteria. If RTS tests were performed, outcomes did not influence time of RTS. Postoperative LSI thresholds likely overestimate knee function since biomechanics are impaired despite achieving RTS criteria. RTS should be considered a continuum, and biomechanical parameters and contextual rehab should be pursued with attention to the individual, task, and environment. There is a need for psychological monitoring of the ACL-R pediatric population.
| S-EPMC10606966 | biostudies-literature
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.
| S-EPMC5577421 | biostudies-literature
Project description:BackgroundGeneralised joint hypermobility (GJH) has been associated with an increased risk of suffering an anterior cruciate ligament (ACL) injury. Patients with GJH exhibit lower muscle strength and poorer scores for patient-reported outcomes after ACL reconstruction, compared with patients without GJH. The aim of this study was to examine differences in the percentages of patients who return to sport (RTS) or pre-injury level of activity (RTP), muscle function and patient-reported outcomes at the time of RTS or RTP, as well as the time of RTS or RTP in patients with GJH compared with patients without GJH in the first two years after ACL reconstruction.MethodsThis prospective study used data from an ACL- and rehabilitation-specific register located in Gothenburg, Sweden. Patients aged between 16 and 50, who had a primary ACL injury treated with reconstruction, were included. Data up to two years after ACL reconstruction were used and consisted of achieving RTS and RTP, results from isokinetic muscle function tests for knee extension and flexion and patient-reported outcomes (Knee Self-Efficacy Scale, Knee injury and Osteoarthritis Outcome Score and ACL-Return to Sport after Injury scale) at the time of RTS, as well as the time of RTP. A Beighton Score of ≥ 5/9 was used to define GJH. A Tegner Activity Scale of ≥ 6 was used to define RTS, while a Tegner equal to or above pre-injury level was used to define RTP.ResultsA total of 1,198 patients (54.7% women) with a mean age of 28.5 ± 8.6 years were included. A smaller proportion of patients with GJH achieved RTS compared with patients without GJH (49.2% vs. 57.3%, Odds ratio: 0.720, p = 0.041). Furthermore, patients with GJH were marginally less symmetrical on the knee extension strength test, expressed as a Limb Symmetry Index, at the time of RTP compared with patients without GJH (87.3 ± 13.5 vs. 91.7 ± 14.3, Cohen's d = 0.142, p = 0.022). No further differences were found between groups regarding any muscle function tests or patient-reported outcomes.ConclusionA smaller proportion of patients with GJH achieved RTS compared with patients without GJH. Patients with GJH displayed less symmetrical knee extension strength at the time of RTP compared with patients without GJH.
| S-EPMC10422717 | biostudies-literature
Project description:ContextClinical guidelines support the use of testing batteries to assess athlete readiness for return to sport (RTS) and risk of reinjury after anterior cruciate ligament (ACL) reconstruction (ACL-R). There is no consensus on the composition of the testing batteries. Test selection is based mainly on commonality in research, personal preference, and equipment availability. Including athletic performance assessments (APA) used in the athlete's sport may assist RTS decision-making for stakeholders.ObjectiveTo determine whether APA for speed, agility, strength, or cardiovascular endurance are (1) used in ACL-R RTS literature and (2) indicative of RTS or reinjury rates.Data sourcesA systematic search was performed in MEDLINE, EMBASE, CINAHL, SPORTDiscus, Scopus, Web of Science, and ProQuest Dissertations and Theses Global.Study selectionEligibility criteria were as follows: (1) athletes between 6 months and 2 years post-ACL-R, (2) commonly used APA, (3) peer-reviewed primary study with original published data.Study designScoping Review.Level of evidenceLevel 4.Data extractionA total of 17 studies included 24 instances of APA with a high degree of heterogeneity for both tests and protocols.ResultsAgility makes up 75% of the APA. Only 17.6% of studies reported RTS or reinjury rates, none of which reported a significant relationship between these rates and APA outcomes.ConclusionSpeed, strength, and cardiovascular endurance tests are underrepresented in ACL-R RTS literature. Compared with healthy controls, deficits in APA results for ACL-R athletes were common; however, many studies reported significant improvements in results for ACL-R athletes over time. There is some evidence that well-trained ACL-R athletes can match the performance of uninjured athletes in high-level sports.
| S-EPMC10732109 | biostudies-literature
Project description:BackgroundDespite the association between hip abduction weakness and non-contact anterior cruciate ligament (ACL) injury, hip abduction strength is rarely considered in return to sport decision-making following ACL reconstruction (ACLR).Hypothesis/purposeThe purpose of this study was to compare self-reported function, objective functional test performance, and re-injury rates in patients with high (≥33%) versus low (<33% ) isometric hip abduction strength to body weight (BW) ratios when returning to activity following ACLR.Study designCohort study.MethodsData were gathered from a single-surgeon database and included baseline demographics. Clinical outcomes were assessed at the time of release to activity and included self-reported outcomes and a functional testing battery. Isometric hip abduction strength was obtained using a handheld dynamometer. Groups were dichotomized into those with low vs high strength to BW ratios. Two-year follow-up was performed using the single assessment numeric evaluation (SANE). Data were analyzed using univariate general linear models with an alpha level of .05.ResultsOf the 528 enrolled patients, 364 (68.9%) demonstrated a low strength to BW ratio. Baseline comparisons revealed more females and higher BMI (P <.05) in the <33% group. At release to activity, the <33% BW group demonstrated lower International Knee Documentation Committee survey scores (88.2 ± 13.6 vs 93.5 ± 10.3, P<.01), ACL-Return to Sport After Injury (76.2 ± 15.4 vs 88.5 ± 16.9, P<.01) scores, and isokinetic hamstring peak torque (P=.04). At 2-years, the <33% group reported lower SANE scores (83.3 ± 21.1 vs 92.83 ± 11.4, P=.05) with no significant differences in re-injuries.ConclusionPatients with low hip abduction strength to BW ratios demonstrated lower subjective function, psychological readiness, and isokinetic hamstring peak torque when completing functional testing following ACLR. Subjective deficits remained at 2-years.Level of evidenceLevel 3.Key termsACL injury, hip abduction strength, return to sport, strength ratio.Clinical relevanceAssessing isometric hip abduction strength to body weight ratio may be beneficial in determining readiness to return to sport following ACL reconstruction.What is known about the subjectThree prospective studies have provided conflicting evidence regarding the relationship between hip abduction strength and ACL injury. A clinical cut-point of hip abduction strength:BW ratio <35.4% has been suggested to identify athletes at risk of sustaining a non-contact ACL injury. To our knowledge no studies have examined isometric hip abduction strength:BW ratios in athletes attempting to return to sport following ACLR.What this study adds to existing knowledgeThis study examines the potential for hip abduction strength:BW ratio to be included as an additional metric in return to sport testing batteries.
| S-EPMC8486405 | biostudies-literature
Project description:Background: Loss of motion and arthrofibrosis after anterior cruciate ligament reconstruction (ACLR) can be a devastating complication for athletes. The cellular and molecular pathogenesis of arthrofibrosis is poorly understood, limiting prevention and treatment options. Synovial inflammation may contribute to post-ACLR arthrofibrosis. Hypothesis/Purpose: We hypothesized that higher synovial immune cell infiltration and inflammatory/catabolic gene expression patterns at the time of ACLR would correlate with poorer motion-related outcomes. Study Design: Case Series Methods: Patients aged 10-18 undergoing primary ACLR were enrolled in a prospective pilot study, and synovial tissue biopsies were obtained during ACLR. Flow cytometry and single cell RNA-sequencing explored synovial cell types/frequencies and gene expression. Principle component analysis followed by clustering grouped patients into distinct immunophenotypes based on their synovial cell composition. Clinical follow-up with knee range of motion (ROM), need for lysis of adhesions, and patient reported outcome measures were collected and compared between immunophenotypes. Results: Enrolled patients (n = 17) underwent ACLR at a median of 37 days post-injury. Analysis revealed three distinct immunophenotypes. Type 1 comprised patients with the longest time between injury and surgery and the lowest hematopoietic and T cell infiltration. Types 2 and 3 had similar times between injury and surgery, and Type 2 had intermediate while Type 3 had the highest hematopoietic and T cell percentages. Type 3 was associated with worse ROM at 2- and 6-weeks post-op; T cell prevalence and ROM were inversely correlated at those time points. The only patient requiring lysis of adhesions for arthrofibrosis was in Type 3. Conclusion: Synovial immune infiltration after ACL injury shows variability between patients that clusters into three immunophenotypes correlating with early ROM and the risk of arthrofibrosis. T cell recruitment and infiltration was the strongest factor correlated with ROM outcomes and presents an exciting venue for future research on post-ACLR arthrofibrosis.
2024-11-10 | GSE280537 | GEO
Project description:BackgroundNowadays, patients widely accept anterior cruciate ligament (ACL) reconstructive surgery. However, its long-term complications are still under investigation in athletes. Therefore, the aim of this study was to evaluate long-term ACL reconstruction especially in athletes.MethodsA total of 426 patients with ACL injury were studied during 2008-2012. Demographic characteristics (gender, age, BMI), graft type, chondral lesion, osteoarthritis, meniscus tear, exercise activity, and pain intensity were noted. The effects of these factors on the return to sport activity after ACL reconstruction were also investigated. Lachman test, KT-1000, ACL quality of life (ACL-QOL), KOOS score, IKDC, and LKS were assessed at 2 years post-operation and at final follow-up. Repeated ACL rupture on the same and contralateral sides were also evaluated.Results: knee stability (based on Lachman and KT-1000), knee function (according to KOOS, LKS, and IKDC scores) and ACL-QOL were improved during the 2 years follow-up. The rate of return to sport activity similar to preinjury in patients was 64.08% in final follow-up. Chondral lesion was a limiting factor among the variables that affected the return to sport activity. It caused a return to sport activity similar to pre injury just in 21.24% of the patients. However, meniscus rupture did not affect return to sport activity similar to pre injury. Also, the rate of return to sport activity similar to pre injury was higher in men, patients under 30 years and those who had BMI of 20-25 kg/m2. In final follow-up, risk of ACL rupture in the injured knee and contralateral knee was 4.22% and 10.57%, respectively.ConclusionDespite the recovery of patients after ACL reconstruction during long-term follow-up in athletes, return to sport activity similar to pre-injury in female, older peoples, overweight patients and athletes with chondral lesion were lower. However, these conditions do not apply to the meniscus rupture.
| S-EPMC7275270 | biostudies-literature
Project description:PURPOSE:To compare return to sport and knee function 1 year after anterior cruciate ligament (ACL) reconstruction using autografts with and without vancomycin presoaking. METHODS:A case-control study based on a retrospective analysis of prospective data included athletes over the age of 16 operated from 2012 to 2018 for ACL reconstruction. There were two groups of patients due to a change in treatment protocols: Group 1?«?without vancomycin?»?before November 2016 and Group 2?«?with vancomycin»?after this date. In Group 2, the graft was soaked in a vancomycin solution for 10 min and then fixed into the bone tunnels. The primary evaluation criterion was the return to sport 1 year after surgery. The secondary criteria were various knee scores. The number of patients needed to perform a non-inferiority study was calculated. RESULTS:1674 patients fulfilled the selection criteria, 1184 in Group 1 and 490 in Group 2. The series included 1112 men and 562 women, mean age 30?±?9.7 years, 68 professional athletes, 674 competitive athletes and 932 recreational athletes. While seven patients presented with post-operative septic arthritis in Group 1, this complication was not found in Group 2. No significant difference was identified in the return to running between the two groups 1 year after surgery (75.9% vs. 76.1%, n.s.). Significantly more of the patients in Group 2 returned to their preinjury sport (p?=?0.04). Knee function was comparable between the groups. CONCLUSION:Vancomycin-soaked grafts during ACL reconstruction reduce the risk of post-operative infection of the knee without affecting the return to sport or knee function. LEVEL OF EVIDENCE:III. TRIAL REGISTRATION:https://clinicaltrials.gov/ , ClinicalTrials.gov Identifier: NCT02511158.
| S-EPMC7429534 | biostudies-literature
Project description:PurposeThe purpose of this study is to analyze the short anterior cruciate ligament return to sport after injury (ACL-RSI) (Persian) version's cultural adaption and validity.MethodsTo assess test-retest reliability, 102 participants were filled out the short ACL-RSI(Per) scale 6 months or more after ACLR surgery. Internal consistency (Cronbach's alpha), test-retest reliability (intraclass correlation coefficients), construct validity (Pearson's r) and sensitivity (floor/ceiling effect) were determined. In addition, patient completed other relevant measures such as Lysholm scores, the hospital for special surgery ACL satisfaction survey (HSS ACL-SS), the visual analogue scale (VAS) of pain and patient's satisfaction, the Tegner activity score (TAS), the single assessment numeric evaluation (SANE) and the Cincinnati Knee Rating System (CKRS).ResultsThe short ACL-RSI(Per) scale showed high internal consistency (Cronbach's alpha = 0.91) and test-retest reliability (ICC = 0.923). Significant correlations between short ACL-RSI(Per) and other scales supported validity. There was a statistically significant connection between the short ACL-RSI(Per) and the following outcomes: HSS ACL-SS (r = 0.698, p < 0.001), VAS pain (r = 0.356, p < 0.001), CKRS (r = 0.644, p < 0.001), TAS (r = 0414, p < 0.001), Lysholm score (r = 0.467, p < 0.001) and SANE score (r = 0.536; p < 0.001). In addition to a satisfactory ceiling impact (15%), a sizeable floor effect (16.7%) was also seen.ConclusionThe short ACL-RSI(Per) scale is a reliable and valid tool for assessing psychological readiness for return to sport after ACL reconstruction in Persian.Level of evidenceIII.
| S-EPMC11228620 | biostudies-literature
Project description:BackgroundThe limited research on prognosis after nonsurgical management of anterior cruciate ligament (ACL) injury has focused on physical factors. We aimed to assess relationships between key patient-reported outcomes, in line with a biopsychosocial approach, and returning to preinjury sport at 12 months after ACL injury treated without reconstruction.HypothesisWe hypothesized that biopsychosocial factors would be associated with returning to preinjury sport at 12 months after ACL injury.Study designProspective single cohort study.Level of evidenceLevel 2.MethodsPatients who had an ACL injury and did not have reconstruction during the first year after injury were recruited from healthcare clinics in Sweden, and followed up at 3, 6, and 12 months after injury. Return to preinjury sport at 12 months was the primary outcome. Explanatory variables were psychological readiness to return to sport, knee-related quality of life, and self-reported knee function. Using generalized estimating equations, we evaluated the relationships between the explanatory variables and the primary outcome at each timepoint.ResultsData were analyzed for 88 participants with a median age of 27 years (15-40 years). Soccer was the most frequently reported preinjury sport (n = 22). Forty participants (46%) had returned to their preinjury sport at 12 months after ACL injury. The odds of returning to preinjury sport at 12 months increased with higher self-reported knee function at 6 months (odds ratio [OR], 1.1; 95% CI, 1.0-1.1), and the odds of being returned to the preinjury sport at 12 months doubled for every 1-point increase (1-10 scale) in psychological readiness to return to sport measured at 12 months (OR, 1.9; 95% CI, 1.2-3.2).ConclusionSuperior self-reported knee function at 6 months and greater psychological readiness to return to sport at 12 months were associated with returning to the preinjury sport 1 year after ACL injury treated without reconstruction.Clinical relevanceConsider highlighting the relevance of biopsychosocial factors to returning to preinjury sport after ACL injury when discussing prognosis during shared decision-making.
| S-EPMC9950991 | biostudies-literature