Anterior Cruciate Ligament Rehabilitation and Return to Sport: How Fast Is Too Fast?
Ontology highlight
ABSTRACT: Level of Evidence
V, expert opinion.
SUBMITTER: Waldron K
PROVIDER: S-EPMC8811519 | biostudies-literature | 2022 Jan
REPOSITORIES: biostudies-literature
Similar Datasets
Project description:Athletes who sustain an anterior cruciate ligament (ACL) injury often opt for an ACL reconstruction (ACLR) with the goal and expectation to return to sports at the preinjury level. The proportion of athletes who successfully return to preinjury-level sport is low and disappointing, whereas the rate of second ACL injury in athletes under the age of 20 has been reported to be as high as 40% after return to sport (RTS). Although in recent years, new insights pertaining to RTS have been published, the lack of validity of RTS criteria after ACLR remain. The purpose of this clinical commentary is to present a critical overview of the current literature on RTS testing after ACLR.
| S-EPMC8811523 | biostudies-literature
Project description:Abstract Despite advancements in our understanding of anterior cruciate ligament (ACL) injury prevention and nonsurgical management, ACL reconstruction continues to occur at an alarming rate. Among athletic patients, individuals participating in basketball, soccer, and football have the highest incidence of ACL injury, often requiring surgical intervention. To ensure the optimal treatment strategy for return to sport and prevention of secondary graft re-tear, it is important to tailor to the specific demands of the injured athlete and apply evidence-based best practices and rehabilitation principles. The purpose of this review is to provide readers with a brief background regarding ACL injuries, a focused review of clinical outcome studies after ACL reconstruction, and an updated framework with expert-guided recommendations for postoperative rehabilitation and return to sporting activity. Currently, there is no gold standard for rehabilitation after ACL reconstruction, highlighting the need for robust studies evaluating the best modalities for athlete rehabilitation, as well as determining the efficacy of new tools for improving therapy including blood flow restriction therapy and neuromuscular electrical stimulation. Based on clinical experience, a renewed focus on objective, criteria-based milestones may maximize the ability of return to preinjury levels of athletic function.
| S-EPMC8811493 | biostudies-literature
Project description:Anterior cruciate ligament (ACL) injuries and surgical intervention in the pediatric population have increased in the recent years. Although surgical techniques have advanced, evidence-based rehabilitation guidelines that consider all aspects of the youth athlete are currently lacking. The purpose of this commentary is to review the current evidence on unique considerations for the pediatric and adolescent population during rehabilitation and return to sport after ACL reconstruction (ACLR), with a focus on children under 18 years of age. This review revealed that returning a youth athlete to sport after ACLR requires knowledge and appreciation of various aspects of the growing athlete different from adults. In addition to postoperative precautions that contribute to a slow rehabilitation process, young athletes need additional time for strength gains. Address risk of reinjury and for contralateral injury by using neuromuscular training and rigorous return-to-sport training programs. Consider return to sport after 9 months because the reinjury rate is high in this population. A combination of time and objective measures, both quantitative and qualitative criteria, and psychological readiness should be used to assess readiness to return to sport and decrease risk of future injury. Healthcare providers should be aware of the psychosocial impact of injury on the youth athletes and refer to sport psychology when necessary.Level of evidenceLevel V.
| S-EPMC8811511 | 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:BackgroundAfter anterior cruciate ligament (ACL) reconstruction (ACLR), biomechanical asymmetries during gait are highly prevalent, persistent, and linked to posttraumatic knee osteoarthritis. Quadriceps strength is an important clinical measure associated with preoperative gait asymmetries and postoperative function and is a primary criterion for return-to-sport clearance. Evidence relating symmetry in quadriceps strength with gait biomechanics is limited to preoperative and early rehabilitation time points before return-to-sport training.Purpose/hypothesisThe purpose was to determine the relationship between symmetry in isometric quadriceps strength and gait biomechanics after return-to-sport training in athletes after ACLR. We hypothesized that as quadriceps strength symmetry increases, athletes will demonstrate more symmetric knee joint biomechanics, including tibiofemoral joint loading during gait.Study designCross-sectional study; Level of evidence, 3.MethodsOf 79 athletes enrolled in the ACL-SPORTS Trial, 76 were participants in this study after completing postoperative rehabilitation and 10 return-to-sport training sessions (mean ± SD, 7.1 ± 2.0 months after ACLR). All participants completed biomechanical walking gait analysis and isometric quadriceps strength assessment using an electromechanical dynamometer. Quadriceps strength was calculated using a limb symmetry index (involved limb value / uninvolved limb value × 100). The biomechanical variables of interest included peak knee flexion angle, peak knee internal extension moment, sagittal plane knee excursion at weight acceptance and midstance, quadriceps muscle force at peak knee flexion angle, and peak medial compartment contact force. Spearman rank correlation (ρ) coefficients were used to determine the relationship between limb symmetry indexes in quadriceps strength and each biomechanical variable; alpha was set to .05.ResultsOf the 76 participants, 27 (35%) demonstrated asymmetries in quadriceps strength, defined by quadriceps strength symmetry <90% (n = 23) or >110% (n = 4) (range, 56.9%-131.7%). For the biomechanical variables of interest, 67% demonstrated asymmetry in peak knee flexion angle; 68% and 83% in knee excursion during weight acceptance and midstance, respectively; 74% in internal peak knee extension moment; 57% in medial compartment contact force; and 74% in quadriceps muscle force. There were no significant correlations between quadriceps strength index and limb symmetry indexes for any biomechanical variable after return-to-sport training (P > .129).ConclusionAmong those who completed return-to-sport training after ACLR, subsequent quadriceps strength symmetry was not correlated with the persistent asymmetries in gait biomechanics. After a threshold of quadriceps strength is reached, restoring strength alone may not ameliorate gait asymmetries, and current clinical interventions and return-to-sport training may not adequately target gait.
| S-EPMC7863565 | biostudies-literature
Project description:Females are at greatest risk for reinjury after return to sport (RTS) following anterior cruciate ligament (ACL) reconstruction (ACLR). The reasons for these sex differences, however, remain unclear. Psychological factors such as kinesiophobia have been identified as a potential predictor for reinjury following RTS. Studies investigating kinesiophobia have identified sex differences, yet whether this holds in the ACLR population remains unknown. The purpose of this study was to examine whether there are sex differences in kinesiophobia and other psychological factors, such as readiness to RTS and self-reported pain in the ACLR population. A total of 20 participants, eleven males (23.0 ± 8.4 years, 178.9 ± 7.6 cm, 76.8 ± 10.4 kg) and 9 females (19.6 ± 5.3 years, 165.1 ± 4.0 cm, 73.2 ± 25.0 kg) voluntarily participated in this study. The Tampa Scale for Kinesiophobia (TSK-11), Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) scale, and self-reported pain using a visual analog scale (VAS) were administered after clearance for RTS (10.5 ± 2.3 months post-ACLR). Statistical significance was set a priori at p<0.05. A significant difference between sexes was observed for the ACL-RSI with males reporting a significantly higher score (92.82±16.16) compared to females (77.0±15.54; p = 0.040). There were no significant differences between sexes for VAS for pain (males = 4.55 ± 6.50; females = 1.22 ± 3.31; p = 0.228) and TSK-11 (males = 18.73 ± 3.17; females = 19.67 ± 4.61; p = 0.596). The results of this study demonstrated males had significantly higher ACL-RSI scores than females, suggesting males may have higher psychological readiness following clearance for RTS. This study did not demonstrate significant differences between sexes for kinesiophobia or pain level. Caution in interpretation of results is warranted due to the small sample size, highlighting the need for further research in this area.
| S-EPMC11410221 | biostudies-literature
Project description:BackgroundHigher scores (closer to 100) on the Anterior Cruciate Ligament - Return to Sport after Injury (ACL-RSI) scale indicate better psychological readiness to return to sport after anterior cruciate ligament reconstruction (ACLR).ObjectivesTo verify the validity and reliability of the ACL-RSI-short version (ACL-RSI-SV) in Brazilian Portuguese in individuals who underwent ACLR.MethodsParticipants (n=168) answered the Brazilian versions of ACL-RSI, Tampa Scale for Kinesiophobia (TSK-17), and International Knee Documentation Committee (IKDC) to assess the convergent validity of the short version. Internal consistency was also verified through correlation between items. Scores of participants who did not return to sport, who returned at a lower level, and at the pre-injury level were compared to verify divergent validity. ACL-RSI was answered again after 5-8 days to verify test-retest reliability.ResultsACL-RSI-SV in Brazilian Portuguese showed good test-retest reliability (ICC2.1 = 0.85, 95% CI: 0.76, 0.90) and acceptable internal consistency (Cronbach's alpha = 0.78). Standard error of measurement (SEM) and smallest detectable change (SDC) were 4.98 and 13.82. High positive correlation was found with the full version of the ACL-RSI (r=0.93, 95% CI: 0.91, 0.95), moderate positive correlation with the IKDC (r=0.52, 95% CI: 0.40, 0.62), and weak negative correlation with the TSK-17 (r = -0.45, 95% CI: -0.60, -0.28). It also presented good divergent validity to identify individuals who returned to sport.ConclusionACL-RSI-SV in Brazilian Portuguese is a consistent, valid, and reliable instrument to assess patients who have undergone ACLR, with good ability to identify those who return to sport.
| S-EPMC9193860 | biostudies-literature
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:The aim of the present study was to quantify joint kinematics through a wearable sensor system in multidirectional high-speed complex movements used in a protocol for rehabilitation and return to sport assessment after Anterior Cruciate Ligament (ACL) injury, and to validate it against a gold standard optoelectronic marker-based system. Thirty-four healthy athletes were evaluated through a full-body wearable sensor (MTw Awinda, Xsens) and a marker-based optoelectronic (Vicon Nexus, Vicon) system during the execution of three tasks: drop jump, forward sprint, and 90° change of direction. Clinically relevant joint angles of lower limbs and trunk were compared through Pearson's correlation coefficient (r), and the Coefficient of Multiple Correlation (CMC). An excellent agreement (r > 0.94, CMC > 0.96) was found for knee and hip sagittal plane kinematics in all the movements. A fair-to-excellent agreement was found for frontal (r 0.55-0.96, CMC 0.63-0.96) and transverse (r 0.45-0.84, CMC 0.59-0.90) plane kinematics. Movement complexity slightly affected the agreement between the systems. The system based on wearable sensors showed fair-to-excellent concurrent validity in the evaluation of the specific joint parameters commonly used in rehabilitation and return to sport assessment after ACL injury for complex movements. The ACL professionals could benefit from full-body wearable technology in the on-field rehabilitation of athletes.
| S-EPMC8037754 | biostudies-literature
Project description:AbstractObjectiveTo determine risk factors for second anterior cruciate ligament (ACL) injury following primary ACL reconstruction (ACLR) using return-to-sport (RTS) tests consisting of qualitative and quantitative measures in young athletes.MethodsA case-control study design was used, and a retrospective review of adolescent athletes after primary ACLR was performed. All athletes completed an RTS test consisting of qualitative and quantitative assessments and psychological assessments with the Tampa Scale of Kinesiophobia. Athlete demographics, surgical characteristics and sports participation were also examined. A binary logistic regression was performed to verify an independent association between risk factors and second ACL injury using adjusted OR (aORs), 95% CI and p<0.05.ResultsIn 72 eligible athletes, 12 (16.7%) suffered a second ACL injury. The mean Tegner activity level was 8.4+1.1, and the mean time from ACLR to RTS test completion was 10.4+2.9 months. One variable that showed the lowest p-value in the preliminary analysis was entered into the binary logistic regression model, which resulted in that qualitative assessment of knee valgus during the sidestep cut was associated with second ACL injury (aOR=4.64, 95% CI: 1.18 to 18.23, p=0.03).ConclusionAthletes who demonstrated excessive dynamic knee valgus on the involved limb during the sidestep cut were approximately 4.6 times more likely to suffer a second ACL injury.
| S-EPMC11298729 | biostudies-literature