ACL Prehabilitation Improves Postoperative Strength and Motion and Return to Sport in Athletes
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SUBMITTER: Cunha J
PROVIDER: S-EPMC8811524 | biostudies-literature | 2022 Jan
REPOSITORIES: biostudies-literature
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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: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:Study designSystematic review.Background and objectivesPreoperative neuromuscular function is predictive for knee function and return to sports (RTS) after reconstruction of the anterior cruciate ligament (ACL). The aim of this review was to examine the potential benefits of prehabilitation on pre-/postoperative objective, self-reported and RTS-specific outcomes.MethodsA systematic search was conducted within three databases. From the 1.071 studies screened, two randomized control trials (RCTs), two control trials (CTs) and two cohort studies (CS) met the inclusion criteria. Methodological quality rating adopted the PEDro- (RCT, CT) or Newcastle-Ottawa-Scale (CS).Results and conclusionsMethodological quality of the included studies was moderate (PEDro score: 6.5 ± 1.7; range 4 to 9). Two studies reported higher increases of the maximal quadriceps torque from baseline to pre-reconstruction: one study in the limb symmetry index (LSI), and one in both legs of the prehabilitation group compared to the controls. At 12-weeks post-reconstruction, one study (from two) indicated that the prehabilitation group had a lesser post-operative decline in the single-leg-hop for distance LSI (clinically meaningful). Similar findings were found in terms of quadriceps strength LSI (one study). At both pre-reconstruction (three studies) and two-year post-surgery (two studies), the prehabilitation groups reached significantly higher self-reported knee function (clinically meaningful) than the controls. RTS tended to be faster (one study). At two years post-surgery, RTS rates (one study) were higher in the prehabilitation groups. The results provide evidence for the relevance of prehabilitation prior to ACL-reconstruction to improve neuromuscular and self-reported knee function as well as RTS. More high quality confirmatory RCTs are warranted.Registration numberPROSPERO 2017: CRD42017065491.
| S-EPMC7592749 | biostudies-literature
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).
| S-EPMC9677345 | biostudies-literature
Project description:BackgroundStrength and power is often reduced on the involved versus contralateral limb and healthy controls after anterior cruciate ligament (ACL) reconstruction, but no study has compared with preinjury values at the time of return to sport (RTS).HypothesisDivergent recovery patterns in strength and power characteristics will be present at RTS relative to preinjury baseline data and healthy matched controls.Study designCohort study.Level of evidenceLevel 3.MethodsIsokinetic strength tests, bilateral and single-leg countermovement jumps (CMJ; SLCMJ) were measured before ACL rupture in 20 professional soccer players. These then had surgical reconstruction (ACL group) and completed follow-up testing before RTS. Healthy controls (uninjured group) were tested at the same time as the ACL group preinjury. Values recorded at RTS of the ACL group were compared with preinjury. We also compared the uninjured and ACL groups at baseline and RTS.ResultsCompared with preinjury, ACL normalized quadriceps peak torque of the involved limb (difference = -7%), SLCMJ height (difference = -12.08%), and Reactive Strength Index modified (RSImod) (difference = -5.04%) were reduced after ACL reconstruction. No significant reductions in CMJ height, RSImod, and relative peak power were indicated at RTS in the ACL group when compared with preinjury values, but deficits were present relative to controls. The uninvolved limb improved quadriceps (difference = 9.34%) and hamstring strength (difference = 7.36%) from preinjury to RTS. No significant differences from baseline were shown in SLCMJ height, power, and reactive strength of the uninvolved limb after ACL reconstruction.ConclusionStrength and power in professional soccer players at RTS after ACL reconstruction were often reduced compared with preinjury values and matched healthy controls.Clinical relevanceDeficits were more apparent in the SLCMJ, suggesting that dynamic and multijoint unilateral force production is an important component of rehabilitation. Use of the uninvolved limb and normative data to determine recovery may not always be appropriate.
| S-EPMC10606975 | biostudies-literature
Project description:BackgroundOutcomes 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 designRandomized controlled trial, Level of evidence, 1; and cohort study, Level of evidence, 3.MethodsA 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.ResultsNo 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).ConclusionAlthough 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.RegistrationNCT01773317 (ClinicalTrials.gov identifier).
| S-EPMC6676263 | biostudies-literature
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:Sport-related concussions (SRC) are characterized by impaired autonomic control. Heart rate variability (HRV) offers easily obtainable diagnostic approaches to SRC-associated dysautonomia, but studies investigating HRV during sleep, a crucial time for post-traumatic cerebral regeneration, are relatively sparse. The aim of this study was to assess nocturnal HRV in athletes during their return to sports (RTS) after SRC in their home environment using wireless wrist sensors (E4, Empatica, Milan, Italy) and to explore possible relations with clinical concussion-associated sleep symptoms. Eighteen SRC athletes wore a wrist sensor obtaining photoplethysmographic data at night during RTS as well as one night after full clinical recovery post RTS (>3 weeks). Nocturnal heart rate and parasympathetic activity of HRV (RMSSD) were calculated and compared using the Mann-Whitney U Test to values of eighteen; matched by sex, age, sport, and expertise, control athletes underwent the identical protocol. During RTS, nocturnal RMSSD of SRC athletes (Mdn = 77.74 ms) showed a trend compared to controls (Mdn = 95.68 ms, p = 0.021, r = -0.382, p adjusted using false discovery rate = 0.126) and positively correlated to "drowsiness" (r = 0.523, p = 0.023, p adjusted = 0.046). Post RTS, no differences in RMSSD between groups were detected. The presented findings in nocturnal cardiac parasympathetic activity during nights of RTS in SRC athletes might be a result of concussion, although its relation to recovery still needs to be elucidated. Utilization of wireless sensors and wearable technologies in home-based settings offer a possibility to obtain helpful objective data in the management of SRC.
| S-EPMC10181314 | biostudies-literature
Project description:Femoroacetabular impingement (FAI) occurs when an osseous abnormality of the proximal femur (cam) or acetabulum (pincer) triggers damage to the acetabular labrum and articular cartilage in the hip. Although the precise etiology of FAI is not well understood, both types of FAI are common in athletes presenting with hip pain, loss of range-of-motion, and disability in athletics. An open surgical approach to decompressing FAI has shown good clinical outcomes; however, this highly invasive approach inherently may delay or preclude a high level athlete's return to play. The purpose of this study was to define associated pathologies and determine if an arthroscopic approach to treating FAI can allow professional athletes to return to high-level sport. Hip arthroscopy for the treatment of FAI allows professional athletes to return to professional sport. Between October 2000 and September 2005, 45 professional athletes underwent hip arthroscopy for the decompression of FAI. Operative and return-to-play data were obtained from patient records. Average time to follow-up was 1.6 years (range: 6 months to 5.5 years). Forty two (93%) athletes returned to professional competition following arthroscopic decompression of FAI. Three athletes did not return to play; however, all had diffuse osteoarthritis at the time of arthroscopy. Thirty-five athletes (78%) remain active in professional sport at an average follow-up of 1.6 years. Arthroscopic treatment of FAI allows professional athletes to return to professional sport.
| S-EPMC1950586 | biostudies-other
Project description:ContextRecurrent shoulder instability in young athletes can lead to a spectrum of soft tissue and bony lesions that can be bothersome and/or disabling. Coracoid transfer is a treatment option for athletes with recurrent instability.ObjectiveTo report the rate of return to sport for athletes after coracoid transfer.Data sourcesAn electronic search of the literature was performed using the PubMed (MEDLINE) and Cochrane Databases (1966-2018).Study selectionStudies were included if they evaluated return to sport after treatment with coracoid transfer at a minimum 1-year follow-up.Study designSystematic review.Level of evidenceLevel 4.Data extractionData were extracted by 2 authors and included study design, level of evidence, patient demographics (number, age, sex), procedure performed, duration of clinical follow-up, rate of return to sport, patient-reported outcome measures, reoperations, and complications.ResultsFourteen studies met the inclusion criteria. The rate of return to sport at any level ranged from 80% to 100% in all but 1 study (38%), and the rate of return to the previous level of play ranged from 56% to 95% in all but 1 study (16%). Patients returned to sport at an average of 3.2 to 8.1 months. The average patient-reported outcome scores ranged from 78% to 94% (Rowe), 223.6 to 534.3 (Western Ontario Shoulder Instability Index), and 75% to 90% (subjective shoulder value). The rate of postoperative dislocation ranged from 0% to 14%, and the reoperation rate ranged from 1.4% to 13%.ConclusionThere was a high early rate of return to sport in patients who underwent coracoid transfer for anterior shoulder instability, although patients did not reliably return to the same level of play. The procedure had very favorable outcomes for treatment of instability, with low rates of recurrent dislocation and reoperation.
| S-EPMC6745815 | biostudies-literature