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Bruce Leicht AS, Thompson XD, Queen RM, Rodu JS, Higgins MJ, Cross KM, Werner BC, Resch JE, Hart JM. Analysis of Limb Loading and Lower Extremity Strength Recovery Across Time After Anterior Cruciate Ligament Reconstruction. Sports Health 2024:19417381241285859. [PMID: 39397655 PMCID: PMC11556615 DOI: 10.1177/19417381241285859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2024] Open
Abstract
BACKGROUND Evidence as to how patient thigh muscle strength and limb loading (LL) during a squatting task recovers throughout rehabilitation after anterior cruciate ligament reconstruction (ACLR) is lacking. HYPOTHESIS Patients will improve LL and strength throughout rehabilitation. Changes in LL and strength over time will be positively correlated. STUDY DESIGN Prospective cohort study. LEVEL OF EVIDENCE Level 3. METHODS A total of 60 participants (28 male/32 female; age, 22.5 ± 9.35 years) participated in 2 visits post-ACLR, assessing LL and strength. Using an instrumented pressure mat, patients completed 3 sets of 3 repetitions of bodyweight squats. Peak force (N), unilateral cumulative load (%), and quadriceps and hamstring isokinetic peak torque (N·m) were calculated and recorded bilaterally. LL and peak torque were compared over time and between limbs. RESULTS A significant limb-by-time interaction was observed for LL peak force (N), where patients underloaded the ACLR limb at visit 1 compared with the contralateral limb (P < 0.01). Patients increased their ACLR LL across visits (P = 0.04). A limb-by-time interaction for quadriceps peak torque (N·m) was observed where the ACLR limb increased peak torque across visits (P < 0.01); however, strength deficits persisted at visit 2 (P < 0.01) when compared with the nonoperative limb. Weak correlations were observed between all change scores metrics (r, 0.20-0.25). CONCLUSION Patients recovering from ACLR exhibited more symmetric loading during a squatting task and improved their lower extremity strength over time. Changes in strength were not related to changes in LL during a squatting task over time. CLINICAL RELEVANCE Squatting tasks are safe and easily implemented throughout ACLR recovery. As changes in functional LL and strength recovery are not related, both should be considered in serial postoperative testing for more comprehensive function and strength assessments.
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Affiliation(s)
- Amelia S. Bruce Leicht
- University of Kentucky, Department of Athletic Training and Clinical Nutrition, Lexington, Kentucky
| | - Xavier D. Thompson
- University of Virginia, Department of Kinesiology, Charlottesville, Virginia
| | - Robin M. Queen
- Virginia Tech, Department of Biomedical Engineering and Mechanics, Blacksburg, Virginia
| | - Jordan S. Rodu
- University of Virginia, Department of Statistics, Charlottesville, Virginia
| | - Michael J. Higgins
- University of Virginia, Department of Kinesiology, Charlottesville, Virginia
| | - Kevin M. Cross
- University of Virginia, Department of Physical Medicine and Rehabilitation, Charlottesville, Virginia
| | - Brian C. Werner
- University of Virginia, Department of Orthopaedic Surgery, Charlottesville, Virginia
| | - Jacob E. Resch
- University of Virginia, Department of Kinesiology, Charlottesville, Virginia
| | - Joe M. Hart
- University of North Carolina at Chapel Hill, Department of Orthopaedics, Chapel Hill, North Carolina
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Thamke MV, Ramteke SU, Keoliya A. Physical Therapy Approaches for Concomitant Anterior Cruciate Ligament and Posterior Cruciate Ligament Avulsion Fractures: A Case Report. Cureus 2024; 16:e69959. [PMID: 39445265 PMCID: PMC11498071 DOI: 10.7759/cureus.69959] [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: 08/27/2024] [Accepted: 09/22/2024] [Indexed: 10/25/2024] Open
Abstract
Multi-ligament knee injury, involving complex destruction of structures like the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL), presents significant challenges in treatment as well as diagnosis. This case study focuses on a 55-year-old woman who was the victim of a severe traffic accident and had an ACL and PCL avulsion fracture, a medial condyle fracture, and a medial collateral ligament rupture. Afterward, open reduction and internal fixation of the right tibial plateau surgery was performed after a delay in order to manage the pain and swelling. Her rehabilitation was greatly helped by postoperative physical therapy, which focused on pain control, early mobilization, and gradual strength development. A well-structured rehabilitation plan was found to be beneficial, as indicated by the remarkable improvements in pain reduction and functional mobility. This case highlights the value of effective physical therapy in helping patients through the difficult recovery process following multiple ligament injuries with the goal of restoring function and improving their quality of life.
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Affiliation(s)
- Maitri V Thamke
- Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Swapnil U Ramteke
- Sports Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Ashish Keoliya
- Sports Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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Ashour AA, Elhafez SM, ElMeligie MM, Hanafy AF. Crossover effect of knee and ankle joint training on knee mechanics after ACL reconstruction: A randomized controlled trial. Gait Posture 2024; 113:512-518. [PMID: 39173441 DOI: 10.1016/j.gaitpost.2024.08.011] [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: 11/30/2023] [Revised: 08/09/2024] [Accepted: 08/13/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) rehabilitation is a common intervention after ACL reconstruction. Since different types of exercise can influence muscle and kinematic parameters in diverse ways, the training order between the knee and ankle joints may also change gait parameters. PURPOSE This study aimed to investigate whether the training sequence of the knee and ankle joints (knee followed by ankle training or vice-versa) in an ACL reconstruction (ACLR) rehabilitation program has any effects on knee extension and flexion torques. METHODS Forty-two men (aged 20-30 years) with ACLR participated in this study. They were randomly allocated to receive one of two interventions: (A) knee joint training followed by ankle training or (B) ankle joint training followed by knee training. After five weeks (four weeks of intervention and one-week washout), participants crossed from one group to another for an additional four weeks. Knee extension and flexion torques were assessed during the stance phase of the gait cycle before and after the intervention program. RESULTS Two-way Mixed-design MANOVA showed that knee extension torque improved significantly in both groups after training (p = 0.001, Cohen's D = 0.65), while the knee flexion torque increased significantly only in group B (p= 0.001, Cohen's D = 0.97). When comparing both groups, patients of group B presented significant improvements in the post-training mean values of all tested variables compared with group A. CONCLUSION Starting a post-ACLR rehabilitation program with ankle training followed by knee training is better to improve knee flexion and extension torques during the stance phase of the gait cycle than starting the program by training the knee first, followed by the ankle. Future studies using a mixed-gender sample and different types of ACLR operations are necessary to examine whether similar improvements will happen as well as to test their effects on many sports activities.
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Affiliation(s)
- Ahmed Atteya Ashour
- Department of Biomechanics, Faculty of Physical Therapy, October 6 University, Egypt.
| | | | | | - Abeer Farag Hanafy
- Department of Biomechanics, Faculty of Physical Therapy, Cairo University, Egypt
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Gharpinde MR, Pundkar A, Dhanwani Y, Chandanwale R, Jaiswal AM. Navigating Post-operative Challenges: A Comprehensive Review of Complications Following Anterior Cruciate Ligament (ACL) Tear Surgery. Cureus 2024; 16:e67768. [PMID: 39323667 PMCID: PMC11422704 DOI: 10.7759/cureus.67768] [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: 08/15/2024] [Accepted: 08/25/2024] [Indexed: 09/27/2024] Open
Abstract
Anterior cruciate ligament (ACL) injuries are among the most common and debilitating sports-related injuries, often necessitating surgical intervention to restore knee stability and function. ACL reconstruction surgery, which has evolved significantly over the years, aims to enable patients, particularly those who are young and physically active, to return to their pre-injury activity levels. However, despite advancements in surgical techniques and rehabilitation protocols, post-operative complications remain a significant concern that can adversely affect patient outcomes. This comprehensive review explores the spectrum of complications that can arise following ACL tear surgery, ranging from common issues such as infection, graft failure, and knee stiffness to less frequent but clinically significant complications like osteoarthritis and neurological injuries. The review also delves into the various factors influencing the likelihood of these complications, including patient-related variables, surgical techniques, and the effectiveness of rehabilitation protocols. By providing an in-depth analysis of these post-operative challenges, this review aims to enhance the understanding of ACL reconstruction outcomes and guide healthcare professionals in implementing preventive strategies and optimizing patient care. Through a multidisciplinary approach, the goal is to minimize the risk of complications, improve surgical outcomes, and ultimately enhance the quality of life for patients undergoing ACL reconstruction.
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Affiliation(s)
- Milind R Gharpinde
- Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Aditya Pundkar
- Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Yash Dhanwani
- Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Akola, IND
| | - Rohan Chandanwale
- Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Ankit M Jaiswal
- Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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Nyland J, Pyle B, Richards J, Yoshida K, Brey J, Carter S. A clinical practice review of therapeutic movement-based anterior cruciate ligament reconstruction return to sports bridge program: the biological, biomechanical and behavioral rationale. ANNALS OF JOINT 2023; 8:23. [PMID: 38529232 PMCID: PMC10929313 DOI: 10.21037/aoj-23-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 06/12/2023] [Indexed: 03/27/2024]
Abstract
This clinical practice review describes the biological, biomechanical and behavioral rationale behind a return to sport bridge program used predominantly with non-elite, youth and adolescent high school and college athletes following anterior cruciate ligament (ACL) reconstruction. Post-physiotherapy, this program has produced outcomes that meet or exceed previous reports. With consideration for athletic identity and the Specific Adaptations to Imposed Demands (SAID) principle, the early program focus was on restoring non-impaired bilateral lower extremity joint mobility and bi-articular musculotendinous extensibility. Building on this foundation, movement training education, fundamental bilateral lower extremity strength and power, and motor learning was emphasized with use of external focus cues and ecological dynamics-social cognition considerations. Plyometric and agility tasks were integrated to enhance fast twitch muscle fiber recruitment, anaerobic metabolic energy system function, and fatigue resistance. The ultimate goal was to achieve the lower extremity neuromuscular control and activation responsiveness needed for bilateral dynamic knee joint stability. The rationale and conceptual basis of selected movement tasks and general philosophy of care concepts are described and discussed in detail. Based on the previously reported efficacy of this movement-based therapeutic exercise program we recommend that supplemental programs such as this become standard practice following release from post-surgical physiotherapy and before return to sports decision-making.
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Affiliation(s)
- John Nyland
- Norton Orthopedic Institute, Louisville, KY, USA
- Department of Orthopaedic Surgery, University of Louisville, Louisville, KY, USA
| | - Brandon Pyle
- MSAT Program, Spalding University, Louisville, KY, USA
| | - Jarod Richards
- Department of Orthopaedic Surgery, University of Louisville, Louisville, KY, USA
| | - Kei Yoshida
- MSAT Program, Spalding University, Louisville, KY, USA
| | - Jennifer Brey
- Norton Orthopedic Institute, Louisville, KY, USA
- Department of Orthopaedic Surgery, University of Louisville, Louisville, KY, USA
| | - Sam Carter
- Norton Orthopedic Institute, Louisville, KY, USA
- Department of Orthopaedic Surgery, University of Louisville, Louisville, KY, USA
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Xu AL, Mun F, Gupta A, Margalit A, Prasad N, Lee RJ. Financial Burden of Pediatric Anterior Cruciate Ligament Reconstruction. J Pediatr Orthop 2022; 42:e943-e948. [PMID: 35941092 DOI: 10.1097/bpo.0000000000002230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND High costs and lack of price transparency for common pediatric orthopaedic procedures create financial burden for patients. We assessed (1) how patient medical debt after anterior cruciate ligament reconstruction (ACLR) correlates with health insurance type; and (2) factors associated with patient financial burden and worry after ACLR. METHODS We reviewed records of 122 patients aged below 18 years who underwent ACLR at our US academic hospital from 2016 to 2020. Patients were grouped by health insurance type: private (n=80) or public (n=42). A telephone survey about ACLR-related financial burden and worry was administered to patients' parents (45% response rate). Primary outcomes were patient medical debt and patient-reported financial burden measured by the financial burden composite score (0 to 6, with 6 representing highest burden) and dichotomized worry score (1 to 3, low worry; 4 to 5, high worry). We used univariate analyses to compare financial outcomes and multivariable regressions to determine factors associated with reported financial burden (alpha=0.05). RESULTS Debt after ACLR was reported by 10 of 122 patients (8%), all of whom had private insurance ( P =0.045). Of 55 survey respondents, treatment-related financial burden was reported by 32 (58%). Mean±SD financial burden composite scores were higher for privately insured (1.8±2.0) versus publicly insured patients (0.74±1.2) ( P =0.02), but rates of high financial worry were similar (private, 8% vs. public, 21%) ( P =0.22). A higher proportion of patients with private insurance (31%) reported having to use savings after ACLR compared with publicly insured patients (5%) ( P =0.04). The most frequently cited reason for financial burden was the cost of postoperative physical therapy (PT) (n=21). Number of PT visits was independently associated with financial burden composite scores ( P =0.02). Insurance type was not independently associated with financial burden ( P >0.05). CONCLUSION Although a small proportion of patients generated medical debt after ACLR (greater for those privately vs. publicly insured), the majority reported treatment-related financial burden primarily driven by PT costs. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Amy L Xu
- Department of Orthopaedics, The Johns Hopkins University, Baltimore, MD
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Li P, Li C, Wang C, Kernkamp WA, Yang CH, Hu H, Tsai TY. In-vivo Tibiofemoral Kinematics of the Normal Knee During Closed and Open Kinetic Chain Exercises: A Comparative Study of Box Squat and Seated Knee Extension. Med Eng Phys 2022; 101:103766. [DOI: 10.1016/j.medengphy.2022.103766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/29/2021] [Accepted: 02/06/2022] [Indexed: 10/19/2022]
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Milner J, Hartnettt D, DeFroda SF. Alternatives to Knee Braces. J Knee Surg 2022; 35:266-272. [PMID: 34600439 DOI: 10.1055/s-0041-1736198] [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] [Indexed: 02/07/2023]
Abstract
Knee braces continue to be a widely utilized piece of medical equipment, ranging from simple over the counter sleeves to more complex functional braces, with the ability to provide electrical stimulation to muscle groups. Despite their popularity, alternatives to knee braces exist for patients who find braces to be ineffective, uncomfortable, cumbersome, or overly expensive. While high-quality studies are lacking for modalities such as neoprene sleeves, compression stockings, and kinesiotaping, there is promising evidence that these interventions can confer an element of stability and pain relief for a variety of knee pathologies both with regard to acute and chronic injuries as well as in the postoperative rehabilitation period. While no "holy grail" exists for the ideal brace, or bracing alternative, it is important for providers to be aware of the options available to patients as well as the current evidence for these various modalities, so that the provider can best guide musculoskeletal care.
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Affiliation(s)
- John Milner
- Department of Orthopedic Surgery, Brown University, Providence, Rhode Island
| | - Davis Hartnettt
- Department of Orthopedic Surgery, Brown University, Providence, Rhode Island
| | - Steven F DeFroda
- Department of Orthopedic Surgery, University of Missouri System, Columbia, Missouri
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9
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Chu CR. Can we afford to ignore the biology of joint healing and graft incorporation after ACL reconstruction? J Orthop Res 2022; 40:55-64. [PMID: 34314066 DOI: 10.1002/jor.25145] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/23/2021] [Accepted: 07/01/2021] [Indexed: 02/04/2023]
Abstract
Anterior cruciate ligament (ACL) reconstruction is successful at restoring stability to return ACL injured patients to high-demand work, sports, and recreational activities. The development of posttraumatic osteoarthritis (OA) in roughly half of patients just 10-15 years after ACLR highlight the need to improve clinical care pathways. Graft failure and reinjury rates, which further increase OA risk, also remain high for younger and more active patients. The biological components of joint recovery and graft incorporation, therefore, impact short- and long-term clinical outcomes. Biochemical and magnetic resonance imaging (MRI) data show substantial compromise of articular cartilage metabolism and matrix composition after ACL injury and reconstructive surgery suggesting a potential need for activity modulation in early recovery. Furthermore, joint recovery is variable with compositional MRI studies showing progressive cartilage degeneration 1 and 2 years after ACLR. Biopsy and MRI studies also show high variability in ACL graft characteristics within the 1st year after ACLR followed by continued graft maturation into the 2nd year and beyond. To improve the care of ACL injured patients, there is a critical need for clinical attention and scientific inquiry into timing the reintroduction of higher load activities in relationship to neuromuscular recovery, joint biology, and graft maturation. In addition to symptomatic and mechanical recovery, development and validation of biological markers for joint and cartilage homeostasis as well as ACL graft healing are needed for personalized decision making on rehabilitation needs, reduction of OA risk, and resumption of athletic, recreational, and vocational activities.
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Affiliation(s)
- Constance R Chu
- Department Orthopaedic Surgery, Stanford University, Stanford, California, USA.,Veterans Affairs Palo Alto Healthcare System, Livermore, California, USA
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10
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Rambaud AJ, Neri T, Dingenen B, Parker D, Servien E, Gokeler A, Edouard P. The modifying factors that help improve anterior cruciate ligament reconstruction rehabilitation: A narrative review. Ann Phys Rehabil Med 2021; 65:101601. [PMID: 34757010 DOI: 10.1016/j.rehab.2021.101601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 10/04/2021] [Accepted: 10/08/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND The goal of a rehabilitation programme after anterior cruciate ligament (ACL) reconstruction is to manage a patient's goals and expectations (i.e., returning to physical activities and sports) while minimizing the risk of new injury, particularly a new ACL injury. Although general rehabilitation programmes have been proposed, some factors can lead to adapting each programme to each patient. OBJECTIVE To describe how different variables, including surgical techniques, sports participation, psycho-social and contextual factors can modify the rehabilitation programme. METHODS We performed a narrative review with input from experts in the field (level of evidence 5). CONCLUSIONS Modifying factors of the ACL rehabilitation programme are related to the initial lesion or surgery, to sports, or to psychological or social aspects. Regarding the type of graft, the rehabilitation is mainly different in the early postoperative phase; the other phases are not graft-based but rather goal-based rehabilitation. Depending on the meniscal or cartilage repair, the rehabilitation protocol will initially take priority over the anterior cruciate ligament reconstruction protocol. The ACL reconstruction rehabilitation programme should meet the requirements of the anticipated sports, to optimize the athlete's ability to return to the expected level and minimize the risk of reinjury. Psycho-social and contextual factors must also be considered in rehabilitation care to individualize and optimize each patient's programme.
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Affiliation(s)
- Alexandre Jm Rambaud
- Univ Lyon, UJM-Saint-Etienne, Laboratoire Interuniversitaire de Biologie de la Motricité, EA 7424, F-42023 Saint-Etienne, France; Motion Analysis Lab, Physiotherapy and Sports Medicine Department, Swiss Olympic Medical Center, La Tour Hospital, Meyrin, Switzerland; SFMKS-Lab, Société Française des Masseurs-kinésithérapeutes du Sport, Pierrefitte/Seine, France.
| | - Thomas Neri
- Univ Lyon, UJM-Saint-Etienne, Laboratoire Interuniversitaire de Biologie de la Motricité, EA 7424, F-42023 Saint-Etienne, France; Department of Orthopaedic Surgery, University Hospital of Saint-Etienne, Faculty of medicine Saint-Etienne, France
| | - Bart Dingenen
- Reval Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan A, 3590 Diepenbeek, Belgium
| | - David Parker
- Sydney Orthopaedic Research Institute, Sydney, Australia; The University of Sydney, Sydney, Australia
| | - Elvire Servien
- Univ Lyon, Laboratoire Interuniversitaire de Biologie de la Motricité, EA 7424, F-42023 Lyon, France; Department of orthopaedic surgery and sports medicine, FIFA medical center of excellence, Lyon University Hospital, Lyon, France
| | - Alli Gokeler
- Exercise Science & Neuroscience Unit, Department Exercise & Health, Faculty of Science, Paderborn University, Paderborn, Germany
| | - Pascal Edouard
- Univ Lyon, UJM-Saint-Etienne, Laboratoire Interuniversitaire de Biologie de la Motricité, EA 7424, F-42023 Saint-Etienne, France; Department of Clinical and Exercise Physiology, Sports Medicine Unity, University Hospital of Saint-Etienne, Faculty of medicine, Saint-Etienne. France
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Rethorn ZD, Bezner JR, Pettitt CD. From expert to coach: health coaching to support behavior change within physical therapist practice. Physiother Theory Pract 2021; 38:2352-2367. [PMID: 34620046 DOI: 10.1080/09593985.2021.1987601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Negative health behaviors are a significant risk factor for non-communicable diseases (NCDs) and are responsible for 40-50% of the burden of disease in the US population. Physical therapists (PTs) have the capacity to effect behavior change in their patients to reduce their risk of disease and promote health. Competence in health behavior change is recommended for physical therapists. One way to achieve this competence is by learning and adopting a health coaching approach. Objectives: To provide a theoretical and practical approach to applying a health coaching approach in physical therapist clinical practice. Methods: 1) Describe a health coaching approach to facilitating behavior change; 2) present behavior change theories, communication strategies, and models underpinning health coaching; and 3) provide suggestions for ways PTs can integrate health coaching in clinical practice. Results: Health coaching is a dynamic and collaborative approach to health behavior change that harnesses the patient's or client's values and strengths to realize their goals for health. Conclusion: Adopting a health coaching approach may enhance adherence to physical therapists' recommendations as well as improve health outcomes.
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Affiliation(s)
- Zachary D Rethorn
- Doctor of Physical Therapy Division, Duke University, Durham, NC, USA.,Rocky Mountain University of Health Professions, Provo, UT, USA
| | - Janet R Bezner
- Department of Physical Therapy, Texas State University, 601 University Dr, Round Rock, TX, USA
| | - Cherie D Pettitt
- Rocky Mountain University of Health Professions, Provo, UT, USA.,WGU Academy, Western Governors University, Salt Lake City, Ut, USA
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12
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Rowell S, Relph N. The Landing Error Scoring System (LESS) and Lower Limb Power Profiles in Elite Rugby Union Players. Int J Sports Phys Ther 2021; 16:1286-1294. [PMID: 34631249 PMCID: PMC8486412 DOI: 10.26603/001c.27632] [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: 06/09/2021] [Accepted: 08/17/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The Landing Error Scoring System (LESS) is a clinical test that assesses landing biomechanics during a drop-jump task. Performance measures such as jump height, power, contact time and reactive strength index are used commonly in athletic populations. Comparing results from the LESS against these performance measures has not been reported in elite rugby union. PURPOSE To report i.) normative LESS scores for elite rugby union players ii.) correlations between LESS scores and performance measures and iii.) differences in performance measures between LESS scoring groups. A secondary purpose was to report the intra- and inter-rater reliability of the LESS test when used in elite rugby union players. # Study DesignCross-sectional design. METHODS Thirty-six male, elite rugby union players participated. Each participant completed three trials of the LESS and performance measures were recorded concurrently using the OptojumpTM. LESS trials were scored independently by the authors. Statistical analyses were used to confirm reliability, data normality, and between group differences (p<0.05). RESULTS The LESS test is a reliable testing tool in elite rugby union players (excellent intra- (ICC=0.96) and inter-rater (ICC=0.94) reliability). One player demonstrated an excellent LESS score, six players had good scores, eight players moderate scores and the majority of the group, 21 players, scored poorly. LESS scores were correlated to contact time (r = -0.461, p = 0.005) only. Participants with moderate to poor LESS scores (a score ≤5) produced greater power (p=0.036, η2 = 0.139), contact time (p=0.002, η2 = 0.268) and reactive strength index (p=0.016, η2 = 0.180). There were no differences in jump height (p=0.842) between players scoring excellent to good and moderate to poor. CONCLUSION The results of the current study demonstrate excellent intra- and inter-rater reliability for the LESS, supporting its use as a clinical assessment tool in elite rugby union players. The majority of players presented with moderate to poor LESS scores, indicating an area of concern in this population. Participants scoring moderate to poor in the LESS recorded significantly higher power and reactive strength index, increased contact time but not jump height. This suggests participants with high-risk landing biomechanics may also produce higher performance measures, but these do not necessarily result in an improved jump height.
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13
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Investigating the landing kinetics factors and preparatory knee muscle activation in female handball players with and without dynamic knee valgus while performing single leg landing. BIOMEDICAL HUMAN KINETICS 2021. [DOI: 10.2478/bhk-2021-0019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Abstract
Study aim: to examine the differences in landing kinetics factors (LKF) to assess the whole body stability and preparatory muscle activation (PMA) in female handball players with and without dynamic knee valgus.
Material and methods: Twenty-four professional female handball players (11 with (DKV) and 13 without (Control) dynamic knee valgus) were asked to perform three trials of a single-leg landing. LKF and surface EMG were recorded. Initial contact knee valgus angle (IC KVA), vertical ground reaction force (vGRF), confidence ellipse area of center of pressure (CEA), time to stability (TTS) and EMG from 100 ms prior to ground contact were used in the data analyses.
Results: Multivariate analyzing of LKF showed significant differences between two groups (p = 0.001) while for PMA the result was not significant (p = 0.361).
Conclusion: Altered landing mechanism considered as a predictor of non-contact knee injuries such as ACL rupture. Therefore according to current study it seems important to focus on reducing valgus angle in designing injury prevention program.
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Meredith SJ, Rauer T, Chmielewski TL, Fink C, Diermeier T, Rothrauff BB, Svantesson E, Hamrin Senorski E, Hewett TE, Sherman SL, Lesniak BP, Symposium P. Return to sport after anterior cruciate ligament injury: Panther Symposium ACL Injury Return to Sport Consensus Group. J ISAKOS 2021; 6:138-146. [PMID: 34006577 DOI: 10.1136/jisakos-2020-000495] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVES A precise and consistent definition of return to sport (RTS) after anterior cruciate ligament (ACL) injury is lacking, and there is controversy surrounding the process of returning patients to sports and their previous activity level. The aim of the Panther Symposium ACL Injury RTS Consensus Group was to provide a clear definition of RTS after ACL injury and description of the RTS continuum, as well as provide clinical guidance on RTS testing and decision-making. METHODS An international, multidisciplinary group of ACL experts convened as part of a consensus meeting. Consensus statements were developed using a modified Delphi method. Literature review was performed to report the supporting evidence. RESULTS Key points include that RTS is characterised by achievement of the preinjury level of sport and involves a criteria-based progression from return to participation to RTS, and ultimately return to performance. Purely time-based RTS decision-making should be abandoned. Progression occurs along an RTS continuum with decision-making by a multidisciplinary group that incorporates objective physical examination data and validated and peer-reviewed RTS tests, which should involve functional assessment as well as psychological readiness. Consideration should be given to biological healing, contextual factors and concomitant injuries. CONCLUSION The resultant consensus statements and scientific rationale aim to inform the reader of the complex process of RTS after ACL injury that occurs along a dynamic continuum. Research is needed to determine the ideal RTS test battery, the best implementation of psychological readiness testing and methods for the biological assessment of healing and recovery.
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Affiliation(s)
- Sean J Meredith
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA .,Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Thomas Rauer
- Klinik für Traumatologie, UniversitätsSpital Zürich, Zurich, Switzerland
| | | | - Christian Fink
- Gelenkpunkt-Sports and Joint Surgery Innsbruck, Innsbruck, Austria
| | - Theresa Diermeier
- Department of Sportorthopedic, Technical University of Munich, Munchen, Germany
| | - Benjamin B Rothrauff
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Eleonor Svantesson
- Department of Orthopedics, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden.,Gothenburg Sport Trauma Research Center, Gothenburg, Sweden
| | - Eric Hamrin Senorski
- Gothenburg Sport Trauma Research Center, Gothenburg, Sweden.,Department of Health and Rehabilitation, University of Gothenburg, Gothenburg, Sweden
| | | | - Seth L Sherman
- Department of Orthopaedic Surgery, Stanford Medicine, Stanford, California, USA
| | - Bryson P Lesniak
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Panther Symposium
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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15
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Meredith SJ, Rauer T, Chmielewski TL, Fink C, Diermeier T, Rothrauff BB, Svantesson E, Hamrin Senorski E, Hewett TE, Sherman SL, Lesniak BP. Return to sport after anterior cruciate ligament injury: Panther Symposium ACL Injury Return to Sport Consensus Group. Knee Surg Sports Traumatol Arthrosc 2020; 28:2403-2414. [PMID: 32347344 DOI: 10.1007/s00167-020-06009-1] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 04/16/2020] [Indexed: 01/07/2023]
Abstract
PURPOSE A precise and consistent definition of return to sport (RTS) after anterior cruciate ligament (ACL) injury is lacking, and there is controversy surrounding the process of returning patients to sports and their previous activity level. The aim of the Panther Symposium ACL Injury RTS Consensus Group was to provide a clear definition of RTS and description of the RTS continuum, as well as to provide clinical guidance on RTS testing and decision-making. METHODS An international, multidisciplinary group of ACL experts convened as part of a consensus meeting. Consensus statements were developed using a modified Delphi method. Literature review was performed to report the supporting evidence. RESULTS Key points include that RTS is characterized by achievement of the pre-injury level of sport and involves a criteria-based progression from return to participation to return to sport, and ultimately return to performance. Purely time-based RTS decision-making should be abandoned. Progression occurs along a RTS continuum with decision-making by a multidisciplinary group that incorporates objective physical examination data and validated and peer-reviewed RTS tests, which should involve functional assessment as well as psychological readiness. Consideration should be given to biological healing, contextual factors and concomitant injuries. CONCLUSION The resultant consensus statements and scientific rationale aim to inform the reader of the complex process of RTS after ACL injury that occurs along a dynamic continuum. Research is needed to determine the ideal RTS test battery, the best implementation of psychological readiness testing and methods for the biologic assessment of healing and recovery. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Sean J Meredith
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA.
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, 3200 S Water St, Pittsburgh, 15203, PA, USA.
| | - Thomas Rauer
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, 3200 S Water St, Pittsburgh, 15203, PA, USA
- Department of Trauma Surgery, University Hospital Zurich, Zurich, Switzerland
| | | | - Christian Fink
- Gelenkpunkt-Sports and Joint Surgery Innsbruck, Innsbruck, Austria
- Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI), UMIT, Hall in Tirol, Austria
| | - Theresa Diermeier
- Department of Sportorthopedics, Klinikum rechts der Isar Technische Universitat Munchen, Munchen, Germany
| | - Benjamin B Rothrauff
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, 3200 S Water St, Pittsburgh, 15203, PA, USA
| | - Eleonor Svantesson
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Gothenburg Sport Trauma Research Center, Gothenburg, Sweden
| | - Eric Hamrin Senorski
- Gothenburg Sport Trauma Research Center, Gothenburg, Sweden
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Seth L Sherman
- Department of Orthopaedic Surgery, Stanford Medicine, Stanford, CA, USA
| | - Bryson P Lesniak
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, 3200 S Water St, Pittsburgh, 15203, PA, USA
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16
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Meredith SJ, Rauer T, Chmielewski TL, Fink C, Diermeier T, Rothrauff BB, Svantesson E, Hamrin Senorski E, Hewett TE, Sherman SL, Lesniak BP, Bizzini M, Chen S, Cohen M, Villa SD, Engebretsen L, Feng H, Ferretti M, Fu FH, Imhoff AB, Kaeding CC, Karlsson J, Kuroda R, Lynch AD, Menetrey J, Musahl V, Navarro RA, Rabuck SJ, Siebold R, Snyder-Mackler L, Spalding T, van Eck C, Vyas D, Webster K, Wilk K. Return to Sport After Anterior Cruciate Ligament Injury: Panther Symposium ACL Injury Return to Sport Consensus Group. Orthop J Sports Med 2020; 8:2325967120930829. [PMID: 32647735 PMCID: PMC7328222 DOI: 10.1177/2325967120930829] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/20/2020] [Indexed: 12/28/2022] Open
Abstract
Background A precise and consistent definition of return to sport (RTS) after anterior cruciate ligament (ACL) injury is lacking, and there is controversy surrounding the process of returning patients to sport and their previous activity level. Purpose The aim of the Panther Symposium ACL Injury Return to Sport Consensus Group was to provide a clear definition of RTS after ACL injury and a description of the RTS continuum as well as provide clinical guidance on RTS testing and decision-making. Study Design Consensus statement. Methods An international, multidisciplinary group of ACL experts convened as part of a consensus meeting. Consensus statements were developed using a modified Delphi method. Literature review was performed to report the supporting evidence. Results Key points include that RTS is characterized by achievement of the preinjury level of sport and involves a criteria-based progression from return to participation to RTS and, ultimately, return to performance. Purely time-based RTS decision-making should be abandoned. Progression occurs along an RTS continuum, with decision-making by a multidisciplinary group that incorporates objective physical examination data and validated and peer-reviewed RTS tests, which should involve functional assessment as well as psychological readiness. Consideration should be given to biological healing, contextual factors, and concomitant injuries. Conclusion The resultant consensus statements and scientific rationale aim to inform the reader of the complex process of RTS after ACL injury that occurs along a dynamic continuum. Research is needed to determine the ideal RTS test battery, the best implementation of psychological readiness testing, and methods for the biological assessment of healing and recovery.
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Affiliation(s)
- Sean J Meredith
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Thomas Rauer
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Terese L Chmielewski
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Christian Fink
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Theresa Diermeier
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Benjamin B Rothrauff
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Eleonor Svantesson
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Eric Hamrin Senorski
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Timothy E Hewett
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Seth L Sherman
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Bryson P Lesniak
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | | | - Mario Bizzini
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Shiyi Chen
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Moises Cohen
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Stefano Della Villa
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Lars Engebretsen
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Hua Feng
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Mario Ferretti
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Freddie H Fu
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Andreas B Imhoff
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Christopher C Kaeding
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jon Karlsson
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ryosuke Kuroda
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Andrew D Lynch
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jacques Menetrey
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Volker Musahl
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ronald A Navarro
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Stephen J Rabuck
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Rainer Siebold
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Lynn Snyder-Mackler
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Tim Spalding
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Carola van Eck
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Dharmesh Vyas
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Kate Webster
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Kevin Wilk
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Gokeler A, Neuhaus D, Benjaminse A, Grooms DR, Baumeister J. Principles of Motor Learning to Support Neuroplasticity After ACL Injury: Implications for Optimizing Performance and Reducing Risk of Second ACL Injury. Sports Med 2020; 49:853-865. [PMID: 30719683 PMCID: PMC6548061 DOI: 10.1007/s40279-019-01058-0] [Citation(s) in RCA: 115] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Athletes who wish to resume high-level activities after an injury to the anterior cruciate ligament (ACL) are often advised to undergo surgical reconstruction. Nevertheless, ACL reconstruction (ACLR) does not equate to normal function of the knee or reduced risk of subsequent injuries. In fact, recent evidence has shown that only around half of post-ACLR patients can expect to return to competitive level of sports. A rising concern is the high rate of second ACL injuries, particularly in young athletes, with up to 20% of those returning to sport in the first year from surgery experiencing a second ACL rupture. Aside from the increased risk of second injury, patients after ACLR have an increased risk of developing early onset of osteoarthritis. Given the recent findings, it is imperative that rehabilitation after ACLR is scrutinized so the second injury preventative strategies can be optimized. Unfortunately, current ACLR rehabilitation programs may not be optimally effective in addressing deficits related to the initial injury and the subsequent surgical intervention. Motor learning to (re-)acquire motor skills and neuroplastic capacities are not sufficiently incorporated during traditional rehabilitation, attesting to the high re-injury rates. The purpose of this article is to present novel clinically integrated motor learning principles to support neuroplasticity that can improve patient functional performance and reduce the risk of second ACL injury. The following key concepts to enhance rehabilitation and prepare the patient for re-integration to sports after an ACL injury that is as safe as possible are presented: (1) external focus of attention, (2) implicit learning, (3) differential learning, (4) self-controlled learning and contextual interference. The novel motor learning principles presented in this manuscript may optimize future rehabilitation programs to reduce second ACL injury risk and early development of osteoarthritis by targeting changes in neural networks.
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Affiliation(s)
- Alli Gokeler
- Exercise Science & Neuroscience Unit, Department Exercise and Health, Faculty of Science, Paderborn University, Paderborn, Germany. .,Luxembourg Institute of Research in Orthopedics, Sports Medicine and Science (LIROMS), Luxembourg, Luxembourg. .,Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Dorothee Neuhaus
- Exercise Science & Neuroscience Unit, Department Exercise and Health, Faculty of Science, Paderborn University, Paderborn, Germany
| | - Anne Benjaminse
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,School of Sport Studies, Hanze University Groningen, Groningen, The Netherlands
| | - Dustin R Grooms
- Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens, OH, USA.,Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH, USA
| | - Jochen Baumeister
- Exercise Science & Neuroscience Unit, Department Exercise and Health, Faculty of Science, Paderborn University, Paderborn, Germany.,Exercise Neuroscience and Health Lab, Institute of Health, Nutrition and Sport Sciences, University of Flensburg, Flensburg, Germany.,Division of Physiotherapy/Central Analytical Facilities (CAF) 3D Human Biomechanics Unit, Faculty of Medicine and Health, Stellenbosch University, Stellenbosch, South Africa
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18
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Fischer AG, Erhart-Hledik JC, Chu CR, Asay JL, Andriacchi TP. Changes in stair ascent biomechanics two to eight years after ACL reconstruction are associated with patient-reported outcomes. Gait Posture 2019; 69:91-95. [PMID: 30685631 DOI: 10.1016/j.gaitpost.2019.01.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 01/08/2019] [Accepted: 01/19/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) injury is often followed by quadriceps deficits that are apparent with gait analysis. The deficit frequently remains after ACL reconstruction (ACLR). As such, evaluation of ACLR patients could be enhanced by a simple method to detect quadriceps deficits. Analyzing forward trunk flexion during stair ascent has been suggested as an assessment of quadriceps function that can be visualized with relatively simple instrumentation. AIM The purpose of this study was to determine if trunk flexion angle (TFA) during stair ascent is associated with quadriceps function (as measured by the peak knee flexion moment (KFM)) at 2 and 8 years post-ACLR and if changes are associated with patient-reported outcomes (PRO). METHODS Fourteen subjects with unilateral primary ACLR performed three stair-ascending trials at two-time periods: 2 years (baseline) and 8 years (follow-up) post-ACLR. Paired Student t-tests determined differences in KFM and TFA. Associations between KFM, TFA, and PRO were determined through Pearson correlations. RESULTS Peak KFM during stair ascent significantly increased from baseline to follow-up (p = 0.01). Though there was no significant difference in TFA (p = 0.84) compared to baseline, 50% of subjects showed decreases in TFA. Further, subjects with reduced TFA during stair ascent at follow-up had significantly increased peak KFM (p = 0.029) and improvements in PRO (p = 0.001). DISCUSSION The results suggest that TFA during stair ascent can provide a simple method to assess changes in quadriceps function and pain over time following ACLR. Further analysis is needed to draw conclusions between knee osteoarthritis development and increases in TFA.
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Affiliation(s)
- Arielle G Fischer
- BioMotion Laboratory, Department of Mechanical Engineering, Stanford University, CA, United States; Palo Alto Veterans Hospital, Palo Alto, CA, United States.
| | - Jennifer C Erhart-Hledik
- BioMotion Laboratory, Department of Mechanical Engineering, Stanford University, CA, United States; Palo Alto Veterans Hospital, Palo Alto, CA, United States; Department of Orthopaedic Surgery, Stanford University, CA, United States
| | - Constance R Chu
- BioMotion Laboratory, Department of Mechanical Engineering, Stanford University, CA, United States; Palo Alto Veterans Hospital, Palo Alto, CA, United States; Department of Orthopaedic Surgery, Stanford University, CA, United States
| | - Jessica L Asay
- BioMotion Laboratory, Department of Mechanical Engineering, Stanford University, CA, United States; Palo Alto Veterans Hospital, Palo Alto, CA, United States
| | - Thomas P Andriacchi
- BioMotion Laboratory, Department of Mechanical Engineering, Stanford University, CA, United States; Department of Orthopaedic Surgery, Stanford University, CA, United States
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Flück M, Viecelli C, Bapst AM, Kasper S, Valdivieso P, Franchi MV, Ruoss S, Lüthi JM, Bühler M, Claassen H, Hoppeler H, Gerber C. Knee Extensors Muscle Plasticity Over a 5-Years Rehabilitation Process After Open Knee Surgery. Front Physiol 2018; 9:1343. [PMID: 30337877 PMCID: PMC6178139 DOI: 10.3389/fphys.2018.01343] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 09/06/2018] [Indexed: 01/26/2023] Open
Abstract
We investigated molecular and cellular parameters which set metabolic and mechanical functioning of knee extensor muscles in the operated and contralateral control leg of 9 patients with a chronically insufficient anterior cruciate ligament (ACL; 26.6 ± 8.3 years, 8 males, 1 female) after open reconstructive surgery (week 0), after ambulant physiotherapy under cast immobilization (week 9), succeeding rehabilitation training (up to week 26), and subsequent voluntary physical activity (week 260). Clinical indices of knee function in the operated leg were improved at 52 weeks and remained at a comparable level at week 260. CSA of the quadriceps (-18%), MCSA of muscle fibers (-24%), and capillary-to-fiber ratio (-24%) in m. vastus lateralis from the ACL insufficient leg were lower at week 0 than reference values in the contralateral leg at week 260. Slow type fiber percentage (-35%) and mitochondrial volume density (-39%) were reduced in m. vastus lateralis from the operated leg at weeks 9 and 26. Composition alterations in the operated leg exceeded those in the contralateral leg and, with the exception of the volume density of subsarcolemmal mitochondria, returned to the reference levels at week 260. Leg-specific deterioration of metabolic characteristics in the vasti from the operated leg was reflected by the down-regulation of mitochondrial respiration complex I-III markers (-41-57%) at week 9. After rehabilitation training at week 26, the specific Y397 phosphorylation of focal adhesion kinase (FAK), which is a proxy for mechano-regulation, was elevated by 71% in the operated leg but not in the contralateral leg, which had performed strengthening type exercise during ambulant physiotherapy. Total FAK protein and Y397 phosphorylation levels were lowered in both legs at week 26 resulting in positive correlations with mitochondrial volume densities and mitochondrial protein levels. The findings emphasize that a loss of mechanical and metabolic characteristics in knee extensor muscle remains detectable years after untreated ACL rupture, which may be aggravated in the post-operative phase by the deterioration of slow-oxidative characteristics after reconstruction due to insufficient load-bearing muscle activity. The reestablishment of muscle composition subsequent to years of voluntary physical activity reinforces that slow-to-fast fiber transformation is reversible in humans.
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Affiliation(s)
- Martin Flück
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Claudio Viecelli
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Andreas M Bapst
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Stephanie Kasper
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Paola Valdivieso
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Martino V Franchi
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Severin Ruoss
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Jean-Marc Lüthi
- Department of Orthopedic Surgery, Inselspital Bern, Bern, Switzerland
| | - Martin Bühler
- Department of Orthopedic Surgery, Inselspital Bern, Bern, Switzerland
| | | | - Hans Hoppeler
- Department of Anatomy, University of Bern, Bern, Switzerland
| | - Christian Gerber
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.,Department of Orthopedic Surgery, Inselspital Bern, Bern, Switzerland
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Janssen RPA, van Melick N, van Mourik JBA, Reijman M, van Rhijn LW. ACL reconstruction with hamstring tendon autograft and accelerated brace-free rehabilitation: a systematic review of clinical outcomes. BMJ Open Sport Exerc Med 2018; 4:e000301. [PMID: 29682311 PMCID: PMC5905729 DOI: 10.1136/bmjsem-2017-000301] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 01/05/2018] [Accepted: 02/19/2018] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To investigate the clinical outcomes after hamstring tendon autograft ACL reconstruction (ACLR) with accelerated, brace-free rehabilitation. DESIGN Systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. DATA SOURCES Embase, MEDLINE Ovid, Web of Science, Cochrane CENTRAL and Google scholar from 1 January 1974 to 31 January 2017. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Study designs reporting outcomes in adults after arthroscopic, primary ACLR with hamstring autograft and accelerated, brace-free rehabilitation. RESULTS Twenty-four studies were included in the review. The clinical outcomes after hamstring tendon autograft ACLR with accelerated brace-free rehabilitation were the following: (1) early start of open kinetic exercises at 4 weeks in a limited range of motion (ROM, 90°-45°) and progressive concentric and eccentric exercises from 12 weeks did not alter outcomes, (2) gender and age did not influence clinical outcomes, (3) anatomical reconstructions showed better results than non-anatomical reconstructions, (4) there was no difference between single-bundle and double-bundle reconstructions, (5) femoral and tibial tunnel widening occurred, (6) hamstring tendons regenerated after harvest and (7) biological knowledge did not support return to sports at 4-6 months. CONCLUSIONS After hamstring tendon autograft ACLR with accelerated brace-free rehabilitation, clinical outcome is similar after single-bundle and double-bundle ACLR. Early start of open kinetic exercises at 4 weeks in a limited ROM (90°-45°) and progressive concentric and eccentric exercises from 12 weeks postsurgery do not alter clinical outcome. Further research should focus on achievement of best balance between graft loading and graft healing in the various rehabilitation phases after ACLR as well as on validated, criterion-based assessments for safe return to sports. LEVEL OF EVIDENCE Level 2b; therapeutic outcome studies.
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Affiliation(s)
- Rob P A Janssen
- Orthopaedic Center Máxima, Máxima Medical Center, Eindhoven, The Netherlands
| | | | - Jan B A van Mourik
- Orthopaedic Center Máxima, Máxima Medical Center, Eindhoven, The Netherlands
| | - Max Reijman
- Orthopaedic Center Máxima, Máxima Medical Center, Eindhoven, The Netherlands
- Department of Orthopaedic Surgery, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Lodewijk W van Rhijn
- Orthopaedic Surgery & Traumatology, Maastricht University Medical Center, Maastricht, The Netherlands
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21
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Janssen RPA, van Melick N, van Mourik JBA, Reijman M, van Rhijn LW. Similar clinical outcome between patellar tendon and hamstring tendon autograft after anterior cruciate ligament reconstruction with accelerated, brace-free rehabilitation: a systematic review. J ISAKOS 2017. [DOI: 10.1136/jisakos-2016-000110] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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22
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Optimization of the Return-to-Sport Paradigm After Anterior Cruciate Ligament Reconstruction: A Critical Step Back to Move Forward. Sports Med 2017; 47:1487-1500. [DOI: 10.1007/s40279-017-0674-6] [Citation(s) in RCA: 181] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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23
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Ardern CL, Kvist J, Webster KE. Psychological Aspects of Anterior Cruciate Ligament Injuries. OPER TECHN SPORT MED 2016. [DOI: 10.1053/j.otsm.2015.09.006] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Nyland J, Mattocks A, Kibbe S, Kalloub A, Greene JW, Caborn DNM. Anterior cruciate ligament reconstruction, rehabilitation, and return to play: 2015 update. Open Access J Sports Med 2016; 7:21-32. [PMID: 26955296 PMCID: PMC4772947 DOI: 10.2147/oajsm.s72332] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Anatomical discoveries and a growing appreciation of the knee as a complex organ are driving innovations in patient care decision-making following anterior cruciate ligament (ACL) injury. Surgeons are increasing their efforts to restore combined mechanical-neurosensory ACL function and placing more consideration on when to reconstruct versus repair native anatomical structures. Surgical options now include primary repair with or without reinforcing the injured ACL with suture-based internal bracing, and growing evidence supports biological augmentation using platelet-rich plasma and mesenchymal stem cells to enhance tissue healing. Physical therapists and athletic trainers are increasing their efforts to facilitate greater athlete cognitive engagement during therapeutic exercise performance to better restore nonimpaired neuromuscular control activation amplitude and timing. Knee brace design and use needs to evolve to better match these innovations and their influence on the rehabilitation plan timetable. There is a growing appreciation for the multifaceted characteristics of the rehabilitation process and how they influence neuromuscular, educational, and psychobehavioral treatment goal achievement. Multiple sources may influence the athlete during the return to sports process and clinical outcome measures need to be refined to better evaluate these influences. This update summarizes contemporary ACL surgical, medical, and rehabilitation interventions and future trends.
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Affiliation(s)
- John Nyland
- Athletic Training Program, Kosair Charities College of Health and Natural Sciences, Spalding University, Louisville, KY, USA; Department of Orthopedic Surgery, University of Louisville, Louisville, KY, USA
| | - Alma Mattocks
- Athletic Training Program, Kosair Charities College of Health and Natural Sciences, Spalding University, Louisville, KY, USA
| | - Shane Kibbe
- Department of Orthopedic Surgery, University of Louisville, Louisville, KY, USA
| | - Alaa Kalloub
- Department of Orthopedic Surgery, University of Louisville, Louisville, KY, USA; Shea Orthopedic Group, Louisville, KY, USA
| | - Joe W Greene
- Norton Orthopedic and Sports, Louisville, KY, USA
| | - David N M Caborn
- Department of Orthopedic Surgery, University of Louisville, Louisville, KY, USA; Shea Orthopedic Group, Louisville, KY, USA
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Zhang JY, Cohen JR, Yeranosian MG, Lord EL, Wang JC, Petrigliano FA, McAllister DR. Rehabilitation Charges Associated With Anterior Cruciate Ligament Reconstruction. Sports Health 2015; 7:538-41. [PMID: 26502448 PMCID: PMC4622380 DOI: 10.1177/1941738115606878] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: Pre- and postoperative rehabilitation are important to the management of patients with anterior cruciate ligament (ACL) reconstruction, but little attention has been given to the costs. This study evaluated the pre- and postoperative rehabilitation charges in patients with ACL reconstruction in the United States. Hypothesis: Patients receive preoperative rehabilitation less commonly than postoperative rehabilitation. Study Design: Retrospective database study. Level of Evidence: Level 4. Methods: Using the PearlDiver database, we identified patients undergoing ACL reconstruction from 2007 through 2011 using Current Procedural Terminology codes. The associated rehabilitation charges billed to insurance providers for 90 days preoperatively and 6 months postoperatively were categorized as physical therapy or as durable medical equipment (DME). The charges were examined by year and geographic region and represented as per-patient average charges (PPACs). Results: A total of 92,179 patients were identified in the study period. The PPAC for rehabilitation was $241 during the 90-day preoperative period and $1876 for the 6-month postoperative period. Patients averaged 2 preoperative sessions for physical therapy, with 44% of patients receiving preoperative rehabilitation in contrast with an average of 17 postoperative sessions per patient in 93% of patients. Rehabilitation charges were greater postoperatively than preoperatively (P < 0.05). Preoperatively, 24% of patients received a DME, while 35% received a DME postoperatively. Preoperative rehabilitation PPACs were highest in the Northeast, followed by Midwest, South, and West (P < 0.05). There were no significant differences in postoperative rehabilitation PPACs for geographic region (P = 0.43). Conclusion: Preoperative rehabilitation charges were lower than postoperative charges. A patient undergoing ACL reconstruction typically received 9 times more sessions of postoperative physical therapy than preoperative. Clinical Relevance: This study found that preoperative supervised rehabilitation for patients with ACL reconstruction was infrequent across the United States.
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Affiliation(s)
- Joanne Y Zhang
- Duke University School of Medicine, Durham, North Carolina
| | - Jeremiah R Cohen
- David Geffen School of Medicine at UCLA, Los Angeles, California
| | | | - Elizabeth L Lord
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Jeffrey C Wang
- Department of Orthopaedic Surgery, Keck School of Medicine at USC, Los Angeles, California
| | - Frank A Petrigliano
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - David R McAllister
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
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Saka T. Principles of postoperative anterior cruciate ligament rehabilitation. World J Orthop 2014; 5:450-459. [PMID: 25232521 PMCID: PMC4133451 DOI: 10.5312/wjo.v5.i4.450] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Revised: 03/19/2014] [Accepted: 06/03/2014] [Indexed: 02/06/2023] Open
Abstract
It is known that anterior cruciate ligament (ACL) reconstruction needs to be combined with detailed postoperative rehabilitation in order for patients to return to their pre-injury activity levels, and that the rehabilitation process is as important as the reconstruction surgery. Literature studies focus on how early in the postoperative ACL rehabilitation period rehabilitation modalities can be initiated. Despite the sheer number of studies on this topic, postoperative ACL rehabilitation protocols have not been standardized yet. Could common, “ossified” knowledge or modalities really prove themselves in the literature? Could questions such as “is postoperative brace use really necessary?”, “what are the benefits of early restoration of the range of motion (ROM)?”, “to what extent is neuromuscular electrical stimulation (NMES) effective in the protection from muscular atrophy?”, “how early can proprioception training and open chain exercises begin?”, “should strengthening training start in the immediate postoperative period?” be answered for sure? My aim is to review postoperative brace use, early ROM restoration, NMES, proprioception, open/closed chain exercises and early strengthening, which are common modalities in the very comprehensive theme of postoperative ACL rehabilitation, on the basis of several studies (Level of Evidence 1 and 2) and to present the commonly accepted ways they are presently used. Moreover, I have presented the objectives of postoperative ACL rehabilitation in tables and recent miscellaneous studies in the last chapter of the paper.
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