Return to play following ACL reconstruction: survey among experienced arthroscopic surgeons (AGA instructors)

2013 ◽  
Vol 133 (7) ◽  
pp. 969-977 ◽  
Author(s):  
Wolf Petersen ◽  
Thore Zantop
Keyword(s):  
Acl Reconstruction ◽  
Return To Play

scholarly journals Performance After Anterior Cruciate Ligament Reconstruction in National Basketball Association Players

2021 ◽  
Vol 9 (2) ◽  
pp. 232596712098164
Author(s):  
Steven F. DeFroda ◽  
Devan D. Patel ◽  
John Milner ◽  
Daniel S. Yang ◽  
Brett D. Owens
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Odds Ratio ◽  
Cruciate Ligament ◽  
Case Series ◽  
National Basketball Association ◽  
High Rate ◽  
Return To Play ◽  
Lower Percentage ◽  
Anterior Cruciate

Background: Anterior cruciate ligament (ACL) injury in National Basketball Association (NBA) players can have a significant impact on player longevity and performance. Current literature reports a high rate of return to play, but there are limited data on performance after ACL reconstruction (ACLR). Purpose/Hypothesis: To determine return to play and player performance in the first and second seasons after ACLR in NBA players. We hypothesized that players would return at a high rate. However, we also hypothesized that performance in the first season after ACLR would be worse as compared with the preinjury performance, with a return to baseline by postoperative year 2. Study Design: Case series; Level of evidence, 4. Methods: An online database of NBA athlete injuries between 2010 and 2019 was queried using the term ACL reconstruction. For the included players, the following data were recorded: name; age at injury; position; height, weight, and body mass index; handedness; NBA experience; dates of injury, surgery, and return; knee affected; and postoperative seasons played. Regular season statistics for 1 preinjury season and 2 postoperative seasons were compiled and included games started and played, minutes played, and player efficiency rating. Kaplan-Meier survivorship plots were computed for athlete return-to-play and retirement endpoints. Results: A total of 26 athletes underwent ACLR; of these, 84% (95% CI, 63.9%-95.5%) returned to play at a mean 372.5 days (95% CI, 323.5-421.5 days) after surgery. Career length after injury was a mean of 3.36 seasons (95% CI, 2.27-4.45 seasons). Factors that contributed to an increased probability of return to play included younger age at injury (odds ratio, 0.71 [95% CI, 0.47-0.92]; P = .0337) and fewer years of experience in the NBA before injury (odds ratio, 0.70 [95% CI, 0.45-0.93]; P = .0335). Postoperatively, athletes played a significantly lower percentage of total games in the first season (48.4%; P = .0004) and second season (62.1%; P = .0067) as compared with the preinjury season (78.5%). Player efficiency rating in the first season was 19.3% less than that in the preinjury season ( P = .0056). Performance in the second postoperative season was not significantly different versus preinjury. Conclusion: NBA players have a high rate of RTP after ACLR. However, it may take longer than a single season for elite NBA athletes to return to their full preinjury performance. Younger players and those with less NBA experience returned at higher rates.

Knee Kinetics in Baseball Hitting and Return to Play After ACL Reconstruction

2020 ◽  
Author(s):  
Kevin Giordano ◽  
Meredith Chaput ◽  
Adam Anz ◽  
Jeremy Braziel ◽  
James Andrews ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
External Rotation ◽  
Tracking System ◽  
Return To Play ◽  
Knee Kinetics ◽  
System Data ◽  
Rehabilitation Exercises ◽  
Kinetics Of ◽  
Electromagnetic Tracking System ◽  
Linear Regressions

AbstractThe purpose of this study was to describe the knee kinetics of baseball hitting, develop a tool to predict knee kinetics from easily obtainable measures, and to compare knee kinetics to other exercises along the rehabilitation continuum to determine a timeline for when hitting may resume after ACL reconstruction. Nineteen high school baseball athletes (16.3±0.8 yrs, 180.6±5.7 cm, 78.4±10.8 kg) participated. Participants took ten swings off a tee. Kinetic data were recorded using an electromagnetic tracking system. Data from swings with the top three exit velocities were averaged for analysis. Linear regressions were used to determine if predictors of height, mass, age and exit velocity could predict the following torques: bilateral knee net, extension, internal and external rotation, valgus and varus torque; and anterior force. Backwards regression models revealed independent variables could significantly predict front knee net, internal and external rotation, extension, and varus torque, and anterior force; and back knee net and valgus torque. Based on the kinetics of baseball hitting compared to those of rehabilitation exercises, if the involved knee is the front, we suggest tee hitting may be initiated at 13 weeks after ACL reconstruction. If the involved knee is the back, we suggest tee hitting may initiated at 17 weeks after ACL reconstruction.

Fifteen-Year Audit of Anterior Cruciate Ligament Reconstructions in the Australian Football League From 1999 to 2013: Return to Play and Subsequent ACL Injury

2018 ◽  
Vol 46 (14) ◽  
pp. 3353-3360 ◽  
Author(s):  
Courtney C.H. Lai ◽  
Julian A. Feller ◽  
Kate E. Webster
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Risk Ratio ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Return To Play ◽  
Rates Of Return ◽  
Australian Football League ◽  
Australian Football ◽  
Anterior Cruciate

Background: Anterior cruciate ligament (ACL) injury has been a major cause of missed game time among Australian Football League (AFL) players. Return to play after ACL reconstruction is not always achieved, even among elite athletes. The rate of subsequent ACL injury in the AFL from 1990 to 2000 was high as compared with that of other elite sports. Purpose: To determine the rates of return to play and subsequent ACL injury after ACL reconstruction among AFL players from 1999 to 2013 and to explore factors associated with differing rates of return to play and subsequent ACL injury. Study Design: Case series; Level of evidence, 4. Methods: A total of 158 AFL players who underwent ACL reconstruction were identified from a prospectively maintained registry of AFL player injuries. Further data were gathered from official playing statistics, surgical records, and structured phone interviews. Results: The rate of return to play after an initial ACL injury was 77% (121 of 158 players). Greater preinjury playing experience and earlier selection in the AFL draft were associated with higher rates of return to play. The rate of subsequent ACL injury to either knee was 30% (48 of 158 players) and was especially high among players aged <21 years (23 of 46 players, 50%). After subsequent ACL injury, 34 of 48 players (71%) returned to play. In primary ACL reconstruction, the use of Ligament Augmentation and Reconstruction System grafts resulted in a faster return to play ( P = .001) but had a higher risk of subsequent revision reconstruction (risk ratio = 2.8, P = .048). Family history of ACL injury was associated with an increased risk of subsequent contralateral ACL injury (risk ratio = 3.8, P = .002). Conclusion: Most AFL players who underwent ACL reconstruction returned to play at least 1 AFL match. The high rate of subsequent ACL injury among AFL players demonstrates the highly demanding nature of Australian football, particularly at the elite level. The risk factors for subsequent ACL injury should be considered carefully when treatment and rehabilitation decisions are made for these high-demand athletes.

scholarly journals Factors Associated With Psychological Readiness to Return to Sports With Cutting, Pivoting, and Jump-Landings After Primary ACL Reconstruction

2020 ◽  
Vol 8 (11) ◽  
pp. 232596712096448
Author(s):  
Junya Aizawa ◽  
Kenji Hirohata ◽  
Shunsuke Ohji ◽  
Takehiro Ohmi ◽  
Hideyuki Koga ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Regression Analysis ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Return To Play ◽  
Return To Sports ◽  
Factors Associated ◽  
Anterior Cruciate ◽  
Primary Acl Reconstruction ◽  
Jump Landings

Background: High psychological readiness is an important element for returning to sports after anterior cruciate ligament (ACL) reconstruction. Identifying factors that contribute to psychological readiness is essential for planning interventions to return to play. No studies have used multivariate analysis to clarify factors associated with psychological readiness to return to specific sports. Hypothesis: To identify factors that contribute to an athlete’s psychological readiness to return after ACL reconstruction to sports that require cutting, pivoting, and jump-landings. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Study participants were athletes who before injury had participated in sports with limited contact that required cutting, pivoting, and jump-landings (basketball, soccer, futsal, volleyball, badminton, tennis, and frisbee) and hoped to return to the same sport after reconstruction. Psychological readiness was measured using the Anterior Cruciate Ligament–Return to Sport After Injury Scale (ACL-RSI) in athletes more than 6 months after primary ACL reconstruction. To clarify factors associated with the ACL-RSI, univariate regression analysis and multivariate regression analysis were performed using the following independent variables: age, sex, body mass index, time from injury to reconstruction, time from reconstruction to testing, meniscal surgery, modified Tegner activity scale before injury, kinesiophobia, limb symmetry index of knee strength, limb symmetry indices of single-leg hop (SLH) distances, and subjective running ability. Results: Higher subjective running ability, a lower kinesiophobia score, and greater limb symmetry in the lateral SLH were positively associated with psychological readiness. Conclusion: The psychological readiness of athletes aiming to return after ACL reconstruction to limited-contact sports that require cutting, pivoting, and jump-landings was affected by subjective running ability, kinesiophobia, and asymmetry of lateral SLH distance. This information may be useful in planning appropriate interventions and thereby increasing the likelihood of an athlete’s returning to such sports.

Playing Performance After Anterior Cruciate Ligament Reconstruction Among Australian Football League Players From 1999 to 2013

2019 ◽  
Vol 47 (7) ◽  
pp. 1550-1556
Author(s):  
Courtney C.H. Lai ◽  
Julian A. Feller ◽  
Kate E. Webster
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Odds Ratio ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Return To Play ◽  
Average Level ◽  
Australian Football League ◽  
Australian Football ◽  
Anterior Cruciate

Background: Achieving preinjury levels of athletic performance has been challenging for elite athletes after anterior cruciate ligament (ACL) reconstruction. Although a recent study found that 77% of Australian Football League (AFL) players who underwent ACL reconstruction from 1999 to 2013 returned to play at the highest level, the study did not indicate how consistently or well they were able to play. Purpose: To identify the number of AFL players who returned to play consistently over 2 seasons after ACL reconstruction, compare their playing performance in these seasons with preinjury performance, and evaluate factors associated with returning to preinjury levels of performance. Study Design: Case series; Level of evidence, 4. Methods: Analysis included 104 AFL players who underwent ACL reconstruction between 1999 and 2013. All had played at least 10 AFL matches in 1 season before ACL injury. Ranking points, as devised by AFL statisticians, were used to measure individual playing performance. Results: Of the 104 players who played at least 10 matches in 1 season before ACL injury, 53 (51%) returned to play at least 10 matches in 2 seasons after surgery. Of these 53 players, 36 (68%) returned to their preinjury levels of performance. The 17 remaining players who did not return to their preinjury performance still performed comparably to the AFL average level after surgery. Players <25 years old (odds ratio = 2.9, P = .01) or <90 kg (odds ratio = 2.7, P = .03) had greater odds of returning to their preinjury levels of performance. Conclusion: Returning to play on a consistent basis was a substantial challenge for AFL players after ACL reconstruction. However, among players who did return to play consistently over 2 seasons, their postsurgery average performance was comparable with the AFL average level of performance, and two-thirds returned to their preinjury levels of performance. Younger and lighter players were more likely to return to their preinjury levels of performance, possibly given the nature of AFL club playing list management decisions.

scholarly journals Return to Play and Performance After Primary ACL Reconstruction in American Football Players: A Systematic Review

2020 ◽  
Vol 8 (10) ◽  
pp. 232596712095965
Author(s):  
Bailey J. Ross ◽  
Ian Savage-Elliott ◽  
Symone M. Brown ◽  
Mary K. Mulcahey
Keyword(s):  
Systematic Review ◽  
Acl Reconstruction ◽  
Study Design ◽  
Acl Injury ◽  
Performance Level ◽  
American Football ◽  
Return To Play ◽  
Football Players ◽  
Cochrane Central Register ◽  
And Performance

Background: Anterior cruciate ligament (ACL) injuries are among the most common sports-related injuries, and they can have a negative impact on players’ ability to return to play (RTP). There is a paucity of literature focused on RTP after ACL reconstruction (ACLR) in collision sports. Purpose: To characterize the impact that an ACL injury has on the ability to RTP and the post-ACLR performance level in American football players. Study Design: Systematic review; Level of evidence, 4. Methods: An electronic search was performed using the following databases: the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed, Embase, and the Cumulative Index to Nursing and Allied Health Literature. Included studies were written in English; were published since the year 2000; examined only American football players; and reported on RTP, performance, and/or career length after primary ACLR. Results: The initial search yielded 442 unique studies. Of these, 427 were removed after screening, leaving 15 studies that met inclusion criteria. An additional 2 studies were identified in these studies’ references, yielding a total of 17. The rate of RTP after ACLR for football players was 67.2% (1249/1859), and the mean time to return was 11.6 months (range, 35.8-55.8 weeks). Although considerable heterogeneity existed in the study design and outcomes measured, in general, a majority of football players experienced greater declines from their preinjury performance level than controls over the same time period. Conclusion: An ACL injury negatively affected football players’ ability to RTP and their post-ACLR performance. The degree of effect varied by several factors, including playing position, preinjury performance level, and National Football League Draft round. These results may be used by physicians and football players to develop reasonable expectations for returning to play and performance after an ACL injury.

scholarly journals Functional outcome in patients following cartilage regeneration outcome at minimum follow-up of 12 months

2020 ◽  
Vol 8 (9_suppl7) ◽  
pp. 2325967120S0054
Author(s):  
Christian Liefke ◽  
Christian Zantop ◽  
Shozaburo Terai ◽  
Thore Zantop
Keyword(s):  
Functional Analysis ◽  
Acl Reconstruction ◽  
Functional Results ◽  
Return To Play ◽  
Isokinetic Strength ◽  
Return To Sports ◽  
Recurrent Instability ◽  
3D Motion Analysis ◽  
Return To Competition

Introduction: Several studies have focused on the return to play rate after ACL reconstruction. Whereas most studies just report the rate as a result, only few studies evaluate specific parameters and tests to further investigate the conditions of when the patients should return to sports. Hypotheses: Aim of this study was to compare the return to competition rate of patients 12 months after ACL reconstruction and correlate the rate and re-rupture fate to the assessed multifactorial “return-to-sports” test 3 months after ACL reconstruction at our institution. Methods: A total of 51 Patients undergoing ACL reconstruction are prospectively evaluated using a “return-to-sports” test 3 months following ACL reconstruction. Inclusion criteria was isolated ACL rupture, Level 1 sports participation, free range of motion at FU 3 months, age >18 and <50, no associated ligamentous or meniscal injury influencing the rehab protocol and intact contralateral leg. ACL reconstructions were performed by a single surgeon with semitendinosus graft and standardized rehabilitation protocol. Follow-up at 3 months postoperatively was performed using a functional analysis including isokinetic strength measurements (BTE-primus), proprioceptive tests (MTF tests) and a 3d-motion analysis (myomotion, Noraxon) during bilateral drop jumps and single leg hop tests. To evaluate the return to play rate and recurrent instability problems a survey was used at timepoint 12 months postoperatively (n=43 at abstract submission). Results: At timepoint 12 months following ACL reconstruction 6 of 43 currently evaluated patients did not return to competition (6/43). A total of 5 patients were evaluated as moderate to high risk for ACL recurrent instability in the return-to-sports analysis at three months whereas one patient not returning to competition showed a not elevated risk for ACL recurrent instability in the analysis. The was a high correlation of patients revealing better functional results in the functional analysis (isokinetic strength, proprioceptive test and a 3d-motion analysis) and returning to sports. A total of 8 patients (4/43) suffered a recurrent instability after returning to sports. Conclusion: This prospective analysis of patients following semitendinosus ACL reconstruction with one single surgeon implicates that the rate of returning to sports in patients using a multifactorial “return-to-sports” analysis at 3 months postoperatively is higher compared to the rate of patients without such an analysis in the literature. We found a high correlation between better functional results and return to play rate as well as a re-rupture rate of 10% in patients after returning to sports.

scholarly journals Improving the ACL-RSI: effect of motion and force analysis during Return-to-sports test 3 months after ACL reconstruction

2020 ◽  
Vol 8 (9_suppl7) ◽  
pp. 2325967120S0054
Author(s):  
Shozaburo Terai ◽  
Christian Zantop ◽  
Thore Zantop
Keyword(s):  
Functional Analysis ◽  
Acl Reconstruction ◽  
Motion Analysis ◽  
Baseline Data ◽  
Return To Play ◽  
Isokinetic Strength ◽  
Return To Sports ◽  
Functional Testing ◽  
3D Motion ◽  
3D Motion Analysis

Introduction: Psychological factors influencing the “return to play” fate of patients following ACL reconstruction are assessed using the ACL-Return to Sports after Injury Scale (ACL-RSI). A mean of 70 points distinguishes if the patients is likely to go back to training (Webster Feller 2018). Strategies of increasing this score hves not been reported yet. Aim of this study was to compare the ACL-RSI of patients three months after ACL reconstruction before and after a multifactorial “return-to-sports” test at our institution. Our hypothesis was that the “return-to-sports” test will increase the ACL-RSI value at three months after surgery. Hypotheses: We hypothesized that following a multi-factorial testing analysis, the LSI will increase compared to the value of the RSI score before testing. Methods: A total of 102 Patients undergoing ACL reconstruction are prospectively evaluated using the ACL-RSI at baseline data prior to surgery. ACL reconstructions were performed by a single surgeon with semitendinosus graft and standardized rehabilitation protocol. Follow-up was performed at 12 weeks postoperatively using a functional analysis including isokinetic strength measurements (BTE-primus), proprioceptive tests (MTF tests) and a 3d-motion analysis (myomotion, Noraxon) during bilateral drop jumps and single leg hop tests. To evaluate the effect of this testing battery on the ACL-RSI, the scale was assessed prior to “return-to-sports” test and after the test (n=80 at abstract submission). Results: Patients showed significantly improved ACL-RSI scale values at 3 months when compared to the baseline data prior to surgery. Using a cut-off of 70 points, 25% of the patients were determined under this cut-off. ACL reconstructed patients having a high value showed a lower increase in ACL-RSI at 3 months postoperatively when the value prior to the multifactorial “return-to-sport” test is compared to after test. Patients below 70 points before the functional testing (pre: 45,23 +/-11,5) showed after the test a value of 79,15 (+/-8,3) and an increase of 33,9 points. Compared to patients higher than 70 points prior to functional testing (pre: 71,4 +/-6,4; post 78,5 +/-8,3; increase 4,4) this increase is significantly lower. The was a high correlation of patients revealing better functional results in the functional analysis (isokinetic strength, proprioceptive test and a 3d-motion analysis) and a high score in the ACL-RSI scale. Conclusion: This prospective analysis of patients following semitendinosus ACL reconstruction with one single surgeon implicates that the use of a multifactorial “return-to-sports” analysis at 3 months postoperatively is able to improve the ACL-RSI score. Interestingly, the increase in the score was significantly higher in patients having a lower baseline and prior to test score when compared to patients showing a score that is more than 70 points. The effects of this elevated score over time remains unclear and needs to investigate in subsequent studies.

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