Hop tests predict future symptoms, function and return to sport after ACL injury: a systematic review and meta-analysis

Background: Injury to the ipsilateral graft used for reconstruction of the anterior cruciate ligament (ACL) or a new injury to the contralateral ACL are disastrous outcomes after successful ACL reconstruction (ACLR), rehabilitation, and return to activity. Studies reporting ACL reinjury rates in younger active populations are emerging in the literature, but these data have not yet been comprehensively synthesized. Purpose: To provide a current review of the literature to evaluate age and activity level as the primary risk factors in reinjury after ACLR. Study Design: Systematic review and meta-analysis. Methods: A systematic review of the literature was conducted via searches in PubMed (1966 to July 2015) and EBSCO host (CINAHL, Medline, SPORTDiscus [1987 to July 2015]). After the search and consultation with experts and rating of study quality, 19 articles met inclusion for review and aggregation. Population demographic data and total reinjury (ipsilateral and contralateral) rate data were recorded from each individual study and combined using random-effects meta-analyses. Separate meta-analyses were conducted for the total population data as well as the following subsets: young age, return to sport, and young age + return to sport. Results: Overall, the total second ACL reinjury rate was 15%, with an ipsilateral reinjury rate of 7% and contralateral injury rate of 8%. The secondary ACL injury rate (ipsilateral + contralateral) for patients younger than 25 years was 21%. The secondary ACL injury rate for athletes who return to a sport was also 20%. Combining these risk factors, athletes younger than 25 years who return to sport have a secondary ACL injury rate of 23%. Conclusion: This systematic review and meta-analysis demonstrates that younger age and a return to high level of activity are salient factors associated with secondary ACL injury. These combined data indicate that nearly 1 in 4 young athletic patients who sustain an ACL injury and return to high-risk sport will go on to sustain another ACL injury at some point in their career, and they will likely sustain it early in the return-to-play period. The high rate of secondary injury in young athletes who return to sport after ACLR equates to a 30 to 40 times greater risk of an ACL injury compared with uninjured adolescents. These data indicate that activity modification, improved rehabilitation and return-to-play guidelines, and the use of integrative neuromuscular training may help athletes more safely reintegrate into sport and reduce second injury in this at-risk population.

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Risk Factors for Contra-Lateral Secondary Anterior Cruciate Ligament Injury: A Systematic Review with Meta-Analysis

Sports Medicine ◽

10.1007/s40279-020-01424-3 ◽

2021 ◽

Author(s):

Anna Cronström ◽

Eva Tengman ◽

Charlotte K. Häger

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Cruciate Ligament ◽

Meta Analysis ◽

Return To Sport ◽

Acl Injury ◽

Activity Level ◽

High Activity Level ◽

History Of ◽

Anterior Cruciate

Abstract Background The risk of sustaining a contra-lateral anterior cruciate ligament (C-ACL) injury after primary unilateral ACL injury is high. C-ACL injury often contributes to a further decline in function and quality of life, including failure to return to sport. There is, however, very limited knowledge about which risk factors that contribute to C-ACL injury. Objective To systematically review instrinsic risk factors for sustaining a C-ACL injury. Methods A systematic review with meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Four databases (MEDLINE, CINAHL, EMBASE, Sport Discus) were searched from inception to January 2020. Inclusion criteria were prospective or retrospective studies investigating any intrinsic risk factor for future C-ACL injury. Meta-analysis was performed and expressed as odds ratios (OR) if two or more articles assessed the same risk factor. Results 44 moderate-to-high quality studies were eventually included in this review, whereof 35 studies were eligible for meta-analysis, including up to 59 000 individuals. We identified seven factors independently increasing the odds of sustaining a C-ACL injury (in order of highest to lowest OR): (1) returning to a high activity level (OR 3.26, 95% CI 2.10–5.06); (2) Body Mass Index < 25 (OR 2.73, 95% CI 1.73–4.36); (3) age ≤ 18 years (OR 2.42, 95% CI 1.51–3.88); (4) family history of ACL injury (OR 2.07, 95% CI 1.54–2.80); (5) primary ACL reconstruction performed ≤ 3 months post injury (OR 1.65, 95% CI: 1.32–2.06); (6) female sex (OR 1.35, 95% CI 1.14–1.61); and (7) concomitant meniscal injury (OR 1.21, 95% CI 1.03–1.42). The following two factors were associated with decreased odds of a subsequent C-ACL injury: 1) decreased intercondylar notch width/width of the distal femur ratio (OR 0.43, 95% CI 0.25–0.69) and 2) concomitant cartilage injury (OR 0.83, 95% CI 0.69–1.00). There were no associations between the odds of sustaining a C-ACL injury and smoking status, pre-injury activity level, playing soccer compared to other sports or timing of return to sport. No studies of neuromuscular function in relation to risk of C-ACL injury were eligible for meta-analysis according to our criteria. Conclusion This review provides evidence that demographic factors such as female sex, young age (≤ 18 years) and family history of ACL injury, as well as early reconstruction and returning to a high activity level increase the risk of C-ACL injury. Given the lack of studies related to neuromuscular factors that may be modifiable by training, future studies are warranted that investigate the possible role of factors such as dynamic knee stability and alignment, muscle activation and/or strength and proprioception as well as sport-specific training prior to return-to-sport for C-ACL injuries. PROSPERO: CRD42020140129.

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Letter to the editor on “Return to sport following Lisfranc injuries: A systematic review and meta-analysis”

Foot and Ankle Surgery ◽

10.1016/j.fas.2019.03.005 ◽

2019 ◽

Vol 25 (6) ◽

pp. 852-853 ◽

Cited By ~ 1

Author(s):

Carlijn S. ter Laak Bolk ◽

Jari Dahmen ◽

Kaj T.A. Lambers ◽

Leendert Blankevoort ◽

Gino M.M.J. Kerkhoffs

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Return To Sport ◽

Letter To The Editor ◽

Lisfranc Injuries

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Return to sport following anterior cruciate ligament reconstruction in elite athletes: A systematic review and meta-analysis

Journal of Science and Medicine in Sport ◽

10.1016/j.jsams.2017.01.083 ◽

2017 ◽

Vol 20 ◽

pp. e101 ◽

Cited By ~ 1

Author(s):

C. Lai ◽

C. Ardern ◽

J. Feller ◽

K. Webster

Keyword(s):

Systematic Review ◽

Anterior Cruciate Ligament ◽

Anterior Cruciate Ligament Reconstruction ◽

Ligament Reconstruction ◽

Elite Athletes ◽

Cruciate Ligament ◽

Meta Analysis ◽

Return To Sport ◽

Cruciate Ligament Reconstruction ◽

Anterior Cruciate

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Over 90 % of children and adolescents return to sport after anterior cruciate ligament reconstruction: a systematic review and meta-analysis

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-018-4830-9 ◽

2018 ◽

Vol 26 (4) ◽

pp. 1019-1036 ◽

Cited By ~ 44

Author(s):

Jeffrey Kay ◽

Muzammil Memon ◽

Robert G. Marx ◽

Devin Peterson ◽

Nicole Simunovic ◽

...

Keyword(s):

Systematic Review ◽

Anterior Cruciate Ligament ◽

Anterior Cruciate Ligament Reconstruction ◽

Children And Adolescents ◽

Ligament Reconstruction ◽

Cruciate Ligament ◽

Meta Analysis ◽

Return To Sport ◽

Cruciate Ligament Reconstruction ◽

Anterior Cruciate

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Return to Sport after Anatomic and Reverse Total Shoulder Arthroplasty in Elderly Patients: A Systematic Review and Meta-Analysis

Journal of Clinical Medicine ◽

10.3390/jcm9051576 ◽

2020 ◽

Vol 9 (5) ◽

pp. 1576

Author(s):

Rocco Papalia ◽

Mauro Ciuffreda ◽

Erika Albo ◽

Chiara De Andreis ◽

Lorenzo Alirio Diaz Balzani ◽

...

Keyword(s):

Systematic Review ◽

Elderly Patients ◽

Shoulder Arthroplasty ◽

Randomized Clinical Trials ◽

Meta Analysis ◽

Total Shoulder Arthroplasty ◽

Case Series ◽

Return To Sport ◽

Rate Of Return ◽

Cochrane Library

The aim of this systematic review and meta-analysis was to evaluate the rate of return to sport in elderly patients who underwent anatomic (ATSA) and reverse (RTSA) total shoulder arthroplasty, to assess postoperative pain and functional outcomes and to give an overview of postoperative rehabilitation protocols. A systematic search in Pubmed-Medline, Cochrane Library, and Google Scholar was carried out to identify eligible randomized clinical trials, observational studies, or case series that evaluated the rate of return to sport after RTSA or ATSA. Six retrospective studies, five case series, and one prospective cohort study were included in this review. The overall rate of return to sport was 82% (95% CI 0.76–0.88, p < 0.01). Patients undergoing ATSA returned at a higher rate (90%) (95% CI 0.80–0.99, p < 0.01) compared to RTSA (77%) (95% CI 0.69–0.85, p < 0.01). Moreover, the results showed that patients returned to sport at the same or a higher level in 75% of cases. Swimming had the highest rate of return (84%), followed by fitness (77%), golf (77%), and tennis (69%). Thus, RTSA and ATSA are effective to guarantee a significative rate of return to sport in elderly patients. A slightly higher rate was found for the anatomic implant.

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Return to Sport After Metacarpal and Phalangeal Fractures: A Systematic Review and Evidence Appraisal

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120980013 ◽

2021 ◽

Vol 9 (2) ◽

pp. 232596712098001

Author(s):

Luke Geoghegan ◽

Alexander Scarborough ◽

Jeremy N. Rodrigues ◽

Mike J. Hayton ◽

Maxim D. Horwitz

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Management Strategies ◽

Treatment Strategies ◽

Return To Sport ◽

Poor Quality ◽

Accurate Estimation ◽

Level Of Evidence ◽

Metacarpal Fractures ◽

Phalangeal Fractures

Background: Fractures of the metacarpals and phalanges account for more than half of all upper extremity fractures sustained by competitive athletes. Purpose: To determine which management strategy is best for expediting return to preinjury levels of competition in adult athletes with metacarpal and/or phalangeal fractures. Study Design: Systematic review; Level of evidence, 4. Methods: A methodology compliant with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) was used. A custom search strategy was designed and applied to MEDLINE and In-Process, Embase, EMCARE, and CINAHL. Results: Overall, 3135 records were identified, of which 8 met full inclusion criteria. All patients returned to preinjury levels of competition, at a mean of 30.6 days for phalangeal fractures and 21.9 days for metacarpal fractures. Meta-analysis demonstrated delayed return-to-sport time for operatively managed metacarpal fractures as compared with nonoperatively managed ones (28.5 vs 22.0 days). All studies were of fair or poor quality, and none were randomized. Conclusion: Optimal management strategies for athletes with metacarpal and phalangeal fractures remain equivocal. Injury, treatment, and sport-specific factors may confound results and preclude accurate estimation of optimal treatment strategies at present.

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