scholarly journals Concussion Assessment and Return to Sport for a High School, Legally Blind, Female Swimmer

2019 ◽  
Vol 34 (5) ◽  
pp. 776-776
Author(s):  
A Custer ◽  
J Tatman ◽  
J Lee
Keyword(s):  
Visually Impaired ◽  
Glaucoma Patient ◽  
Cognitive Activity ◽  
Balance Training ◽  
Return To Sport ◽  
Interdisciplinary Approach ◽  
Return To Play ◽  
Symptom Scale ◽  
Dry Land ◽  
Sport Concussion

Abstract Purpose Limited research exists on treatment of sport concussion in visually impaired individuals. Adaptation to athlete’s needs is vital for individualized sport specific return to play (RTP). Methods Fifteen year-old, visually impaired, female, swimmer presented to an interdisciplinary Sport Concussion Program for protracted recovery with complaints of disequilibrium, headaches, cognitive fatigue, and exacerbation of premorbid resting nystagmus after being kicked in the head during practice. Patient is legally blind due to Peter’s Anomaly and right retinal detachment, with history of migraine, carsickness, and glaucoma. Patient completed two visits with clinical sports neuropsychologist and three vestibular therapy (VT) appointments, assessed via Post-Concussion Symptom Scale (PCSS), Montreal Cognitive Assessment (MoCA-BLIND), Modified Balance Error Scoring System (mBESS), Dizziness Handicap Inventory (DHI), Activities-Specific Balance Confidence scale (ABC), Buffalo Concussion Treadmill Test (BCTT), and Children's Memory Scales (CMS). Differential Diagnosis: Concussion, Post-Concussion Syndrome, Post-Traumatic Headache, Vestibular Dysfunction. Results Initial consult revealed PCSS of 35 and normal MoCA-BLIND (18/22). Patient’s mBESS improved from 7 to 3 errors with VT, DHI mildly elevated (36%), ABC moderately elevated (43%). VT consisted of: neuromuscular re-education, balance training, positional changes, cognitive activity, sport specific RTP progressions (dry land modifications, transitions into water, communication to team athletic trainer). BCTT passed on third VT visit. Patient cleared for RTP with PCSS at 7 and (CMS) Stories, Word Lists, Numbers, and Sequences subtests within expectations (average to high average ranges). Conclusion This case study illustrates an interdisciplinary approach to concussion treatment with modification of established tools and proposal of sport specific RTP guidelines for visually impaired athletes.

Information about Sports Related Concussion and Return to Play Rules in Youth Soccer, Rugby and Handball on Websites of German Sports Clubs (Preprint)

2020 ◽  
Author(s):  
Laura Rihani ◽  
Jennifer Usinger ◽  
Nicola Jungbäck ◽  
Gabriele Stumm ◽  
Thorsten Schulz ◽  
...  
Keyword(s):  
Brain Injuries ◽  
Return To Play ◽  
Online Information ◽  
Lower Saxony ◽  
Systematic Analysis ◽  
Youth Soccer ◽  
Sports Clubs ◽  
Sport Concussion ◽  
The Usa ◽  
Sports Activities

BACKGROUND Sports-related mild traumatic brain injuries (sports related concussion, SRC) have received increasing attention since neurodegenerative processes have been linked to repetitive SRCs. Return-to-Play (RTP) rules have been established for medical advised return into sports activities after concussion, but it is not clear if these rules also reach the sports clubs and its young athletes. OBJECTIVE In youth sports, athletes and their parents search the internet for advice after SRC. We therefore investigated which websites of German sports associations and clubs in football (soccer), handball and rugby offer information on SRC and RTP rules. METHODS The systematic analysis included websites of local football, handball and rugby clubs in two comparable regions in Southern Bavaria and Lower Saxony. The websites of the regional and the German umbrella associations were also included into the study. Eight criteria of the revised Sport Concussion Consensus Statement served as standard for the evaluation according to the protocol published by Swallow et al. (J Neurosurg Pediatr, 2018). RESULTS No information on RTP rules or the topic “sports-related brain injuries” could be found on any of the clubs’ websites. Only the Bavarian Football Association and the Rugby Association sporadically provided information on the topic. The German umbrella associations in football and rugby take up international documents and regulations of the European and the world associations. No information could be found at the German Handball Association. CONCLUSIONS The topics of sports-related brain injuries and RTP rules are mostly neglected on the analysed Websites. This is remarkable, as there are clearly defined consensus guidelines which are widely accepted in international comparison. Especially in the USA, online information on this topic has become standard.

scholarly journals The Evolving Approach to Treating Syndesmotic Injuries in the Elite Athlete: An International Perspective

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0003
Author(s):  
Kenneth Hunt ◽  
Shanthan Challa ◽  
Pieter D’Hooghe ◽  
Pam Kumparatana ◽  
Phinit Phisitkul ◽  
...  
Keyword(s):  
Return To Sport ◽  
High Impact ◽  
Optimal Treatment ◽  
The Body ◽  
Return To Play ◽  
Considerable Variability ◽  
Fixation Device ◽  
Flexible Devices ◽  
Fixation Devices ◽  
Rehabilitation Protocols

Category: Ankle, Sports Introduction/Purpose: There exists little consensus regarding optimal treatment protocols for syndesmotic injuries. Orthopaedic clinicians have implemented a variety of treatment strategies, ranging from immobilization to screw fixation to new flexible fixation devices. While the body of literature is growing with regard to both the biomechanics and clinical outcomes for various constructs and rehabilitation protocols, there is little consensus on the optimal treatment and return to sport strategy for these injuries. We endeavored to assess current approaches to syndesmotic injures by orthopedic foot and ankle specialists around the world in 6 athlete scenarios with increasing degree of injury. Commensurate with the lack of available data to guide treatments, we hypothesize that there will be variability in the treatment and management strategies for syndesmotic injuries. Methods: A REDcap survey was created with 27 questions, including respondent demographics, indications for treatment of syndesmotic injuries, preferred treatment, preferred technique for repairing the syndesmosis and post-operative management. Respondents were asked to choose their preferred fixation device and post-operative return to play protocols in six different athlete scenarios (moderate impact, high impact and very high impact and each with/without complete deltoid injury). The survey was disseminated among the memberships of 18 North American and International medical societies. Society members were surveyed via three emails disseminated 2 weeks apart. Frequencies and percentages were calculated for all categorical responses. Results: A total of 596 providers responded to the survey, including 337 American surgeons and 259 members of various international societies. There was a 70% survey completion rate with a wide geographic distribution among respondents. Flexible devices were the preferred fixation construct (48.1%), followed by screws (27.5%), hybrid fixation (18.5%) and other (5.9%). There was a higher preference for flexible devices among sports medicine trained providers. 62% of respondents noted that their rehabilitation protocols would not change for each athlete scenario. Considerable variability was present in anticipated full return to sport, ranging from immediately following injury to 6 months post-op (Fig 1). One-third of respondents indicated that they repair the deltoid greater than 50% of the time when injured. Conclusion: We found a wide variety of indications and treatment constructs employed by orthopaedic surgeons for athletes with ligamentous syndesmotic injuries requiring fixation. Although, flexible fixation devices are the preferred among all respondents but there was a considerable variability in device choices. Fellowship training also appears to affect the preferred fixation device choice. There also exists substantial variability in expected return to play for every athlete scenario (Fig 1). The diversity in approaches and post-operative recommendations underscores the need for evidence-based guidelines to inform management of syndesmotic injuries.

scholarly journals Essentials for Best Practice: Treatment Approaches for Athletes With Eating Disorders

2018 ◽  
Vol 12 (4) ◽  
pp. 495-507 ◽  
Author(s):  
Jenny H. Conviser ◽  
Amanda Schlitzer Tierney ◽  
Riley Nickols
Keyword(s):  
Eating Disorders ◽  
Emotional Regulation ◽  
Best Practice ◽  
Sport Participation ◽  
Emotional Health ◽  
Multidisciplinary Treatment ◽  
Return To Sport ◽  
Multidisciplinary Care ◽  
Return To Play ◽  
Treatment Team

Eating disorders (EDs) and disordered-eating behaviors (DEBs), pose a high risk of morbidity and mortality, threatening physical health, emotional health, and overall quality of life. Unfortunately, among athletes, prevalence rates continue to increase. This document summarizes the challenges of establishing and navigating the multidisciplinary care needed to effectively treat EDs and DEBs among athletes. The benefits of timely and frequent communication within the multidisciplinary treatment team (MDTT) are emphasized and discussed. Authors advise who should be selected as members of the MDTT and suggest that all personnel, including athletic coaches, athletic trainers, physical therapists, and certified fitness professionals be ED-informed and ED-sensitive. Vital components of care are noted including use of a variety of evidence-based psychotherapeutic modalities, interventions which target emotional regulation, and prioritize values based compassionate care. Authors caution that performance decrements and medical/physiological changes are not always easily observable in individuals with EDs and DEBs and therefore, attuned, consistent, and ongoing monitoring is needed. Consensus regarding previously established parameters for return to play and careful titration of physical activity throughout the ED recovery process are suggested as important for preserving health, preventing re-injury, or relapse and facilitating successful return to sport participation.

Minimally Invasive Double-Button Fixation of Displaced Lateral Clavicular Fractures in Athletes

2016 ◽  
Vol 45 (2) ◽  
pp. 462-467 ◽  
Author(s):  
Maximiliano Ranalletta ◽  
Luciano A. Rossi ◽  
Hugo Barros ◽  
Francisco Nally ◽  
Ignacio Tanoira ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Closed Reduction ◽  
Functional Outcomes ◽  
Constant Score ◽  
Case Series ◽  
Return To Sport ◽  
Return To Play ◽  
Short Version ◽  
Level Of Evidence ◽  
The Mean

Background: Early union and a rapid return to prior function are the priorities for young athletes with lateral clavicular fractures. Furthermore, it is essential to avoid nonunion in this subgroup of patients, as this is frequently associated with persistent pain, restriction of movement, and loss of strength and endurance of the shoulder. Purpose: To analyze the time to return to sport, functional outcomes, and complications in a group of athletes with displaced lateral clavicular fractures treated using closed reduction and minimally invasive double-button fixation. Study Design: Case series; Level of evidence, 4. Methods: A total of 21 athletes with displaced lateral clavicular fractures were treated with closed reduction and minimally invasive double-button fixation between March 2008 and October 2013. Patients completed a questionnaire focused on the time to return to sport and treatment course. Functional outcomes were assessed with the Constant score and the short version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire. Pain was evaluated with the visual analog scale (VAS). Radiographs were reviewed to identify radiographic union, malunion, and nonunion. Results: Of the 21 study patients, 20 returned to sport after treatment; 100% returned to the same level. The mean time to return to play was 78 days (range, 41-120 days). Four patients (20%) returned to sport less than 6 weeks after surgery, 14 (70%) returned between 6 and 12 weeks after surgery, and 2 (10%) returned after 12 weeks. The mean Constant score was 89.1 ± 4.2 (range, 79-100), the mean QuickDASH score was 0.4 ± 2.6 (range, 0-7.1), and the mean VAS pain score was 0.4 ± 1.0 (range, 0-3) at final follow-up (mean, 41 months). The only complication was asymptomatic nonunion. Hardware removal was not necessary in any patient. Conclusion: Closed reduction and minimally invasive double-button fixation of displaced lateral clavicular fractures in athletes was successful in terms of returning to the previous level of athletic activity regardless of the type of sport, with excellent clinical results and a low rate of complications.

scholarly journals TANTRA O YOGA. ESTUDIOS CLÍNICOS, 3ª PARTE: COMPARATIVA

2017 ◽  
Vol 2 (2) ◽  
pp. 117-142
Author(s):  
Oscar R. Gómez
Keyword(s):  
Cognitive Activity ◽  
Lactate Concentration ◽  
Blood Lactate Concentration ◽  
Interdisciplinary Approach ◽  
Fold Increase ◽  
Thyroid Stimulating Hormone ◽  
Endocrine Function ◽  
Plasma Prolactin ◽  
Revisión Sistemática ◽  
Hypometabolic State

Varios estudios clínicos muestran cómo las prácticas tántricas y los ejercicios de las tradiciones védicas -como el yoga- o budistas theravada o mahayana tienen un impacto psicobiológico significativo. Este estudio compara el correlato neurofisiológico de las prácticas llamadas meditaciones tántricas y no-tántricas mediante una revisión sistemática cualitativa de los datos recolectados. Se evidenció que las prácticas tántricas producen aumento en la actividad simpática, del estado de «alerta fásica» y en el rendimiento en tareas cognitivo visuales. Promueven una mayor vigilia y menor propensión al sueño, generan un incremento en la actividad cognitiva y modificaciones metabólicas contrarias a las que se verifican de las no-tántricas como consecuencia del relax inducido por esas prácticas. En oposición,  las no-tántricas crean una mejor respuesta de relajación con actividad parasimpática incrementada e inhibición del sistema simpático, que induce un estado hipometabólico de descanso profundo donde el practicante permanece despierto y su atención en «alerta tónica» con los síntomas correspondientes a ese estado hipometabólico -hipotonía, disminución del consumo de oxígeno, de la tasa cardíaca y de la concentración de lactato en sangre-, modificación del normal funcionamiento endócrino, aumentos en la concentración de fenilalanina en los meditadores avanzados, en los niveles de prolactina plasmática, un incremento de cinco veces en los niveles plasmáticos de arginina vasopresina, mientras que la hormona estimulante de la tiroides disminuye de forma crónica y aguda. Esta diferencia neurofisiológica se corresponde con las diferencias encontradas en los textos investigados que señalan que las tántricas apuntan a incrementar el estado de alerta o una cualidad despierta de la mente y advierten contra la calma excesiva y, por el contrario, las escrituras y las instrucciones de meditación de la tradición védica -yoga, theravada o mahayana- apuntan a lograr quietud y calma. Indicamos futuras investigaciones clínicas desde un enfoque más interdisciplinario e incorporamos el marco teórico/filosófico de los diferentes tipos de meditación. AbstractSeveral clinical studies show how tantric practices and exercises of Vedic traditions - such as yoga- or Theravada or Mahayana Buddhists - have a significant psychobiological impact. This study compares the neurophysiological correlates of the practices called tantric and non-tantric meditations by a qualitative systematic review of the data collected. It was evidenced that the tantric practices produce increase in the sympathetic activity, the state of "phasic alertness" and in the performance in visual cognitive tasks. They promote greater alertness and lower propensity to sleep, generate an increase in cognitive activity and metabolic modifications contrary to those that are verified of non-tantric as a result of the relaxation induced by these practices. In contrast, non-tantric creams create a better relaxation response with increased parasympathetic activity and inhibition of the sympathetic system, inducing a deep rest hypometabolic state where the practitioner remains awake and his attention on "tonic alertness" with corresponding symptoms to that hypometabolic state -hypotonia, decreased oxygen consumption, heart rate and blood lactate concentration- change in normal endocrine function, increased phenylalanine concentration in advanced meditators, increased plasma prolactin levels, a five-fold increase in arginine vasopressin plasma levels, while thyroid stimulating hormone decreases chronically and acutely. This neurophysiological difference corresponds to the differences found in the investigated texts which point out that: the tantric ones aim to increase alertness or an awakened quality of the mind and warn against excessive calm and on the contrary, the writings and instructions of meditation of the Vedic tradition, yoga, Theravada or Mahayana aim to achieve stillness and calmness. We indicate future clinical research from a more interdisciplinary approach and incorporating the theoretical / philosophical framework of the different types of meditation.

scholarly journals A Small Bowel Perforation in a Goalkeeper: A Case Report and Return to Play Progression

2021 ◽  
Author(s):  
Kenzie Johnston ◽  
Tara A. Condon ◽  
Mario Ciocca ◽  
Alain Aguilar
Keyword(s):  
Case Report ◽  
Small Bowel ◽  
Primary Repair ◽  
Bowel Perforation ◽  
Return To Sport ◽  
Return To Play ◽  
Small Bowel Perforation ◽  
Unique Challenge ◽  
Surgical Interventions ◽  
High Level

Abstract Sports-related intra-abdominal injuries are rare and may be associated with significant morbidity if missed. We present the case of a 21-year-old male collegiate goalkeeper who suffered a small bowel perforation in practice after colliding with a teammate. This athlete underwent laparoscopic primary repair of his small bowel perforation, a relatively uncommon type of surgical intervention for this injury given that similar patients are typically treated via laparotomy. Due to rarity of small intestine injuries in sport, information regarding the success of surgical interventions and return to play (RTP) standards are lacking, let alone information on outcomes and return to sport following a laparoscopic repair. In this case report, we discuss the unique challenge of constructing a RTP protocol for this high-level athlete and propose a protocol for RTP following intra-abdominal injury treated laparoscopically.

scholarly journals Return to Play After Hip Arthroscopy Among Tennis Players: Outcomes with Minimum Five-Year Follow-up

2020 ◽  
Author(s):  
David R. Maldonado ◽  
Mitchell J. Yelton ◽  
Philip J. Rosinsky ◽  
Jacob Shapira ◽  
Mitchell Meghpara ◽  
...  
Keyword(s):  
Hip Arthroscopy ◽  
Cartilage Damage ◽  
Arthroscopic Surgery ◽  
Return To Sport ◽  
Return To Play ◽  
Harris Hip Score ◽  
Level Of Evidence ◽  
Tennis Players ◽  
Patient Reported

Abstract Background: Playing tennis is associated with various movements that can lead to labral injuries and may require arthroscopic surgery. While hip arthroscopies have demonstrated good outcomes in athletes, there is limited literature reporting Patient Reported Outcomes (PROs) and return to play in competitive or recreational tennis players after hip arthroscopic surgery. Therefore, the purpose of the present study was to (1) report minimum five-year PROs and return to sport in tennis players who underwent hip arthroscopic surgery and (2) compare outcomes between recreational and competitive tennis players.Methods: Data for patients who underwent hip arthroscopy surgery in the setting of femoroacetabular impingement (FAI) and labral tears between March 2009 and January 2014 and who played tennis at any level within one-year of surgery were retrospectively reviewed. Patients with preoperative and minimum five-year postoperative scores for the following PROs were included: modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Sport Specific Subscale (HOS-SSS), and visual analog scale (VAS) for pain. Patients with preoperative Tönnis osteoarthritis Grade >1, Workers’ Compensation claims, age > 60 years old, or previous ipsilateral hip surgeries or conditions were excluded. Patient Acceptable Symptomatic State (PASS) and Minimal Clinically Important Difference (MCID) for mHHS and HOS-SSS were calculated. Results: Of 28 patients, 31 hips met all inclusion and exclusion criteria of which 28 (90.3%) had minimum 5-year follow-up (mean: 72.8 ± 13.9 months). There were 3 professional, 3 collegiate, 2 high school, 2 organized amateur, and 18 recreational level tennis players. All PROs significantly improved at latest follow-up: mHHS from 67.0 to 86.7 (P < 0.001), NAHS from 65.9 to 87.2 (P < 0.001), HOS-SSS from 50.0 to 77.9 (P = 0.009), and VAS from 5.4 to 1.8 (P < 0.001). There was a 75.0% return to sport rate. Additionally, 66.7% of patients achieved MCID and 83.3% achieved PASS for mHHS, and 63.6% achieved MCID and 58.3% achieved PASS for HOS-SSS.Conclusion: Regardless of the level of participation, tennis players who underwent hip arthroscopic surgery reported statistically significant PRO improvements. A favorable rate of return to sport was also achieved by players with a continued interest in playing. The severity of cartilage damage was shown to not influence rate of returned to sport nor PROs in this population. The data here may be useful in counseling tennis players of various levels who are considering arthroscopic treatment of a hip injury. Level of Evidence: IV

Confidence to Return to Play After ACL Reconstruction: An Evaluation of Quadriceps Strength Symmetry and Injury Mechanism in Male Athletes

2021 ◽  
pp. 194173812110438
Author(s):  
Rachel K. Straub ◽  
Francesco Della Villa ◽  
Bert Mandelbaum ◽  
Christopher M. Powers
Keyword(s):  
Female Athletes ◽  
Cruciate Ligament ◽  
Linear Regression Analysis ◽  
Return To Sport ◽  
Quadriceps Strength ◽  
Injury Mechanism ◽  
Return To Play ◽  
Negative Consequences ◽  
Male Athletes ◽  
The Relationship

Background: After anterior cruciate ligament reconstruction (ACLR), diminished quadriceps strength symmetry and reduced psychological readiness to return to play (RTP) increase the risk for subsequent injury. Although the relationship between quadriceps strength symmetry and psychological readiness to RTP has been reported to be influenced by injury mechanism in female athletes, it is unclear whether such a relationship exists in male athletes. Hypothesis: Quadriceps strength symmetry would be positively associated with greater psychological readiness to RTP after ACLR, regardless of injury mechanism. Study Design: Retrospective cohort. Level of Evidence: Level 3 (cohort study). Methods: Sixty male patients completed strength testing and the Injury-Psychological Readiness to Return to Sport Scale (I-PRRS) at an outpatient clinical facility as part of return to sport testing after ACLR. Linear regression analysis was used to assess the relationship between the I-PRRS and the independent variables of interest (quadriceps strength symmetry and injury mechanism). Results: For all patients combined, no symmetry × mechanism interaction was found ( P = 0.11). A significant positive relationship was found between quadriceps strength symmetry and the I-PRRS score ( P < 0.001, R2 = 0.31), after adjusting for time post-ACLR and injury mechanism. Conclusion: Greater quadriceps strength symmetry was associated with greater psychological readiness to RTP after ACLR in male athletes. In contrast to what has been reported in female athletes, this relationship was independent of injury mechanism. Clinical Relevance: Given the potential negative consequences of quadriceps strength deficits on one’s confidence to RTP, the need to restore quadriceps symmetry during the postoperative period is readily apparent. Low confidence or low psychological readiness to RTP may be indicative of quadriceps strength asymmetry or poor physical function in general.

scholarly journals Results of hip arthroscopy in elite level water polo players with femoroacetabular impingement: return to play and patient satisfaction

2020 ◽  
Vol 7 (1) ◽  
pp. 116-121
Author(s):  
Nicholas Ramos ◽  
Keon Youssefzadeh ◽  
Michael Gerhardt ◽  
Michael Banffy
Keyword(s):  
Patient Satisfaction ◽  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Return To Sport ◽  
The Body ◽  
Return To Play ◽  
Water Polo ◽  
Study Results ◽  
Division 1 ◽  
Elite Level

Abstract Water polo places significant stress on the hip joint requiring repetitive hip flexion and rotation to elevate the body out of water for passing, shooting and blocking. Femoroacetabular impingement (FAI) is common in water polo athletes; however, no study to date has investigated the results of hip arthroscopy in this patient population. The purpose of this study was to determine return to play rates and satisfaction following hip arthroscopy for FAI in a cohort of elite level water polo players. A retrospective review of our surgical database was performed. Collegiate water polo players with clinical and radiographic FAI who underwent hip arthroscopy were identified. Pre- and post-operative modified Harris hip scores (mHHSs) were obtained. Patient surveys were administered to determine return to play rates, level of return to play, timing of return and patient satisfaction. A Wilcoxon ranked sum test was performed to compare pre- and post-operative outcome scores. Ten patients met inclusion criteria. Average age was 19.5 years old (SD  ±1.08). All patients were male Division 1 collegiate water polo players. Median mHHS improved from 66.0 (SD  ±7.9) pre-operatively to 89.5 (SD  ±3.2) at average 1.6 years (range: 0.4–3.6 years) post-operatively. Patient survey responses demonstrated a 100% return to water polo and 100% return to the same level of play (NCAA Division 1) at mean 5.75 months (SD  ±1.8). All patients (10/10) reported being satisfied with their surgical result. Our study results, suggest that return to sport rates and patient satisfaction are high in water polo players who undergo hip arthroscopy for FAI.

scholarly journals Bioaugmentation in the surgical treatment of anterior cruciate ligament injuries: A review of current concepts and emerging techniques

2020 ◽  
Vol 8 ◽  
pp. 205031212092105
Author(s):  
Austin MacFarland Looney ◽  
Joseph Daniel Leider ◽  
Andrew Ryan Horn ◽  
Blake Michael Bodendorfer
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Return To Play ◽  
Cruciate Ligament Reconstruction ◽  
Anterior Cruciate Ligament Injuries ◽  
Anterior Cruciate Ligament Repair ◽  
Anterior Cruciate

Injuries involving the anterior cruciate ligament are among the most common athletic injuries, and are the most common involving the knee. The anterior cruciate ligament is a key translational and rotational stabilizer of the knee joint during pivoting and cutting activities. Traditionally, surgical intervention in the form of anterior cruciate ligament reconstruction has been recommended for those who sustain an anterior cruciate ligament rupture and wish to remain active and return to sport. The intra-articular environment of the anterior cruciate ligament makes achieving successful healing following repair challenging. Historically, results following repair were poor, and anterior cruciate ligament reconstruction emerged as the gold-standard for treatment. While earlier literature reported high rates of return to play, the results of more recent studies with longer follow-up have suggested that anterior cruciate ligament reconstruction may not be as successful as once thought: fewer athletes are able to return to sport at their preinjury level, and many still go on to develop osteoarthritis of the knee at a relatively younger age. The four principles of tissue engineering (cells, growth factors, scaffolds, and mechanical stimuli) combined in various methods of bioaugmentation have been increasingly explored in an effort to improve outcomes following surgical treatment of anterior cruciate ligament injuries. Newer technologies have also led to the re-emergence of anterior cruciate ligament repair as an option for select patients. The different biological challenges associated with anterior cruciate ligament repair and reconstruction each present unique opportunities for targeted bioaugmentation strategies that may eventually lead to better outcomes with better return-to-play rates and fewer revisions.

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