Incidence of Contralateral and Ipsilateral Anterior Cruciate Ligament (ACL) Injury After Primary ACL Reconstruction and Return to Sport

Background: Lower psychological readiness to return to sport has been reported for younger patients (≤20 years) who go on to a second anterior cruciate ligament (ACL) injury. However, changes in psychological readiness and specific psychological responses associated with second injury have not been identified. Purpose/Hypothesis: To identify changes in psychological readiness over time associated with a second ACL injury. It was hypothesized that younger patients who suffered a second injury would have smaller changes in psychological readiness to return to sport when compared with those who did not have a second injury. Study Design: Case-control study; Level of evidence, 2. Methods: Patients ≤20 years old at the time of surgery who had a primary ACL reconstruction procedure between June 2014 and June 2016 were recruited for this study. The short version of the Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) scale was completed by patients before their ACL reconstruction and repeated at 12 months after surgery to assess psychological readiness to return to sport. The primary outcome of interest was the relationship between the change in psychological readiness and second ACL injuries. Results: Among 115 young patients who returned to sport after ACL reconstruction, 21 (18%) experienced a second ACL injury. Injured patients did not show improvement in their ACL-RSI score between the preoperative assessment and 12-month time point (58.5 vs 60.8 points, P = .60) and had a significantly smaller change when compared with noninjured patients (9.2 vs 24.9 points, P = .01). When compared with the noninjured group, the injured group reported they were more nervous about playing sport, less confident in playing sport without concern for the knee, more frustrated with having to consider the knee with respect to sport, and more fearful of reinjuring the knee by playing sport ( P≤ .05). Conclusion: Injured patients exhibited less improvement in psychological readiness at a group level and reported different psychological characteristics with regard to return to sport at 12 months after ACL reconstruction as monitored by the ACL-RSI scale.

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Return to sport outcomes in the younger patient with anterior cruciate ligament reconstruction

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967117s00173 ◽

2017 ◽

Vol 5 (5_suppl5) ◽

pp. 2325967117S0017

Author(s):

TS Whitehead ◽

JA Feller ◽

KE Webster

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Return To Sport ◽

Acl Injury ◽

Younger Patients ◽

Reconstruction Surgery ◽

Anterior Cruciate ◽

Work Commitments

Objective: Anterior cruciate ligament (ACL) reconstruction is generally regarded as a successful procedure, however only 65% of patients return to their pre-injury sport. While return to sport rates are likely higher in younger patients, there is a paucity of data on this topic. The purpose of this study was to investigate a range of return to sport outcomes in younger athletes who had undergone ACL reconstruction surgery. Methods: This was a cross-sectional study design. A group of 140 young patients (<20 years at surgery) who had one ACL reconstruction and no subsequent ACL injuries were surveyed regarding details of their sport participation at an average follow up of 5 years (range 3-7). Results: Overall, 76% of the young patient group returned to the same pre-injury sport. Return rates were higher for males than females (81% vs. 71% respectively, p>0.05). Of those who returned to their sport, 65% reported that they could perform as well as before the ACL injury and 66% were still currently playing in their respective sport. Young athletes who never returned to sport cited fear of a new injury (37%) or study/work commitments (30%) as the primary reasons. For those who had successfully returned to their pre-injury sport but subsequently stopped playing, the most common reason was study/work commitments (53%). At follow-up 48% of female patients were still participating in Level I sports as were 54% of males. Conclusions: A high percentage of younger patients return to their pre-injury sport following ACL reconstruction surgery. For this group who have not sustained a second ACL injury, the majority continue to play and are satisfied with their performance.

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Association Between Psychological Readiness, Patient Reported Outcomes and Return to Sports Following Primary Anterior Cruciate Ligament Reconstruction: Readiness Outcomes Affecting Return-to-Sport (ROAR)

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00489 ◽

2020 ◽

Vol 8 (7_suppl6) ◽

pp. 2325967120S0048

Author(s):

Jessica Traver ◽

Melissa Christino ◽

Ryan Coene ◽

Kathryn Williams ◽

Dai Sugimoto ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Patient Reported Outcomes ◽

Cruciate Ligament ◽

Age Groups ◽

Return To Sport ◽

Functional Testing ◽

Patient Reported ◽

Anterior Cruciate ◽

Primary Acl Reconstruction

Objectives: Successful return-to-sport (RTS) following anterior cruciate ligament (ACL) reconstruction can be affected by several variables, including a patient’s physical and psychological states throughout the rehabilitation process. Several studies have reported patients with increased fear-of-reinjury may be at risk for secondary injury following ACL reconstruction. The primary objective was to compare the relationship between ACL-RSI, Pedi-IKDC, Pedi-FABS, and PROMIS-Psychological Stress Experiences (PSE) across various age groups and graft types between patients undergoing primary ACL reconstruction at the 6 month post-operative visit. Secondary outcome was timing of RTS clearance. Methods: Patients prospectively enrolled were 8-30 years old who underwent primary ACL reconstruction at a large pediatric academic sports medicine center from August 2018 until February 2019. They were evaluated at their 6 month follow-up appointment and underwent functional RTS testing. Patients were divided into 3 groups based on their age: Pre-Adolescent (ages 8-14), Adolescent (ages 15-18), and Adult (ages >18) to reflect their psychological/emotional maturity. Demographic information, time to RTS clearance, and functional testing measurements were collected. Analysis included one-way ANOVA and Kruskal-Wallis tests. Results: A total of 100 patients were included in the study (57 males, 43 females; mean age, 17.3±2.9 years). RTS functional testing was performed at a mean of 6.3±0.7 months after primary ACL reconstruction. The 3 age groups consisted of Pre-Adolescent (n=13), Adolescent (n=62), and Adult (n=25). The graft types were HS (n=79), BTB (n=14), ITB (n=7). Mean ACL-RSI scores were significantly different among age groups (Pre-Adolescent 80.3±10.6, Adolescent 60.4±23.3, Adult 54.3±21.3; p=0.003) and graft type (HS 61.2±22.0, BTB 52.9±26.4, ITB 82.1±9.7; p=0.019). Scores were significantly different among the 3 age groups for IKDC (Pre-Adolescent 85.4±12.1, Adolescent 77.5±13.8, Adult 61.0±8.4; p<0.001). Scores were not significantly different among the three age groups for Pedi-FABS (Pre-Adolescent 24.9±5.4, Adolescent 23.6±8.1, Adult 20.6±9.2; p=0.212). The mean PROMIS-PSE t-scores were significantly different among the age groups (Pre-Adolescent 45.8±8.6, Adolescent 52.0±7.2, Adult 53.8±8.1; p=0.009) and graft type (HS 52.4±7.7, BTB 52.7±6.6, ITB 40.9±4.9; p<0.001). There were no significant differences for average timing of RTS clearance among the 3 age groups (Pre-Adolescent 8.5±1.5 months, Adolescent 8.0±1.3 months, Adult 8.1±1.2 months; p=0.618). Conclusion: This study suggests that psychological profiles and subjective perceptions of knee function following ACL reconstruction may vary in young patients of different ages. Pre-adolescent patients had better scores on all patient reported outcomes compared to adolescent and adult patients. Age-related differences in patient reported outcomes should be considered when evaluating young athletes. [Figure: see text]

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Clinical Risk Profile for a Second Anterior Cruciate Ligament Injury in Female Soccer Players After Anterior Cruciate Ligament Reconstruction

The American Journal of Sports Medicine ◽

10.1177/0363546521999109 ◽

2021 ◽

pp. 036354652199910

Author(s):

Anne Fältström ◽

Joanna Kvist ◽

Natalia F.N. Bittencourt ◽

Luciana D. Mendonça ◽

Martin Hägglund

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Return To Sport ◽

Acl Injury ◽

Soccer Players ◽

Factors Associated ◽

Cart Analysis ◽

Jump Test ◽

Anterior Cruciate

Background: The risk of a second anterior cruciate ligament (ACL) injury when participating in pivoting sports after ACL reconstruction is high. Risk factors associated with a second ACL injury are complex. Purpose: To investigate the combinations of various clinical risk factors associated with second ACL injury in female soccer players with a primary unilateral ACL reconstruction, using Classification and Regression Tree (CART) analysis. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 117 active female soccer players (mean ± SD age, 20 ± 2 years) were included. Athletes were enrolled 19 ± 9 months after ACL reconstruction and were prospectively followed for 2 years. At baseline, all players underwent assessment of knee and ankle joint range of motion (ROM), participated in functional tests (postural control, hop performance, and movement asymmetries in the lower limbs and trunk), and answered questionnaires (patient-reported knee function, knee-related quality of life, psychological and personality factors). A clinical prediction model using CART was developed. Results: A total of 28 players (24%) sustained a second ACL injury (21 ipsilateral and 7 contralateral ruptures) while playing soccer. CART analysis selected 9 of 19 independent variables associated with second ACL injury: the 5-jump test, knee collapse on the non–ACL reconstructed leg in a drop vertical jump, tuck jump, limb symmetry index on side hop and the single hop for distance, side difference in ankle dorsiflexion ROM, and scores for the questionnaires ACL-Return to Sport After Injury and the Swedish Universities Scales of Personality subscales of Stress Susceptibility and Adventure Seeking. The accuracy of the model was 89%, with 100% sensitivity and 76% specificity. CART analysis indicated that the interaction of longer jumps in the 5-jump test (>916 cm) with more side difference in ankle dorsiflexion ROM (>–2.5°) and more knee valgus collapse in the nonreconstructed knee (>−1.4 cm) (relative risk, 4.03; 95% CI, 2.21-7.36) best predicted an increased likelihood of a second ACL injury. Conclusion: The risk profiles selected by CART could accurately identify female soccer players at high risk for a second ACL injury. There was an interaction between functional performance, clinical assessment, and psychological factors, and it is reasonable to include these factors in return-to-sport decisions and in athlete screening after ACL injury.

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Deficits in Hip-Ankle Coordination in Female Athletes who Suffer a Second Anterior Cruciate Ligament (ACL) Injury after ACL Reconstruction and Return to Sport

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967114s00039 ◽

2014 ◽

Vol 2 (7_suppl2) ◽

pp. 2325967114S0003 ◽

Cited By ~ 1

Author(s):

Mark V. Paterno ◽

Adam W. Kiefer ◽

Scott H. Bonnette ◽

Michael A. Riley ◽

Laura Schmitt ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Female Athletes ◽

Cruciate Ligament ◽

Return To Sport ◽

Acl Injury ◽

Anterior Cruciate

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Rehabilitation and Return to Sport Assessment after Anterior Cruciate Ligament Injury: Quantifying Joint Kinematics during Complex High-Speed Tasks through Wearable Sensors

Sensors ◽

10.3390/s21072331 ◽

2021 ◽

Vol 21 (7) ◽

pp. 2331

Author(s):

Stefano Di Paolo ◽

Nicola Francesco Lopomo ◽

Francesco Della Villa ◽

Gabriele Paolini ◽

Giulio Figari ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Excellent Agreement ◽

High Speed ◽

Cruciate Ligament ◽

Wearable Sensors ◽

Return To Sport ◽

Acl Injury ◽

Wearable Sensor ◽

Anterior Cruciate ◽

Full Body

The aim of the present study was to quantify joint kinematics through a wearable sensor system in multidirectional high-speed complex movements used in a protocol for rehabilitation and return to sport assessment after Anterior Cruciate Ligament (ACL) injury, and to validate it against a gold standard optoelectronic marker-based system. Thirty-four healthy athletes were evaluated through a full-body wearable sensor (MTw Awinda, Xsens) and a marker-based optoelectronic (Vicon Nexus, Vicon) system during the execution of three tasks: drop jump, forward sprint, and 90° change of direction. Clinically relevant joint angles of lower limbs and trunk were compared through Pearson’s correlation coefficient (r), and the Coefficient of Multiple Correlation (CMC). An excellent agreement (r > 0.94, CMC > 0.96) was found for knee and hip sagittal plane kinematics in all the movements. A fair-to-excellent agreement was found for frontal (r 0.55–0.96, CMC 0.63–0.96) and transverse (r 0.45–0.84, CMC 0.59–0.90) plane kinematics. Movement complexity slightly affected the agreement between the systems. The system based on wearable sensors showed fair-to-excellent concurrent validity in the evaluation of the specific joint parameters commonly used in rehabilitation and return to sport assessment after ACL injury for complex movements. The ACL professionals could benefit from full-body wearable technology in the on-field rehabilitation of athletes.

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Assessing Physical Activity After ACL Injury: Moving Beyond Return to Sport

Sports Health A Multidisciplinary Approach ◽

10.1177/19417381211025307 ◽

2021 ◽

pp. 194173812110253

Author(s):

Christopher Kuenze ◽

Katherine Collins ◽

Karin Allor Pfeiffer ◽

Caroline Lisee

Keyword(s):

Physical Activity ◽

Anterior Cruciate Ligament ◽

Cruciate Ligament ◽

Young Patients ◽

Return To Sport ◽

Acl Injury ◽

Noncommunicable Diseases ◽

Successful Recovery ◽

Patient Reported ◽

Anterior Cruciate

Context: Return to sport is widely utilized by sports medicine researchers and clinicians as a primary outcome of interest for successful recovery when working with young patients who have undergone anterior cruciate ligament (ACL) reconstruction (ACLR). While return-to-sport outcomes are effective at tracking progress post-ACLR, they are limited because they do not necessarily capture physical activity (PA) engagement, which is important to maintain knee joint health and reduce the risk of noncommunicable diseases. Therefore, there is a critical need (1) to describe current PA participation and measurement recommendations; (2) to appraise common PA measurement approaches, including patient-reported outcomes and device-based methodologies; and (3) to provide clinical recommendations for future evaluation. Evidence Acquisition: Reports of patient-reported or device-based PA in patients with ACL injury were acquired and summarized based on a PubMed search (2000 through July 2020). Search terms included physical activity OR activity AND anterior cruciate ligament OR ACL. Study Design: Clinical review. Level of Evidence: Level 5. Results: We highlight that (1) individuals with ACLR are 2.36 times less likely to meet the US Department of Health and Human Services PA recommendations even when reporting successful return to sport, (2) common patient-reported PA assessments have significant limitations in the data that can be derived, and (3) alternative patient-reported and device-based assessments may provide improved assessment of PA in this patient population. Conclusion: Clinicians and researchers have relied on return to sport status or self-reported PA participation via surveys. These approaches are not consistent with current recommendations for PA assessment and do not allow for comparison with contemporary PA recommendations or guidelines. Return to sport, patient-reported outcome measures, and device-based assessment approaches should be used in complementary manners to comprehensively assess PA participation after ACLR. However, appropriate techniques should be used when assessing PA in adult and adolescent populations.

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Timeline for Maximal Subjective Outcome Improvement After Anterior Cruciate Ligament Reconstruction

The American Journal of Sports Medicine ◽

10.1177/0363546518803365 ◽

2018 ◽

Vol 47 (10) ◽

pp. 2501-2509 ◽

Cited By ~ 3

Author(s):

Avinesh Agarwalla ◽

Richard N. Puzzitiello ◽

Joseph N. Liu ◽

Gregory L. Cvetanovich ◽

Anirudh K. Gowd ◽

...

Keyword(s):

Systematic Review ◽

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Clinical Significance ◽

Cruciate Ligament ◽

Return To Sport ◽

Pubmed Database ◽

Patient Reported ◽

Clinically Significant ◽

Anterior Cruciate

Background: Anterior cruciate ligament (ACL) tears are one of the most common traumatic knee injuries experienced by athletes. Return to sport is considered the pinnacle endpoint among patients receiving ACL reconstruction. However, at the time of return to sport, patients may not be participating at their previous levels of function, as defined by clinical metrics. Purpose: To establish when patients perceive maximal subjective medical improvement according to patient-reported outcome measures (PROMs). Study Design: Systematic review. Methods: A systematic review of the PubMed database was conducted to identify studies that reported sequential PROMs up to a minimum of 2 years after ACL reconstruction. Pooled analysis was conducted for PROMs at follow-up points of 3 months, 6 months, 1 year, and 2 years. Clinically significant improvement was determined between pairs of intervals with the minimal clinically important difference. Results: This review contains 30 studies including 2253 patients who underwent ACL reconstruction. Clinically significant improvement in the KOOS (Knee injury and Osteoarthritis Outcome Score) was seen up to 1 year after ACL reconstruction, but no clinical significance was noted from 1 to 2 years. Clinically significant improvement in the IKDC (International Knee Documentation Committee) and Lysholm questionnaires was seen up to 6 months postoperatively, but no clinical significance was noted beyond that. Conclusion: After ACL reconstruction, maximal subjective medical improvement is established 1 year postoperatively, with no further perceived clinical improvement beyond this time point according to current PROMs. The KOOS may be a more responsive metric to subjective improvements in this patient cohort than other patient-reported outcomes, such as the IKDC and Lysholm. Clinical Relevance: After ACL reconstruction, patients perceive interval subjective improvements until 1 year postoperatively.

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HOP TEST AS A TOOL FOR THE ASSESSMENT AND PREVENTION OF INJURIES IN FOOTBALLERS DURING PRESEASON

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118s00044 ◽

2018 ◽

Vol 6 (6_suppl3) ◽

pp. 2325967118S0004

Author(s):

F García-Bol ◽

V Posada-Franco ◽

A Roldán-Valero ◽

R Del Caño-Espinel

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Reference Values ◽

Cruciate Ligament ◽

Return To Sport ◽

Performance Criteria ◽

Return To Sports ◽

Hop Tests ◽

Hop Test ◽

Anterior Cruciate

Hop Tests (unipodal horizontal jumps) have been recommended as one of the reliable assessment tests when allowing a return to competition for a sportsperson after an anterior cruciate ligament injury1,2,3,4. Currently, comparison is made of the results with the contralateral limb through the symmetry index, a method which might not provide sufficient security upon the return to competitive sport5. Hop tests can be used in preseason to gain reference values prior to a possible injury. The objective of this review is to analise the scientific literature such as the F-Marc6 (reference manual of FIFA) to confirm whether include said tests in preseason for football teams. A search was conducted in the Pubmed y Cochrane databases (17/04/17) with the search terms “Hop Test”, “Football”, “Soccer”, and “Preseason”. Articles in English and Spanish were both accepted. Articles excluded were those that did not make reference to the knee, to football, and those that did not conduct tests during preseason. From a total of 33 articles, 4 with these search criteria were included, 5 articles were added trough the bibliography of other studies, and the F-Marc manual was analised. 4 of the articles used the hop tests in preseason for some type of study, of which 3 were used as part of a prospective assessment for the season. On the other hand, the F-Marc does not consider Hop Tests as an assessment test. Hop tests were not found to be used in preseason as reference values prior to possible future injuries, data which could be beneficial for a safe return to sport. Harris J, Abrams G, Bach B, Williams D, Heidloff D, Bush-Joseph C, Verma N, Forsythe B, Cole B. Return to Sport After ACL Reconstruction. ORTHOPEDICS. 2014; 37: e103-e108. Barber-Westin SD, Noyes FR. Factors used to determine return to unrestricted sports activities after anterior cruciate ligament reconstruction. Arthroscopy. 2011 Dec;27(12):1697-705. Thomeé R, Kaplan Y, Kvist J, Myklebust G, Risberg MA, Theisen D, Tsepis E, Werner S, Wondrasch B, Witvrouw E. Muscle strength and hop performance criteria prior to return to sports after ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. 2011 Nov;19(11):1798-805. Bolgla LA, Keskula DR. Reliability of lower extremity functional performance tests. J Orthop Sports Phys Ther. 1997 Sep;26(3):138-42. Wellsandt E, Failla MJ, Snyder-Mackler L. Limb Symmetry Indexes Can Overestimate Knee Function After Anterior Cruciate Ligament Injury. J Orthop Sports Phys Ther. 2017 Mar 29:1-18. F-MARC. Football Medicine Manual. 2nd Edition. Available from: http://f-marc.com . 2017.

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