scholarly journals Psychological, social and contextual factors across recovery stages following a sport-related knee injury: a scoping review

2020 ◽  
Vol 54 (19) ◽  
pp. 1149-1156 ◽  
Author(s):  
Linda K Truong ◽  
Amber D Mosewich ◽  
Christopher J Holt ◽  
Christina Y Le ◽  
Maxi Miciak ◽  
...  
Keyword(s):  
Social Support ◽  
Knee Injury ◽  
Contextual Factors ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Active Role ◽  
Original Data ◽  
Time Loss ◽  
Scoping Reviews ◽  
Meta Analyses

ObjectiveTo explore the role of psychological, social and contextual factors across the recovery stages (ie, acute, rehabilitation or return to sport (RTS)) following a traumatic time-loss sport-related knee injury.Material and methodsThis review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews and Arksey and O’Malley framework. Six databases were searched using predetermined search terms. Included studies consisted of original data written in English that identified or described a psychological, social or contextual factor related to recovery after a traumatic time-loss sport-related knee injury. Two authors independently conducted title–abstract and full-text reviews. Study quality was assessed using the Mixed Methods Appraisal Tool. Thematic analysis was undertaken.ResultsOf 7289 records, 77 studies representing 5540 participants (37% women, 84% anterior cruciate ligament tears, aged 14–60 years) were included. Psychological factors were investigated across all studies, while social and contextual factors were assessed in 39% and 21% of included studies, respectively. A cross-cutting concept of individualisation was present across four psychological (barriers to progress, active coping, independence and recovery expectations), two social (social support and engagement in care) and two contextual (environmental influences and sport culture) themes. Athletes report multiple barriers to recovery and valued their autonomy, having an active role in their recovery and diverse social support.ConclusionDiverse psychological, social and contextual factors are present and influence all stages of recovery following a traumatic sport-related knee injury. A better understanding of these factors at the time of injury and throughout rehabilitation could assist with optimising injury management, promoting RTS, and long-term health-related quality-of-life.

scholarly journals Mapping EQ-5D-3L from the Knee Injury and Osteoarthritis Outcome Score (KOOS)

2019 ◽  
Vol 29 (1) ◽  
pp. 265-274
Author(s):  
Ali Kiadaliri ◽  
Monica Hernández Alava ◽  
Ewa M. Roos ◽  
Martin Englund
Keyword(s):  
Disease Severity ◽  
Knee Injury ◽  
Cruciate Ligament ◽  
Simulated Data ◽  
Probit Model ◽  
Original Data ◽  
Cost Utility ◽  
Superior Performance ◽  
Outcome Score ◽  
Mapping Models

Abstract Purpose To develop a mapping model to estimate EQ-5D-3L from the Knee Injury and Osteoarthritis Outcome Score (KOOS). Methods The responses to EQ-5D-3L and KOOS questionnaires (n = 40,459 observations) were obtained from the Swedish National anterior cruciate ligament (ACL) Register for patients ≥ 18 years with the knee ACL injury. We used linear regression (LR) and beta-mixture (BM) for direct mapping and the generalized ordered probit model for response mapping (RM). We compared the distribution of the original data to the distributions of the data generated using the estimated models. Results Models with individual KOOS subscales performed better than those with the average of KOOS subscale scores (KOOS5, KOOS4). LR had the poorest performance overall and across the range of disease severity particularly at the extremes of the distribution of severity. Compared with the RM, the BM performed better across the entire range of disease severity except the most severe range (KOOS5 < 25). Moving from the most to the least disease severity was associated with 0.785 gain in the observed EQ-5D-3L. The corresponding value was 0.743, 0.772 and 0.782 for LR, BM and RM, respectively. LR generated simulated EQ-5D-3L values outside the feasible range. The distribution of simulated data generated from the BM model was almost identical to the original data. Conclusions We developed mapping models to estimate EQ-5D-3L from KOOS facilitating application of KOOS in cost-utility analyses. The BM showed superior performance for estimating EQ-5D-3L from KOOS. Further validation of the estimated models in different independent samples is warranted.

scholarly journals Is resistance training intensity adequately prescribed to meet the demands of returning to sport following anterior cruciate ligament repair? A systematic review

2021 ◽  
Vol 7 (3) ◽  
pp. e001144
Author(s):  
Zackary William Nichols ◽  
Daniel O'Brien ◽  
Steven Gordon White
Keyword(s):  
Systematic Review ◽  
Resistance Training ◽  
Outcome Measures ◽  
Data Extraction ◽  
Cruciate Ligament ◽  
Case Series ◽  
Return To Sport ◽  
Eligibility Criteria ◽  
Randomised Controlled ◽  
Meta Analyses

ObjectiveTo identify, critique and synthesise the research findings that evaluate the use of resistance training (RT) programmes on return to sport outcome measures for people following ACL repair (ACLR).Design and data sourcesThis systematic review included a comprehensive search of electronic databases (EBSCO health databases (CINAHL, MEDLINE, SPORTDiscus), Scopus and Pedro) performed in June 2020 and was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Studies were appraised using the Downs and Black checklist.Eligibility criteriaRandomised and non-randomised controlled trials, longitudinal cohort studies and case series were considered for inclusion where an adequate description of the RT intervention was provided as a part of the study’s ACLR rehabilitation protocol. Articles that did not include outcome measures related to return to sport criteria were excluded.ResultsEleven articles met the inclusion criteria and were subjected to appraisal and data extraction. Study quality ranged from poor to excellent. RT intensity varied considerably among studies (between 5% and >80% of one repetition maximum). Only one identified study specifically investigated the effect of a low-intensity versus high-intensity RT protocol. The majority of studies reported participant outcomes that would not meet commonly used return to sport criteria.ConclusionThere appears to be considerable variation in the intensity of RT prescribed in research for people following ACLR. Furthermore, in most of the identified studies, RT protocols promoted muscle endurance and hypertrophy without progressing to strength or power-based RT. The findings of this review provide insight into potential factors limiting returning to sport and contributing to reinjury for people following ACLR.

scholarly journals Intrinsic factors associated with return to sport after anterior cruciate ligament reconstruction: A systematic review

2015 ◽  
Vol 71 (1) ◽  
Author(s):  
Cheryl A. Ross ◽  
Amanda Clifford ◽  
Quinette A. Louw
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Cruciate Ligament Reconstruction ◽  
Intrinsic Factors ◽  
Factors Associated ◽  
Anterior Cruciate ◽  
Meta Analyses

Objectives: The anterior cruciate ligament is the most commonly injured ligament in the knee, with an average of only 64% of affected athletes returning to their pre-injury level of sport. Intrinsic factors associated with an increased likelihood of return to sport may be addressed during rehabilitation to improve the outcome of the reconstruction. The objectives of this review were to systematically appraise publications from six electronic databases describing intrinsic factors that may be associated with return to sport after anterior cruciate ligament reconstruction.Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Methodological quality appraisal was performed according to the Critical Appraisal Skills Programme for cohort studies. We performed a descriptive synthesis of the findings that associated intrinsic factors with return to sport.Results: Ten studies were included in the review. The findings show that fear of re-injury is a common reason for not returning to participation in sport. Younger patients may be more likely to return to sport, but findings regarding gender were equivocal, with male competitive athletes appearing to be more likely to return to sport than their female counterparts. Good knee function is not always associated with a higher likelihood to return to sport.Conclusion: Fear of re-injury and age should be considered in the management of sports participants after anterior cruciate ligament reconstruction.

scholarly journals Current Concepts for Injury Prevention in Athletes After Anterior Cruciate Ligament Reconstruction

2012 ◽  
Vol 41 (1) ◽  
pp. 216-224 ◽  
Author(s):  
Timothy E. Hewett ◽  
Stephanie L. Di Stasi ◽  
Gregory D. Myer
Keyword(s):  
Risk Factors ◽  
Anterior Cruciate Ligament ◽  
High Risk ◽  
Knee Injury ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Neuromuscular Control ◽  
Injury Incidence ◽  
Anterior Cruciate

Ligament reconstruction is the current standard of care for active patients with an anterior cruciate ligament (ACL) rupture. Although the majority of ACL reconstruction (ACLR) surgeries successfully restore the mechanical stability of the injured knee, postsurgical outcomes remain widely varied. Less than half of athletes who undergo ACLR return to sport within the first year after surgery, and it is estimated that approximately 1 in 4 to 1 in 5 young, active athletes who undergo ACLR will go on to a second knee injury. The outcomes after a second knee injury and surgery are significantly less favorable than outcomes after primary injuries. As advances in graft reconstruction and fixation techniques have improved to consistently restore passive joint stability to the preinjury level, successful return to sport after ACLR appears to be predicated on numerous postsurgical factors. Importantly, a secondary ACL injury is most strongly related to modifiable postsurgical risk factors. Biomechanical abnormalities and movement asymmetries, which are more prevalent in this cohort than previously hypothesized, can persist despite high levels of functional performance, and also represent biomechanical and neuromuscular control deficits and imbalances that are strongly associated with secondary injury incidence. Decreased neuromuscular control and high-risk movement biomechanics, which appear to be heavily influenced by abnormal trunk and lower extremity movement patterns, not only predict first knee injury risk but also reinjury risk. These seminal findings indicate that abnormal movement biomechanics and neuromuscular control profiles are likely both residual to, and exacerbated by, the initial injury. Evidence-based medicine (EBM) strategies should be used to develop effective, efficacious interventions targeted to these impairments to optimize the safe return to high-risk activity. In this Current Concepts article, the authors present the latest evidence related to risk factors associated with ligament failure or a secondary (contralateral) injury in athletes who return to sport after ACLR. From these data, they propose an EBM paradigm shift in postoperative rehabilitation and return-to-sport training after ACLR that is focused on the resolution of neuromuscular deficits that commonly persist after surgical reconstruction and standard rehabilitation of athletes.

scholarly journals Evaluation of the current methods used for assessing dietary intake in military research settings: a scoping review

2020 ◽  
pp. bmjmilitary-2020-001436
Author(s):  
Shaun Chapman ◽  
A J Rawcliffe ◽  
L Smith ◽  
R Izard ◽  
J Roberts
Keyword(s):  
Food Intake ◽  
Dietary Intake ◽  
Scoping Review ◽  
Original Data ◽  
Control Measures ◽  
Sufficient Evidence ◽  
Food Diary ◽  
Scoping Reviews ◽  
Combination Of Methods ◽  
Meta Analyses

IntroductionIt is important to collate the literature that has assessed dietary intake within military settings to establish which methods are commonly used and which are valid so that accurate nutrition recommendations can be made. This scoping review aims to identify which methods are typically used to assess dietary intake in military settings and which of these have been validated. This review also aims to provide a recommendation as to which method(s) should be used in military settings.MethodsThis scoping review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Searches were conducted in PubMed, Web of Science and SPORTDiscus with the most recent search executed on 12th June 2020. Eligible studies had to report original data, assess and quantify dietary intake and have been published in peer-reviewed academic journals. The reporting bias was calculated for each study where possible.ResultsTwenty-eight studies used a single method to assess dietary intake and seven studies used a combination of methods. The most commonly used methods were the gold standard food intake/waste method, Food Frequency Questionnaire (FFQ) or a food diary (FD). The only method to date that has been validated in military settings is weighed food records (WFR).ConclusionsThe food intake/waste method or WFR should be used where feasible. Where this is not practical the FFQ or FD should be considered with control measures applied. There is currently not sufficient evidence to state that using multiple methods together improves validity.

scholarly journals Earlier Resolution of Symptoms and Return of Function After Bridge-Enhanced Anterior Cruciate Ligament Repair As Compared With Anterior Cruciate Ligament Reconstruction

2021 ◽  
Vol 9 (11) ◽  
pp. 232596712110525
Author(s):  
Samuel C. Barnett ◽  
Martha M. Murray ◽  
Gary J. Badger ◽  
Yi-Meng Yen ◽  
Dennis E. Kramer ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Repeated Measures ◽  
Knee Injury ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
International Knee Documentation Committee ◽  
Time Points ◽  
Anterior Cruciate Ligament Repair ◽  
Postoperative Time ◽  
Anterior Cruciate

Background: Bridge-enhanced anterior cruciate ligament repair (BEAR) has noninferior patient-reported outcomes when compared with autograft anterior cruciate ligament reconstruction (ACLR) at 2 years. However, the comparison of BEAR and autograft ACLR at earlier time points—including important outcomes such as resolution of knee pain and symptoms, recovery of strength, and return to sport—has not yet been reported. Hypothesis: It was hypothesized that the BEAR group would have higher outcomes on the International Knee Documentation Committee and Knee injury and Osteoarthritis Outcome Score, as well as improved muscle strength, in the early postoperative period. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 100 patients aged 13 to 35 years with complete midsubstance anterior cruciate ligament injuries were randomized to receive a suture repair augmented with an extracellular matrix implant (n = 65) or an autograft ACLR (n = 35). Outcomes were assessed at time points up to 2 years postoperatively. Mixed-model repeated-measures analyses were used to compare BEAR and ACLR outcomes. Patients were unblinded after their 2-year visit. Results: Repeated-measures testing revealed a significant effect of group on the International Knee Documentation Committee Subjective Score ( P = .015), most pronounced at 6 months after surgery (BEAR = 86 points vs ACLR = 78 points; P = .001). There was a significant effect of group on the Knee injury and Osteoarthritis Outcome Score-Symptoms subscale scores ( P = .010), largely attributed to the higher BEAR scores at the 1-year postoperative time point (88 vs 82; P = .009). The effect of group on hamstring strength was significant in the repeated-measures analysis ( P < .001), as well as at all postoperative time points ( P < .001 for all comparisons). At 1 year after surgery, approximately 88% of the patients in the BEAR group and 76% of the ACLR group had been cleared for return to sport ( P = .261). Conclusion: Patients undergoing the BEAR procedure had earlier resolution of symptoms and increased satisfaction about their knee function, as well as improved resolution of hamstring muscle strength throughout the 2-year follow-up period. Registration: NCT02664545 (ClinicalTrials.gov identifier)

scholarly journals Risk of Secondary Injury in Younger Athletes After Anterior Cruciate Ligament Reconstruction

2016 ◽  
Vol 44 (7) ◽  
pp. 1861-1876 ◽  
Author(s):  
Amelia J. Wiggins ◽  
Ravi K. Grandhi ◽  
Daniel K. Schneider ◽  
Denver Stanfield ◽  
Kate E. Webster ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cruciate Ligament ◽  
Meta Analysis ◽  
Return To Sport ◽  
Injury Rate ◽  
Acl Injury ◽  
Return To Play ◽  
Review Of The Literature ◽  
Anterior Cruciate ◽  
Meta Analyses

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.

scholarly journals The Role of Psychological Readiness in Return to Sport Assessment After Anterior Cruciate Ligament Reconstruction

2021 ◽  
Vol 49 (5) ◽  
pp. 1236-1243
Author(s):  
Anne Gro Heyn Faleide ◽  
Liv Heide Magnussen ◽  
Torbjørn Strand ◽  
Bård Erik Bogen ◽  
Rolf Moe-Nilssen ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Knee Injury ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Predictive Ability ◽  
Functional Tests ◽  
Cruciate Ligament Reconstruction ◽  
Anterior Cruciate

Background: Knowledge about the predictive value of return to sport (RTS) test batteries applied after anterior cruciate ligament reconstruction (ACLR) is limited. Adding assessment of psychological readiness has been recommended, but knowledge of how this affects the predictive ability of test batteries is lacking. Purpose: To examine the predictive ability of a RTS test battery on return to preinjury level of sport and reinjury when evaluation of psychological readiness was incorporated. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 129 patients were recruited 9 months after ACLR. Inclusion criteria were age ≥16 years and engagement in sports before injury. Patients with concomitant ligamentous surgery or ACL revision surgery were excluded. Baseline testing included single-leg hop tests, isokinetic strength tests, the International Knee Documentation Committee (IKDC) Subjective Knee Form 2000, a custom-made RTS questionnaire, and the Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) scale. The RTS criteria were IKDC 2000 score ≥85% and ≥85% leg symmetry index on hop and strength test. At a 2-year follow-up evaluation, further knee surgery and reinjuries were registered and the RTS questionnaire was completed again. Regression analyses and receiver operating characteristic analyses were performed to study the predictive ability of the test battery. Results: Out of the 103 patients who completed the 2-year follow-up, 42% returned to their preinjury level of sport. ACL-RSI 9 months after surgery (odds ratio [OR], 1.03) and age (OR, 1.05) predicted RTS. An ACL-RSI score <47 indicated that a patient was at risk of not returning to sport (area under the curve 0.69; 95% CI, 0.58-0.79), with 85% sensitivity and 45% specificity. The functional tests did not predict RTS. Six patients sustained ACL reinjuries and 7 underwent surgery for other knee complaints/injuries after RTS testing. None of the 29 patients who passed all RTS criteria, and were therefore cleared for RTS, sustained a second knee injury. Conclusion: ACL-RSI and age were predictors of 2-year RTS, while functional tests were not informative. Another main finding was that none of the patients who passed the 85% RTS criteria sustained another knee injury.

scholarly journals Decision to Return to Sport Participation After Anterior Cruciate Ligament Reconstruction, Part II: Self-Reported and Functional Performance Outcomes

2018 ◽  
Vol 53 (5) ◽  
pp. 464-474 ◽  
Author(s):  
Jennifer L. Werner ◽  
Julie P. Burland ◽  
Carl G. Mattacola ◽  
Jenny Toonstra ◽  
Robert A. English ◽  
...  
Keyword(s):  
Performance Measures ◽  
Knee Injury ◽  
Sport Participation ◽  
Outcome Measure ◽  
Functional Performance ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
International Knee Documentation Committee ◽  
Activity Scale ◽  
Anterior Cruciate

Context: Anterior cruciate ligament (ACL) reconstruction (ACLR) is the most commonly used method for helping athletes regain function and return to preinjury activity levels after ACL injury. Outcomes after ACLR have suggested that athletes return to a level of function that would support a return to sport participation; however, in a recent meta-analysis, pooled return rates were only 55%. It is unclear whether this discrepancy is a result of functional impairments.Objective: To compare patient-reported outcomes (PROs), dynamic balance, dynamic functional performance, strength, and muscular endurance in athletes who returned to sport (RTS) and athletes who did not return to sport (NRTS) after ACLR.Design: Case-control study.Setting: University research laboratory.Patients or Other Participants: Two groups of participants with primary unilateral ACLR: 18 RTS individuals (7 males, 11 females; age = 23 ± 11 years, height = 163.58 ± 40.41 cm, mass = 70.00 ± 21.75 kg, time since surgery = 4.02 ± 3.20 years) and 12 NRTS individuals (5 males, 7 females; age = 26 ± 13 years, height = 171.33 ± 48.24 cm, mass = 72.00 ± 21.81 kg, time since surgery = 3.68 ± 2.71 years).Intervention(s): The PROs consisted of the International Knee Documentation Committee Subjective Knee Evaluation Form, Knee Injury and Osteoarthritis Outcome Score, Tegner Activity Scale, and Marx Activity Scale. Functional performance outcome measures were the anterior and posteromedial reach on the Star Excursion Balance Test, a battery of single-legged–hop tests, isokinetic quadriceps and hamstrings strength at 60°/s and 180°/s, and a novel step-down-to-fatigue test. All measures were taken during a single laboratory session.Main Outcome Measure(s): The Limb Symmetry Index was calculated for all functional performance measures. Mann-Whitney U tests were used to compare measures between groups (P &lt; .10).Results: Compared with the RTS group, the NRTS group had lower scores on the International Knee Documentation Committee Subjective Knee Evaluation Form (RTS median = 92.52, range = 66.67–97.70; NRTS median = 82.76, range = 63.22–96.55; P = .03) and Knee Injury and Osteoarthritis Outcome Score Symptoms subscale (RTS median = 88, range = 54–100; NRTS median = 71, range = 54–100; P = .08). No differences were observed for any functional performance measures.Conclusions: The NRTS athletes displayed lower PROs despite demonstrating similar function on a variety of physical performance measures. These results further support existing evidence that physical performance alone may not be the ideal postoperative outcome measure. Measures of patients' symptoms and self-perceived physical function may also greatly influence postoperative activity choices.

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