scholarly journals Periodization in Anterior Cruciate Ligament Rehabilitation: A Novel Framework

2020 ◽  
pp. 1-8
Author(s):  
George Kakavas ◽  
Nikolaos Malliaropoulos ◽  
Georgios Bikos ◽  
Ricard Pruna ◽  
Xavier Valle ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Injury Risk ◽  
Physical Therapists ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Cost Effective ◽  
Psychological Trauma ◽  
Training Methods ◽  
The Usa ◽  
Anterior Cruciate

More than 250,000 anterior cruciate ligament (ACL) injuries occur each year in the USA, and approximately 65% of these injuries undergo reconstructive surgery. Appropriate rehabilitation after ACL reconstruction can yield predictably good outcomes, with return to previous levels of activity and high knee function. At present, periodization is used at all levels of sports training. Whether conceptualized and directed by coaches, or by athletes themselves, competitors structure their training in a cyclic fashion, enabling athletes to best realize their performance goals. In practical application, sport physical therapists use periodization: postoperative “protocols” serve as rudimentary forms of periodization, albeit implemented over shorter time frames than that typically employed in preparation for competition. An ACL injury should not be considered a “simple” musculoskeletal pathology with only local mechanical or motor dysfunctions. Together with the psychological trauma and reduction in physical capacity, there is a cascade of events, including neurological insult to the central nervous system and reduction in afferences to the sensorimotor system. Rehabilitation should consider all these issues, and periodization would allow to better define and to plan aims and objectives to return athletes to their sport. Technological resources including advanced neuroimaging methods, virtual reality for injury risk screening and return to sport assessment, and interactive artificial reality-based neuromuscular training methods offer new approaches and tools to address this important biomedical problem. The cost and availability of many of these technologies will continue to decrease, providing greater availability, scientific rigor, and ultimately, utility for cost-effective and data-driven assessments.

scholarly journals Return to Sport Following Anterior Cruciate Ligament Reconstruction: Women's Lacrosse

2021 ◽  
Vol 1 (1) ◽  
pp. 6-16
Author(s):  
Rachel Lampros ◽  
Isabella Sprague
Keyword(s):  
Anterior Cruciate Ligament ◽  
Physical Therapists ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Neuromuscular Control ◽  
Rehabilitation Program ◽  
Strength And Conditioning ◽  
Functional Rehabilitation ◽  
Cardiovascular Training ◽  
Anterior Cruciate

Participation in women’s lacrosse has increased in popularity over the last 20 years with a subsequent rise in sports-related injuries. Despite this increase, there is a paucity of research examining this population, particularly regarding guidelines for safe return to lacrosse after anterior cruciate ligament (ACL) reconstruction.  A lacrosse-specific functional rehabilitation program is critical to the success of the athlete.  The athlete must be prepared and demonstrate the ability to cut, pivot, jump, pass, and shoot with the incidental contact required for sport clearance.  A criterion-based program delineating a progression of range of motion, mobility, strength, neuromuscular control, agility, and cardiovascular training is an essential part of ACL rehabilitation.  Early incorporation of lacrosse-specific skills emphasizing multiplanar neuromuscular control should gradually progress to more challenging field-based tasks as the athlete transitions through their rehabilitation program.  A multidisciplinary team of physicians, physical therapists, athletic trainers, strength and conditioning specialists, coaches, and parents must collaborate effectively to reduce the athlete’s risk for reinjury, meet the demands of the sport, and facilitate returning to the field without complications.  Associated video content

Recent Advances in Prevention of Primary and Secondary Anterior Cruciate Ligament Injury: What Does the Future Hold for Optimizing Knee-Joint Function?

2020 ◽  
Vol 9 (1) ◽  
pp. 72-78
Author(s):  
Sandra J. Shultz ◽  
Randy J. Schmitz
Keyword(s):  
Anterior Cruciate Ligament ◽  
Injury Risk ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Acl Injury ◽  
Risk Identification ◽  
Ligament Injury ◽  
The Future ◽  
Anterior Cruciate ◽  
Acl Injury Prevention

Despite considerable advances in anterior cruciate ligament (ACL) injury-risk identification and prevention over the past 20 years, the annual incidence of ACL injury has continued to rise, and females remain at greater risk of both primary and secondary ACL injury. Important questions remain regarding ancillary risk factors we should target, the most effective training and rehabilitation approaches to ensure retention and transfer of learned skills from the rehabilitation setting to real-world sporting environment, and the development of more evidence-based criteria for return to sport that consider the whole athlete. As we look to the future, the optimization of primary and secondary ACL-injury prevention represents a complex, multidisciplinary problem with many unique and exciting opportunities to engage the various subdisciplines of kinesiology to address these emerging questions.

scholarly journals The Incidence of Second Anterior Cruciate Ligament Injury in Young Athletes is Not Influenced by Time to Return to Sport

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0018
Author(s):  
Christin M. Zwolski ◽  
Laura C. Schmitt ◽  
Staci Thomas ◽  
Mark V. Paterno
Keyword(s):  
Anterior Cruciate Ligament ◽  
Injury Risk ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Acl Injury ◽  
International Knee Documentation Committee ◽  
Ligament Injury ◽  
Young Athletes ◽  
Patient Reported ◽  
Anterior Cruciate

Background: Incidence of second anterior cruciate ligament (ACL) injury among the population of young athletes is reported to be as high as 30%. Time between ACL reconstruction (ACLR) and return to sport (RTS) has been considered as a factor in second injury risk. Hypothesis/Purpose: The purpose of this study was to investigate the effect of time between ACLR and RTS on incidence of 2nd ACL injury. The tested hypothesis was that incidence of 2nd ACL injury among young athletes would not be influenced by time to RTS or patient-reported function following primary ACLR. Methods: 188 participants (mean age=16.8±3.0 years; 124 females) underwent ACLR, completed rehabilitation, and were medically cleared to RTS. Subjects were enrolled in the study within 4 weeks of their medical clearance to RTS. At this time, each subject completed the International Knee Documentation Committee (IKDC) Survey, the Knee injury and Osteoarthritis Outcome Score (KOOS) and was grouped into an early RTS group (<6 months post-operative (PO)) (n=19), an average RTS group (6-9 months PO)(n=106), and a late RTS group (≥9 months PO)(n=63). Subjects were then tracked for 24 months to record the incidence of a second ACL injury to either the involved limb or contralateral limb. One-way ANOVA was used to identify differences in demographics and patient-reported outcomes among the groups. Crude incidence of 2nd ACL injury was identified within each group and chi-squared analyses were used to determine the difference in proportion of 2nd ACL injuries between groups. Results: No significant differences in age (p=0.40), height (p=0.65) or weight (p=0.92) existed among the groups. At time of RTS, no differences between the early RTS, average RTS and late RTS groups were seen in patient-reported function on the IKDC (84.9±10.8, 90.5±9.5, 88.7±10.9; p= 0.08) and all KOOS subscales (p=0.05-0.41). With respect to 2nd ACL injury, there were no group differences (p=0.716) in the proportion of patients within each group who suffered a 2nd ACL injury within 24 months of RTS date (26.3% (5/19) of patients in the early RTS group, 18.9% (20/106) in the average RTS group and 22.2% (14/63) in the late RTS group). Conclusion: In accordance with our hypothesis, length of time between ACLR and RTS had no influence on incidence of second ACL injury among a population of young athletes after ACLR. Furthermore, patient-reported function at time of RTS was similar among groups, regardless of time between ACLR and RTS.

Anterior cruciate ligament injury risk factors in football

2019 ◽  
Vol 59 (10) ◽  
Author(s):  
Gian Nicola Bisciotti ◽  
Karim Chamari ◽  
Emanuele Cena ◽  
Andrea Bisciotti ◽  
Alessandro Bisciotti ◽  
...  
Keyword(s):  
Risk Factors ◽  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Injury ◽  
Injury Risk ◽  
Cruciate Ligament ◽  
Ligament Injury ◽  
Injury Risk Factors ◽  
Anterior Cruciate

scholarly journals Electromyographic Assessment of Anterior Cruciate Ligament Injury Risk in Male Tennis Players: Which Role for Visual Input? A Proof-of-Concept Study

Diagnostics ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 997
Author(s):  
Alessandro de Sire ◽  
Nicola Marotta ◽  
Andrea Demeco ◽  
Lucrezia Moggio ◽  
Pasquale Paola ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Injury Risk ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Visual Input ◽  
Proof Of Concept ◽  
Tennis Players ◽  
Concept Study ◽  
Acl Injury Risk ◽  
Anterior Cruciate

Anterior cruciate ligament (ACL) injury incidence is often underestimated in tennis players, who are considered as subjects conventionally less prone to knee injuries. However, evaluation of the preactivation of knee stabilizer muscles by surface electromyography (sEMG) showed to be a predictive value in the assessment of the risk of ACL injury. Therefore, this proof-of-concept study aimed at evaluating the role of visual input on the thigh muscle preactivation through sEMG to reduce ACL injury risk in tennis players. We recruited male, adult, semiprofessional tennis players from July to August 2020. They were asked to drop with the dominant lower limb from a step, to evaluate—based on dynamic valgus stress—the preactivation time of the rectus femoris (RF), vastus medialis, biceps femoris, and medial hamstrings (MH), through sEMG. To highlight the influence of visual inputs, the athletes performed the test blindfolded and not blindfolded on both clay and grass surfaces. We included 20 semiprofessional male players, with a mean age 20.3 ± 4.8 years; results showed significant early muscle activation when the subject lacked visual input, but also when faced with a less-safe surface such as clay over grass. Considering the posteromedial–anterolateral relationship (MH/RF ratio), tennis players showed a significant higher MH/RF ratio if blindfolded (22.0 vs. 17.0% not blindfolded; p < 0.01) and percentage of falling on clay (17.0% vs. 14.0% in grass; p < 0.01). This proof-of-principle study suggests that in case of absence of visual input or falling on a surface considered unsafe (clay), neuro-activation would tend to protect the anterior stress of the knee. Thus, the sEMG might play a crucial role in planning adequate athletic preparation for semiprofessional male athletes in terms of reduction of ACL injury risk.

Altered Knee Laxity and Stiffness in Response to a Soccer Match Simulation in Players Returning to Sport Within 12 Months After Anterior Cruciate Ligament Reconstruction

2021 ◽  
pp. 036354652110130
Author(s):  
Stefano Nuccio ◽  
Luciana Labanca ◽  
Jacopo Emanuele Rocchi ◽  
Pier Paolo Mariani ◽  
Paola Sbriccoli ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Knee Laxity ◽  
Activity Level ◽  
Soccer Players ◽  
Control Group ◽  
Soccer Match ◽  
Anterior Cruciate ◽  
Anterior Knee

Background: The acute effects of exercise on anterior knee laxity (AKL) and anterior knee stiffness (AKS) have been documented in healthy participants, but only limited evidence has been provided for athletes cleared to return to sports after anterior cruciate ligament (ACL) reconstruction (ACLR). Purpose/Hypothesis: The purpose was to determine if 45 minutes of a soccer match simulation lead to acute changes in AKL and AKS in soccer players returning to sport within 12 months after ACLR. We hypothesized that the reconstructed knee of the ACLR group would exhibit an altered response to sport-specific exercise. Study Design: Controlled laboratory study. Methods: A total of 13 soccer players cleared to return to sport after ACLR and 13 healthy control soccer players matched for age, physical activity level, limb dominance, and anthropometric characteristics were recruited. To assess the effects of a standardized soccer match simulation (Soccer Aerobic Field Test [SAFT45]) on AKL and AKS, an arthrometric evaluation was carried out bilaterally before and immediately after SAFT45. To conduct a comprehensive examination of the force-displacement curve, the absolute and side-to-side difference (SSD) values of both AKL and AKS were extracted at 67, 134, and 200 N. Results: The ACLR and control groups showed similar AKL and AKS at baseline ( P > .05). In response to SAFT45, laxity increased bilaterally at all force levels by 14% to 17% only in the control group ( P < .025). Similarly, AKS at 134 and 200 N decreased in response to SAFT45 only in the control group (10.5% and 20.5%, respectively; P < .025). After SAFT45, the ACLR group had 1.9 and 2.5 times higher SSDs of AKS at 67 and 134 N compared with the control group, respectively ( P < .025), as well as a 1.9 times higher SSD of AKS at 134 N compared with baseline ( P = .014). Conclusion: Soccer players at the time of return to sport after ACLR showed an altered mechanical response to a sport-specific match simulation consisting of bilaterally unchanged AKL and AKS. Clinical Relevance: Soccer players showing altered AKL and AKS in response to exercise after ACLR may not be ready to sustain their preinjury levels of sport, thus potentially increasing the risk of second ACL injuries.

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