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 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.

A Systematic Review of Risk Factors for Anterior Cruciate Ligament Reconstruction Failure

2021 ◽  
Author(s):  
Xianyue Shen ◽  
Yanguo Qin ◽  
Jianlin Zuo ◽  
Tong Liu ◽  
Jianlin Xiao
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Anterior Cruciate Ligament ◽  
High Risk ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Cruciate Ligament Reconstruction ◽  
Technical Factors ◽  
Anterior Cruciate

AbstractAlthough most studies have introduced risk factors related to anterior cruciate ligament reconstruction failure, studies on combinations of high-risk factors are rare. To provide a systematic review of the risk factors of anterior cruciate ligament reconstruction failure to guide surgeons through the decision-making process, an extensive literature search was performed of the Medline, Embase and Cochrane Library databases. Studies published between January 1, 2009, and September 19, 2019, regarding the existing evidence for risk factors of anterior cruciate ligament reconstruction failure or graft failure were included in this review. Study quality was evaluated with the quality index. Ultimately, 66 articles met our criteria. There were 46 cases classified as technical factors, 21 cases as patient-related risk factors, and 14 cases as status of the knee joint. Quality assessment scores ranged from 14 to 24. This systematic review provides a comprehensive summary of the risk factors for anterior cruciate ligament reconstruction failure, including technical factors, patient-related factors, and the factors associated with the status of the knee joint. Emphasis should be placed on avoiding these high-risk combinations or correcting modifiable risk factors during preoperative planning to reduce the rate of graft rupture and anterior cruciate ligament reconstruction failure.

scholarly journals Risk Factors for Failure After Anterior Cruciate Ligament Reconstruction in a Pediatric Population: A Prediction Algorithm

2021 ◽  
Vol 9 (3) ◽  
pp. 232596712199116
Author(s):  
Nicholas J. Lemme ◽  
Daniel S. Yang ◽  
Brooke Barrow ◽  
Ryan O’Donnell ◽  
Alan H. Daniels ◽  
...  
Keyword(s):  
Risk Factors ◽  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Ligament Reconstruction ◽  
Pediatric Patients ◽  
Cruciate Ligament ◽  
Adult Patients ◽  
Collateral Ligament ◽  
Cruciate Ligament Reconstruction ◽  
Anterior Cruciate

Background: Anterior cruciate ligament reconstruction (ACLR) in pediatric patients is becoming increasingly common. There is growing yet limited literature on the risk factors for revision in this demographic. Purpose: To (1) determine the rate of pediatric revision ACLR in a nationally representative sample, (2) ascertain the associated patient- and injury-specific risk factors for revision ACLR, and (3) examine the differences in the rate and risks of revision ACLR between pediatric and adult patients. Study Design: Case-control study; Level of evidence, 3. Methods: The PearlDiver patient record database was used to identify adult patients (age ≥20 years) and pediatric patients (age <20 years) who underwent primary ACLR between 2010 and 2015. At 5 years postoperatively, the risk of revision ACLR was compared between the adult and pediatric groups. ACLR to the contralateral side was also compared. Multivariate logistic regression was used to determine the significant risk factors for revision ACLR and the overall reoperation rates in pediatric and adult patients; from these risk factors, an algorithm was developed to predict the risk of revision ACLR in pediatric patients. Results: Included were 2055 pediatric patients, 1778 adult patients aged 20 to 29 years, and 1646 adult patients aged 30 to 39 years who underwent ACLR. At 5 years postoperatively, pediatric patients faced a higher risk of revision surgery when compared with adults (18.0 % vs 9.2% [adults 20-29 years] and 7.1% [adults 30-39 years]; P < .0001), with significantly decreased survivorship of the index ACLR ( P < .0001; log-rank test). Pediatric patients were also at higher risk of undergoing contralateral ACLR as compared with adults (5.8% vs 1.6% [adults 20-29 years] and 1.9% [adults 30-39 years]; P < .0001). Among the pediatric cohort, boys (odds ratio [OR], 0.78; 95% CI, 0.63-0.96; P = .0204) and patients >14 years old (OR, 0.62; 95% CI, 0.45-0.86; P = .0035) had a decreased risk of overall reoperation; patients undergoing concurrent meniscal repair (OR, 1.84; 95% CI, 1.43-2.38; P < .0001) or meniscectomy (OR, 2.20; 95% CI, 1.72-2.82; P < .0001) had an increased risk of revision surgery. According to the risk algorithm, the highest probability for revision ACLR was in girls <15 years old with concomitant meniscal and medial collateral ligament injury (36% risk of revision). Conclusion: As compared with adults, pediatric patients had an increased likelihood of revision ACLR, contralateral ACLR, and meniscal reoperation within 5 years of an index ACLR. Families of pediatric patients—especially female patients, younger patients, and those with concomitant medial collateral ligament and meniscal injuries—should be counseled on such risks.

Alterations in Quadriceps Neurologic Complexity After Anterior Cruciate Ligament Reconstruction

2020 ◽  
pp. 1-6
Author(s):  
Steven M. Davi ◽  
Colleen K. Woxholdt ◽  
Justin L. Rush ◽  
Adam S. Lepley ◽  
Lindsey K. Lepley
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Ligament Reconstruction ◽  
Vastus Lateralis ◽  
Cruciate Ligament ◽  
Neuromuscular Control ◽  
Electromyographic Activity ◽  
Vastus Medialis ◽  
Cruciate Ligament Reconstruction ◽  
Anterior Cruciate

Context: Traditionally, quadriceps activation failure after anterior cruciate ligament reconstruction (ACLR) is estimated using discrete isometric torque values, providing only a snapshot of neuromuscular function. Sample entropy (SampEn) is a mathematical technique that can measure neurologic complexity during the entirety of contraction, elucidating qualities of neuromuscular control not previously captured. Objective: To apply SampEn analyses to quadriceps electromyographic activity in order to more comprehensively characterize neuromuscular deficits after ACLR. Design: Cross-sectional. Setting: Laboratory. Participants: ACLR: n = 18; controls: n = 24. Interventions: All participants underwent synchronized unilateral quadriceps isometric strength, activation, and electromyography testing during a superimposed electrical stimulus. Main Outcome Measures: Group differences in strength, activation, and SampEn were evaluated with t tests. Associations between SampEn and quadriceps function were evaluated with Pearson product–moment correlations and hierarchical linear regressions. Results: Vastus medialis SampEn was significantly reduced after ACLR compared with controls (P = .032). Vastus medialis and vastus lateralis SampEn predicted significant variance in activation after ACLR (r2 = .444; P = .003). Conclusions: Loss of neurologic complexity correlates with worse activation after ACLR, particularly in the vastus medialis. Electromyographic SampEn is capable of detecting underlying patterns of variability that are associated with the loss of complexity between key neurophysiologic events after ACLR.

scholarly journals The hybrid anterior cruciate ligament reconstruction surgical technique does permit an accelerated early functional recovery and return to sport.

2017 ◽  
Vol 5 (5_suppl5) ◽  
pp. 2325967117S0017
Author(s):  
Peter Annear ◽  
Ebert Jay
Keyword(s):  
Anterior Cruciate Ligament ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Quadriceps Strength ◽  
Hamstring Graft ◽  
Cruciate Ligament Reconstruction ◽  
Hop Tests ◽  
Anterior Cruciate ◽  
Tegner Score

Objectives: A major reason for undergoing anterior cruciate ligament reconstruction (ACLR) for patients is to return to high demand activity and sport. Published literature supports a return to sport (RTS) at 6-12 months, though the recovery of lower limb strength and functional symmetry is critical and is linked with a patient’s ability to RTS, as well as reducing the incidence of secondary re-tear. This study aimed to compare clinical outcomes and RTS between patients undergoing ACLR utilizing a hamstring graft and those undergoing a hybrid technique which augments the hamstring graft with a synthetic LARS ligament. Methods: A non-randomized study design was used to compare clinical outcomes at 10-12 months post-surgery, in 82 patients undergoing conventional ACLR via a hamstring graft (HG) and 35 patients undergoing a hybrid hamstring/LARS graft (HLG). All patients were assessed using a range of patient-reported outcome (PRO) scores (IKDC, KOOS, Cinncinati, Lysholm, SF-36, Tegner, Noyes, Global Rating of Change – GRC). Limb symmetry indices (LSIs) presenting the operated limb as a percentage of the unaffected limb were calculated for several strength/functional assessments (peak isokinetic quadriceps and hamstring strength, the single, triple and triple crossover hop for distance, and the 6 m timed hop). Results: There were no group differences (p>0.05) in patient demographics and the majority of PROs. The HLG group perceived themselves to be significantly ‘more recovered’ (p=0.046) on the GRC scale (HLG = 3.2, HG = 2.2), and also reported a significantly greater (p=0.004) Tegner score (HLG = 7.2, HG = 5.9). For the HG group, 62% of patients had returned to Noyes Level 1 or 2 activities, versus 80% of the HLG group. For the Tegner score, 57% of patients reported a score >6, versus 77% of the HLG group. There were no significant differences (p>0.05) in LSIs between groups for the strength and functional hop tests. However, the HLG group demonstrated a mean LSI above 90% for all four hop tests, while all four were below 90% in the HG group. Both groups demonstrated mean hamstring strength LSIs above 90%, while the quadriceps strength LSI was 81.9% and 85.8% for the HG and HLG groups, respectively. Conclusion: Patients in the HLG group perceived themselves to be more recovered, and had returned to a higher level of activity/sport, compared with the HG group. While not significant, the HLG group did demonstrate more favorable functional hop and quadriceps strength LSIs, which has been linked with the ability to RTS and the incidence of ACL re-tear. A larger patient cohort and follow-up is required to observe long-term outcomes.

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