scholarly journals Psychosocial Barriers After Anterior Cruciate Ligament Reconstruction: A Clinical Review of Factors Influencing Postoperative Success

2019 ◽  
Vol 11 (6) ◽  
pp. 528-534
Author(s):  
Julie P. Burland ◽  
Jennifer L. Toonstra ◽  
Jennifer S. Howard
Keyword(s):  
Anterior Cruciate Ligament ◽  
Clinical Review ◽  
Psychosocial Factors ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Neuromuscular Control ◽  
Ample Evidence ◽  
Rehabilitation Process ◽  
Anterior Cruciate ◽  
Return To Activity

Context: Psychosocial factors arising after anterior cruciate ligament (ACL) injury may have a direct influence on an individual’s decision to return to sport after ACL reconstruction (ACLR). While there is ample evidence to suggest that deficits in quadriceps strength, neuromuscular control, and clinical functional tasks exist after ACLR, the root and contribution of psychological dysfunction to an individual’s success or return to sport after ACLR is still largely uncertain and unexplored. Given the discrepancy between successful functional outcomes and the percentage of athletes who return to sport, it is important to thoroughly address underlying factors, aside from physical function, that may be contributing to these lower return rates. Evidence Acquisition: Articles that reported on return to sport, psychological factors, and psychosocial factors after ACLR were collected from peer-reviewed sources available on Medline (1998 through August 2018). Search terms included the following: anterior cruciate ligament OR ACL AND return-to-sport OR return-to-activity, anterior cruciate ligament OR ACL AND psychological OR psychosocial OR biopsychosocial OR fear OR kinesiophobia OR self-efficacy, return-to-activity AND psychological OR psychosocial. Study Design: Clinical review. Level of Evidence: Level 5. Results: Psychosocial factors relative to injury are important components of the rehabilitation process. To fully understand how psychosocial factors potentially influence return to sport, an athlete’s emotions, experiences, and perceptions during the rehabilitation process must be acknowledged and taken into consideration. Conclusion: Acknowledgment of these psychosocial factors allows clinicians to have a better understanding of readiness to return to sport from a psychological perspective. Merging of the current ACLR rehabilitation protocols with knowledge related to psychosocial factors creates a more dynamic, comprehensive approach in creating a positive and successful rehabilitation environment, which may help improve return-to-sport rates in individuals after ACLR.

scholarly journals Decision to Return to Sport After Anterior Cruciate Ligament Reconstruction, Part I: A Qualitative Investigation of Psychosocial Factors

2018 ◽  
Vol 53 (5) ◽  
pp. 452-463 ◽  
Author(s):  
Julie P. Burland ◽  
Jenny Toonstra ◽  
Jennifer L. Werner ◽  
Carl G. Mattacola ◽  
Dana M. Howell ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Psychosocial Factors ◽  
Biopsychosocial Model ◽  
Cruciate Ligament ◽  
Academic Medical Center ◽  
Strong Support ◽  
Return To Sport ◽  
Acl Injury ◽  
Patient Reported ◽  
Anterior Cruciate

Context:  Return-to-sport criteria after anterior cruciate ligament (ACL) injury are often based on “satisfactory” functional and patient-reported outcomes. However, an individual's decision to return to sport is likely multifactorial; psychological and physical readiness to return may not be synonymous. Objective:  To determine the psychosocial factors that influence the decision to return to sport in athletes 1 year post–ACL reconstruction (ACLR). Design:  Qualitative study. Setting:  Academic medical center. Patients or Other Participants:  Twelve participants (6 males, 6 females) were purposefully chosen from a large cohort. Participants were a minimum of 1-year postsurgery and had been active in competitive athletics preinjury. Data Collection and Analysis:  Data were collected via semistructured interviews. Qualitative analysis using a descriptive phenomenologic process, horizontalization, was used to derive categories and themes that represented the data. The dynamic-biopsychosocial model was used as a theoretical framework to guide this study. Results:  Six predominant themes emerged that described the participants' experiences after ACLR: (1) hesitation and lack of confidence led to self-limiting tendencies, (2) awareness was heightened after ACLR, (3) expectations and assumptions about the recovery process influenced the decision to return to sport after ACLR, (4) coming to terms with ACL injury led to a reprioritization, (5) athletic participation helped reinforce intrinsic personal characteristics, and (6) having a strong support system both in and out of rehabilitation was a key factor in building a patient's confidence. We placed themes into components of the dynamic-biopsychosocial model to better understand how they influenced the return to sport. Conclusions:  After ACLR, the decision to return to sport was largely influenced by psychosocial factors. Factors including hesitancy, lack of confidence, and fear of reinjury are directly related to knee function and have the potential to be addressed in the rehabilitation setting. Other factors, such as changes in priorities or expectations, may be independent of physical function but remain relevant to the patient-clinician relationship and should be considered during postoperative rehabilitation.

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

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.

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.

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

Sensors ◽  
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.

scholarly journals Knetex – Development of a textile-integrated sensor system for feedback-supported rehabilitation after surgery of the anterior cruciate ligament

2020 ◽  
Vol 6 (3) ◽  
pp. 368-371
Author(s):  
Julia Demmer ◽  
A. Kitzig ◽  
N. Schlage ◽  
G. Stockmanns ◽  
E. Naroska
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Sensors And Actuators ◽  
Integrated Sensor ◽  
Rehabilitation Process ◽  
Active User ◽  
Smart Textile ◽  
First Results ◽  
Anterior Cruciate ◽  
The One

AbstractPatients often report an effect after surgery of the anterior cruciate ligament which is called "giving way". This manifest itself by a drop of the knee or a felt instability. This phenomenon is difficult to measure and validate because it usually does not occur regularly and is not reproducible under laboratory conditions. The Knetex project takes up this point by trying to actively support the rehabilitation process with a bandage that can be worn in everyday life and is constructed as a smart textile using sensors and actuators. For this purpose, on the one hand it is attempted to actively record the phenomenon of the "giving way" by measuring knee angles etc. and by active user feedback. At the same time, the patient is specifically advised by means of actuators to correct incorrect posture or movement in order to make the rehabilitation process more effective and prevent further damage. Two 9-axis IMUs (inertial measurement units) form the basis of the system. These are used together with a textile strain sensor to calculate the knee angles. This paper gives an overview of the planned system, the initial experiments to measure the knee angles and the first results of the actuator study.

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