scholarly journals Confidence to Return to Play After Anterior Cruciate Ligament Reconstruction Is Influenced by Quadriceps Strength Symmetry and Injury Mechanism

2021 ◽  
pp. 194173812097637
Author(s):  
Francesco Della Villa ◽  
Rachel K. Straub ◽  
Bert Mandelbaum ◽  
Christopher M. Powers
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Quadriceps Strength ◽  
Injury Mechanism ◽  
Return To Play ◽  
Cruciate Ligament Reconstruction ◽  
Anterior Cruciate

Background: Although the restoration of quadriceps strength symmetry is a primary rehabilitation goal after anterior cruciate ligament reconstruction (ACLR), little is known about the potential relationship between quadriceps strength symmetry and psychological readiness to return to play (RTP). Hypothesis: Quadriceps strength symmetry will be associated with psychological readiness to RTP after ACLR. Secondarily, injury mechanism will influence the association between quadriceps strength and psychological readiness to RTP. Study Design: Retrospective cohort. Level of Evidence: Level 3 (cohort study). Methods: A total of 78 female patients completed strength testing and the Injury–Psychological Readiness to Return to Sport (I-PRRS) scale at an outpatient clinical facility as part of return to sport testing after ACLR. Linear regression analysis was used to assess the relationship between the I-PRRS and the independent variables of interest (quadriceps strength symmetry and injury mechanism). Results: For all patients combined, a significant symmetry × mechanism interaction was found. When split by injury mechanism, a significant linear relationship was found between quadriceps strength symmetry and the I-PRRS score in patients who experienced a noncontact injury (n = 55; P = 0.01; R2 = 0.24). No such relationship was found for those who experienced a contact injury (n = 23; P = 0.97; R2 = 0.01). Conclusion: Greater quadriceps strength symmetry was associated with greater psychological readiness to RTP in female athletes after ACLR. This relationship, however, was present only in those who experienced a noncontact injury. Clinical Relevance: Clinicians should consider both the physical and the psychological factors in assessing a patient’s readiness to RTP. This may be particularly important for those who have experienced an ACL tear through a noncontact mechanism.

scholarly journals Bioaugmentation in the surgical treatment of anterior cruciate ligament injuries: A review of current concepts and emerging techniques

2020 ◽  
Vol 8 ◽  
pp. 205031212092105
Author(s):  
Austin MacFarland Looney ◽  
Joseph Daniel Leider ◽  
Andrew Ryan Horn ◽  
Blake Michael Bodendorfer
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Return To Play ◽  
Cruciate Ligament Reconstruction ◽  
Anterior Cruciate Ligament Injuries ◽  
Anterior Cruciate Ligament Repair ◽  
Anterior Cruciate

Injuries involving the anterior cruciate ligament are among the most common athletic injuries, and are the most common involving the knee. The anterior cruciate ligament is a key translational and rotational stabilizer of the knee joint during pivoting and cutting activities. Traditionally, surgical intervention in the form of anterior cruciate ligament reconstruction has been recommended for those who sustain an anterior cruciate ligament rupture and wish to remain active and return to sport. The intra-articular environment of the anterior cruciate ligament makes achieving successful healing following repair challenging. Historically, results following repair were poor, and anterior cruciate ligament reconstruction emerged as the gold-standard for treatment. While earlier literature reported high rates of return to play, the results of more recent studies with longer follow-up have suggested that anterior cruciate ligament reconstruction may not be as successful as once thought: fewer athletes are able to return to sport at their preinjury level, and many still go on to develop osteoarthritis of the knee at a relatively younger age. The four principles of tissue engineering (cells, growth factors, scaffolds, and mechanical stimuli) combined in various methods of bioaugmentation have been increasingly explored in an effort to improve outcomes following surgical treatment of anterior cruciate ligament injuries. Newer technologies have also led to the re-emergence of anterior cruciate ligament repair as an option for select patients. The different biological challenges associated with anterior cruciate ligament repair and reconstruction each present unique opportunities for targeted bioaugmentation strategies that may eventually lead to better outcomes with better return-to-play rates and fewer revisions.

scholarly journals How Much Do Psychological Factors Affect Lack of Return to Play After Anterior Cruciate Ligament Reconstruction? A Systematic Review

2019 ◽  
Vol 7 (5) ◽  
pp. 232596711984531 ◽  
Author(s):  
Benedict U. Nwachukwu ◽  
Joshua Adjei ◽  
Ryan C. Rauck ◽  
Jorge Chahla ◽  
Kelechi R. Okoroha ◽  
...  
Keyword(s):  
Systematic Review ◽  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Psychological Factors ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Return To Play ◽  
Cruciate Ligament Reconstruction ◽  
Anterior Cruciate

Background: Variables affecting return to sport after anterior cruciate ligament reconstruction (ACLR) are multifactorial. The nonphysical factors germane to successful return to play (RTP) are being increasingly recognized. Purpose: To (1) evaluate the available evidence base for psychological factors relating to RTP after ACLR, (2) identify psychological factors affecting RTP after ACLR, and (3) understand currently available metrics used to assess psychological RTP readiness. Study Design: Systematic review; Level of evidence, 4. Methods: A review of the MEDLINE database was performed for studies reporting RTP after ACLR. Studies reporting on the psychological determinants of RTP were included. Demographic, methodological, and psychometric properties of the included studies were extracted. Weighted analysis was performed after patients were pooled across included studies. Results: Of 999 studies identified in the initial search, 28 (2.8%) studies, comprising 2918 patients, were included; 19 studies (n = 2175 patients) reported RTP rates. The mean time for RTP was 17.2 months. There was a 63.4% rate of RTP, and 36.6% of patients returning to sport were not able to perform at their prior level of play. Of the 795 patients who did not achieve RTP, 514 (64.7%) cited a psychological reason for not returning. Fear of reinjury was the most common reason (n = 394; 76.7%); other psychological factors included lack of confidence in the treated knee (n = 76; 14.8%), depression (n = 29; 5.6%), and lack of interest/motivation (n = 13; 2.5%). The Tampa Scale for Kinesiophobia, the Hospital Anxiety and Depression Scale, the ACL–Return to Sport after Injury scale, and the Knee Self-Efficacy Scale were reported measures for assessing the influence of psychology on RTP. Conclusion: Psychological factors play an important role in RTP after ACLR. Among studies evaluating the impact of psychology on RTP, there was a delay in returning as well as lower RTP rates compared with the previously reported normative literature. Fear of reinjury was the most commonly reported impediment to RTP. The psychosocial measures identified in this review may have a role in RTP protocols for assessing mental resiliency; however, their roles need to be further investigated and validated in patients who have undergone ACLR.

scholarly journals Comparison of Short-term Biodex Results After Anatomic Anterior Cruciate Ligament Reconstruction Among 3 Autografts

2019 ◽  
Vol 7 (5) ◽  
pp. 232596711984763 ◽  
Author(s):  
Jonathan D. Hughes ◽  
Jeremy M. Burnham ◽  
Angela Hirsh ◽  
Volker Musahl ◽  
Freddie H. Fu ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Quadriceps Strength ◽  
Return To Play ◽  
Quadriceps Weakness ◽  
Cruciate Ligament Reconstruction ◽  
Significant Difference ◽  
Anterior Cruciate

Background: An individualized approach to anterior cruciate ligament reconstruction (ACLR) typically includes criteria-based postoperative rehabilitation. However, recent literature has suggested residual quadriceps weakness up to 12 months after ACLR, especially with a quadriceps tendon (QT) autograft. Hypothesis: The QT would have poorer quadriceps strength symmetry at 5 to 8 months compared with the hamstring tendon (HS) and patellar tendon (BPTB), but there would be no significant difference at 9 to 15 months among all 3 groups. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent anatomic primary ACLR with an autograft were reviewed retrospectively. Isometric quadriceps and hamstring strength measurements were obtained clinically at 5 to 8 months and 9 to 15 months postoperatively. Return-to-running and return-to-play criteria included greater than 80% and 90% quadriceps strength symmetry, respectively. Results: A total of 73 patients with 5- to 8-month follow-up were identified, and 52 patients had 9- to 15-month data. The QT group had a significantly lower quadriceps index at 5 to 8 months (69.5 ± 17.4) compared with the BPTB (82.8 ± 14.6; P = .014) and the HS (86.0 ± 18.6; P = .001) groups. More patients with an BPTB autograft met criteria for return to running and return to play (60% and 47%, respectively) compared with the QT group (26% and 13%, respectively) at 5 to 8 months. Given the sample sizes available, we observed no significant difference in the quadriceps index and return-to-play and return-to-running criteria at 9 to 15 months among those undergoing ACLR with a QT, BPTB, or HS graft. Conclusion: Patients undergoing ACLR with a QT graft demonstrated clinically meaningful quadriceps asymmetry at 5 to 8 months and 9 to 15 months postoperatively. Additionally, fewer patients in the QT group met criteria for return to play and running at 5 to 8 months than the BPTB and HS groups. These data suggest that a longer time to return to play and specific rehabilitation protocols that emphasize quadriceps strengthening may be necessary because of residual quadriceps weakness after ACLR with a QT graft.

scholarly journals An Exploration of Sports Rehabilitators’ and Athletic Rehabilitation Therapists’ Views on Fear of Reinjury After Anterior Cruciate Ligament Reconstruction

2015 ◽  
Vol 24 (2) ◽  
pp. 140-150 ◽  
Author(s):  
Fiona McVeigh ◽  
Stephen M. Pack
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Ligament Reconstruction ◽  
Psychological Intervention ◽  
Cruciate Ligament ◽  
Critical Role ◽  
Return To Sport ◽  
Return To Play ◽  
Cruciate Ligament Reconstruction ◽  
Anterior Cruciate

Background:Research involving long-term follow-up of patients after successful anterior cruciate ligament reconstruction (ACLR) has shown that return-to-sport rates are not as good as would be expected despite many patients’ having normal knee-function scores. The psychological component, specifically fear of reinjury, plays a critical role in determining patients’ return to play and is frequently underestimated. Little is known about the recognition and intervention from the therapist’s perspective.Aim:To gain a greater understanding of the views of sports rehabilitators and athletic rehabilitation therapists on recognition of fear of reinjury in clients after ACLR.Method and Design:A qualitative approach, consisting of semistructured interviews with a purposive sample of 8 participants, sports rehabilitators, or athletic rehabilitation therapists. This population has been largely unexamined in this context in previous research.Main Findings:Thematic analysis yielded 2 main themes: communication and education. Participants discussed the importance of communication in the client–therapist relationship and how it is used in addressing misinformation and fear of reinjury. All participants used education in outlining the rehabilitation pathway and dealing with those providing social support around the client. Issues emerged relating to therapists’ recognition of observable signs of fear of reinjury in the clinical setting. Overall, participants thought that fear of reinjury was not a barrier to return to play after ACLR.Conclusion:There is a need for more education of therapists on recognizing fear of reinjury and the appropriate use of psychological intervention skills as a method for dealing with this throughout the rehabilitation process.

scholarly journals STRONGER THAN EVER! ADOLESCENT ATHLETES SHOW STRENGTH GAINS WITHIN THE UNINJURED LEG AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0005
Author(s):  
Elliot Greenberg ◽  
Joshua Bram ◽  
Theodore Ganley
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Cohort Analysis ◽  
Peak Torque ◽  
Quadriceps Strength ◽  
Strength Assessment ◽  
Cruciate Ligament Reconstruction ◽  
Anterior Cruciate

Background: The restoration of quadriceps strength after anterior cruciate ligament reconstruction (ACLR) is critical to restore optimal patient function and reduce the incidence of secondary ACL injury. Strength is typically quantified during return to sport assessments, by comparing the strength in the involved limb to that of the uninvolved limb. A limb symmetry index (LSI) is calculated and used to determine if any residual strength deficits persist. Recent evidence demonstrates that the uninvolved limb may lose strength during ACLR recovery and suggests that pre-operative uninvolved limb strength values may offer a better representation and more stringent indicator of strength recovery after ACLR. However, this body of literature is limited and no studies have specifically evaluated this occurrence within youth athletes. Purpose: To evaluate the change in strength in the uninvolved limb from pre-operative to 6 months post-ACLR, and assess the effect of pre-operative strength comparison on 6-month post-op LSI. Methods: A retrospective cohort analysis of pediatric patients (≤18 years) undergoing primary ACLR from 1/2018-1/2020 without concomitant multi-ligamentous reconstruction was conducted. Isokinetic peak torque values for the uninvolved and involved quadriceps were extracted at pre-operative (uninvolved only) and 6 months post-operative. Strength changes were analyzed using paired-samples t-test. Results: Complete data was available for a total of 17 subjects (mean age 15.1±1.7, 53% female). Pre-operative strength assessment was performed a mean of 11.5 days (range 1-26) prior to surgery. The mean 6-month post-operative assessment occurred at 177 days (range 127-246). The uninvolved limb was significantly stronger (p<0.001) at 6 months compared to preoperatively, with a mean improvement of 12.1ft/lbs (95%CI 18.3 – 7.2) with a change from 82.4ft/lbs to 95.1 ft/lbs. The LSI was calculated using both pre-operative and 6-month post-operative uninvolved limb values and demonstrated substantially lower LSI values when using concurrent 6-month data (LSIpre 91.3% vs LSI6M 76.9%). Conclusions: Among this sample, the uninvolved limb got stronger during post-ACLR recovery and comparison to concurrently assessed strength values led to a more stringent determination of LSI. Differences in rehabilitation programming, adolescent physiology, and pre-injury training patterns may explain why these results differ than those found in older cohorts.

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