Clinical Outcome and Return to Competition after Microfracture in the Athlete’s Knee

Microfracture is frequently used for articular cartilage repair in athletes. This study aimed to define the strength and weaknesses of this minimally invasive cartilage repair technique in the athletic population in an effort to optimize indications, functional outcome, and athletic participation after microfracture in the athlete’s knee. A systematic analysis of original studies using microfracture in athletes was performed. Functional outcome was assessed by activity outcome scores, ability to return to sports participation, timing of the return to sport, level of postoperative sports activity, and continuation of athletic competition over time. Thirteen studies describing 821 athletes were included in the analysis with an average follow-up of 42 months. Good or excellent results were reported in 67% of athletes with normal International Knee Documentation Committee (IKDC) scores in 80% and significant increase of Lysholm scores, Tegner activity scores, and Knee injury and Osteoarthritis Outcome Score (KOOS) sports subscales. Return to sports was achieved in 66% at an average of 8 months after surgery, with return to competition at the preinjury level in 67%. Forty-nine percent of athletes continued to compete without change in level of play, while decreasing function was observed in 42% after 2 to 5 years. Athlete’s age, preoperative duration of symptoms, level of play, lesion size, and repair tissue morphology affected sports activity after microfracture. Microfracture improves knee function and frequently allows for return to sports at the preinjury level, but deterioration of athletic function occurs in some patients. Several independent factors were identified that can help to optimize the return to athletic competition after microfracture in the athlete’s knee.

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Good to Excellent Functional Outcome and High Return to Sports Rate after Operative Treatment of Unstable Lateral Clavicle Fractures: Comparison of Two Coracoclavicular Button Fixation Techniques

Journal of Clinical Medicine ◽

10.3390/jcm10204685 ◽

2021 ◽

Vol 10 (20) ◽

pp. 4685

Author(s):

Markus Wurm ◽

Michael Zyskowski ◽

Sebastian Pesch ◽

Peter Biberthaler ◽

Chlodwig Kirchhoff ◽

...

Keyword(s):

Functional Outcome ◽

Constant Score ◽

Surgical Techniques ◽

Return To Sport ◽

Implant Removal ◽

Return To Sports ◽

Lateral Clavicle ◽

Clavicle Fractures ◽

Group 2 ◽

Group 1

Purpose: Operative therapy for unstable lateral clavicle fractures is necessary to reduce the risk of bony non-union. Irritation and restriction during sportive activities due to the implanted materials are a common reason for impaired function and implant removal. The aim of this study was to gain information on functional outcome and time until return to sport (RTS) after surgical treatment of unstable lateral clavicle fractures, comparing two coracoclavicular button techniques. Methods: A retrospective chart review of patients who were consecutively treated for unstable lateral clavicle fractures at our level one trauma center from 2014 to 2018 was conducted. Two different surgical techniques were evaluated and compared. Group 1 was treated using a locking compression plate and knotted DogBone™ Button, while group 2 received an LCP and knotless DogBone™ Button. Functional outcome (ASES (American Shoulder and Elbow Score), Constant-Score, DASH (Disability of Arm, Shoulder and Hand), MSQ (Munich Shoulder Questionnaire) and SPADI (Shoulder Pain and Disability Index) and time until RTS were investigated and compared between both groups, 1 year postoperatively. Results: A total of 56 patients (n = 35 group 1, n = 21 group 2) with a mean age of 45.1 ± 14.6 years met the inclusion criteria. Functional outcome reached good to excellent results (ASES 94.7 ± 9.8, Constant Score 85.1 ± 8.1, DASH 5.5 ± 8.4, MSQ 90.9 ± 7.2, SPADI 96.1 ± 5.7). Implant removal rates were higher in group 1 (48.3% vs. 35.3%) yet without statistical significance (p = 0.122). All patients returned to sports postoperatively with a mean time period until return to sport of 4.6 (3–9) months. Conclusion: Locking compression plating and coracoclavicular fixation using a knotless Dogbone ™ technique provides good to excellent functional outcomes, a high and fast rate of return to sport and lower irritation rates compared to the knotted DogBone ™ technique.

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Return to Sport, integrating the process from conventional rehabilitation up to reconditioning: a narrative review

Archivos de Medicina del Deporte ◽

10.18176/archmeddeporte.00049 ◽

2021 ◽

Vol 38 (5) ◽

pp. 253-260

Author(s):

Pavel Loeza-Magaña ◽

Héctor R. Quezada-González ◽

Pedro I. Arias-Vázquez

Keyword(s):

Motor Skills ◽

Meta Analysis ◽

Sport Activity ◽

Return To Sport ◽

Return To Sports ◽

Sports Performance ◽

Sports Activity ◽

Sports Team ◽

Communication And Coordination ◽

Sports Activities

Introduction: The process of return to sport after injury, has traditionally been approached in 2 separate stages; first the athlete is treated the medical service through conventional rehabilitation processes and is then referred to the sports team (coach and / or physical trainer) who complete the return to the sport activity. This approach may lack communication and coordination between both teams and may be insufficient for the demands of the current sports environment, causing longer processes of return to sport and greater risk of re-injury. The objective of this manuscript is to document the current models of return to sport, its stages, objectives and contents. Material and method: A comprehensive review of publications was carried out, including observational studies, clinical trials, reviews, consensus, systematic reviews and meta-analysis, related to treatment, rehabilitation, readaptation and return to sport. Results: The description of a model of return to sports of gradual progression that includes 3 stages was found: return to participation, readaptation to sport and return to maximum sports performance. The stage of return to participation aims to eliminate the symptoms and regain the functionality of the athlete in their non-sports activities, through conventional rehabilitation processes. The stage of readaptation to sport aims to achieve asymptomatic performance of training and competition activities, through the rehabilitation of deficiencies caused by the injury and the maintenance and / or development of motor skills with modified training. The stage of return to maximum sports performance includes specific sports training to reach the level of performance prior to the injury. Conclusions: This model could be associated with greater success in returning to sports activity and lower risk of recurrence of the injury.

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Return to Sports and Activity After Total Ankle Arthroplasty and Arthrodesis: A Systematic Review

Foot & Ankle International ◽

10.1177/1071100720927706 ◽

2020 ◽

Vol 41 (8) ◽

pp. 916-929 ◽

Cited By ~ 1

Author(s):

William L. Johns ◽

Christopher B. Sowers ◽

Kempland C. Walley ◽

Daniel Ross ◽

David B. Thordarson ◽

...

Keyword(s):

Systematic Review ◽

Participation Rate ◽

Sports Participation ◽

Operative Management ◽

Cochrane Library ◽

Activity Participation ◽

Return To Sports ◽

Level Of Evidence ◽

Sports Activity ◽

The Mean

Background: There is no consensus regarding participation in sports and recreational activities following total ankle replacement (TAR) and ankle arthrodesis (AA). This systematic review summarizes the evidence on return to sports and activity after operative management with either TAR or AA for ankle osteoarthritis (OA). Methods: A literature search of MEDLINE, EMBASE, CINAHL, and Cochrane Library databases was performed. Risk of bias of included studies was assessed using Methodological Index for Non-Randomized Studies (MINORS) criteria. Included studies reported sport and activity outcomes in patients undergoing TAR and AA, with primary outcomes being the percentage of sports participation and level of sports participation. Results: Twelve studies met inclusion criteria for analysis. There were 1270 ankle procedures, of which 923 TAR and 347 AA were performed. The mean reported patient age was 59.2 years and the mean BMI was 28 kg/m2. The mean follow-up was 43 months. Fifty-four percent of patients were active in sports preoperatively compared with 63.7% postoperatively. The mean preoperative activity participation rate was 41% in the TAR cohort, but it improved to 59% after TAR, whereas the preoperative activity participation rate of 73% was similar to the postoperative rate of 70% in the AA cohort. The most common sports in the TAR and AA groups were swimming, hiking, cycling, and skiing. Conclusion: Participation in sports activity was nearly 10% improved after operative management of ankle OA with TAR and remains high after AA. The existing literature demonstrated a large improvement in pre- to postoperative activity levels after TAR, with minimal change in activity after AA; however, AA patients were more active at baseline. The most frequent postoperative sports activities after operative management of ankle OA were swimming, hiking, cycling, and skiing. Participation in high-impact sports such as tennis, soccer, and running was consistently limited after surgery. This review of the literature will allow patients and foot and ankle surgeons to set evidence-based goals and establish realistic expectations for postoperative physical activity after TAR and AA. Level of Evidence: Level III, systematic review.

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Psychometric Properties of the Hip–Return to Sport After Injury Scale (Short Form) for Evaluating Psychological Readiness to Return to Sports After Arthroscopic Hip Surgery

The American Journal of Sports Medicine ◽

10.1177/0363546519888644 ◽

2019 ◽

Vol 48 (2) ◽

pp. 376-384 ◽

Cited By ~ 4

Author(s):

Denise M. Jones ◽

Kate E. Webster ◽

Kay M. Crossley ◽

Ilana N. Ackerman ◽

Harvi F. Hart ◽

...

Keyword(s):

Hip Arthroscopy ◽

Discriminant Validity ◽

Short Form ◽

Return To Sport ◽

Sports Participation ◽

Important Change ◽

Return To Sports ◽

Healthy Controls ◽

Detectable Difference ◽

Minimally Important Change

Background: Successful return to sports activity after surgery requires both physical and psychological readiness. The Hip–Return to Sport After Injury (Short Form) has been developed to assess psychological readiness to return to sports after hip injury and hip surgery, including hip arthroscopy. Purpose: To evaluate the reliability, validity, responsiveness, and interpretability of the scale for a cohort of patients after hip arthroscopy with a range of sports participation levels. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Invitations to participate were sent to 145 patients from 3 specialist surgeons. The study included 77 participants 1 to 24 months after hip arthroscopy (mean ± SD age, 35 ± 9 years; 62% women) and 33 healthy age-matched controls (age, 37 ± 7 years; 52% women). The scale was administered electronically on 3 occasions to patients: baseline (≥1 month postarthroscopy), 1 week later, and 6 months later. In addition to the scale, participants were asked about sports participation status and their global rating of postsurgical change. The scale was administered to healthy controls on 1 occasion. The minimal detectable difference, discriminant validity, floor and ceiling effects, responsiveness, and interpretability (minimally important change) were determined for the scale. Results: Among the postarthroscopy group, excellent test-retest reliability was found (intraclass correlation coefficient = 0.869; 95% CI, 0.756-0.932) with a minimal detectable difference of 26 points out of 100 at the individual level and 4 points out of 100 at the group level. At baseline discriminant validity was evident between those who had returned to sports (median = 69, n = 35) and those who had not returned to sports (median = 30, n = 42; Mann-Whitney U score = 232.5, z = −5.141, P < .001) and between the returned-to-sports postarthroscopy group and healthy controls (median = 96, n = 33; Mann-Whitney U score = 165.500, z = 5.666, P < .001). No floor or ceiling effects were evident. Responsiveness was demonstrated for the scale in relation to sports status. With sports status as an anchor, a minimally important change of 26 points was identified. Conclusion: Assessment of the Hip–Return to Sport After Injury (Short Form) supports its use as a reliable and valid measure of psychological readiness to return to sports in patients after hip arthroscopy.

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Symptom free return to sport following supervised exercise and a return to play progression

Neurology ◽

10.1212/01.wnl.0000550665.57781.73 ◽

2018 ◽

Vol 91 (23 Supplement 1) ◽

pp. S10.2-S10

Author(s):

Matthew T. Lorincz ◽

Melvin Darwin ◽

Andrea Almeida ◽

Andrew R. Sas

Keyword(s):

Sport Participation ◽

Clinical Care ◽

Secondary Analysis ◽

Return To Sport ◽

Sports Participation ◽

Return To Play ◽

Return To Sports ◽

Supervised Exercise ◽

Institutional Review ◽

Data Elements

ObjectiveTo determine if completion of a symptom free return to play progression (RTPP) was associated with a symptom free return to sport. A secondary analysis investigated symptom free return to sports participation following supervised exercise.BackgroundThe current consensus statement on concussion in sport recommends a graded return-to-sport strategy but there is limited data on the utility of this approach.Methods200 sequential clinic patients with physician-diagnosed concussion sustained during sport participation were contacted by phone following completion of care from a University-associated Sports Neurology clinic. A survey about their success in returning to their sport was administered. Standardized data elements were extracted from the medical records and analyzed. The study was approved by the university of Michigan Institutional Review Board.ResultsThe survey was completed on 61 (31%) patients. Of these, 57 (93%) returned to sport participation without symptom reoccurrence. Of those who returned to sport 41 (80%) returned to sport without symptom reoccurrence within 2 weeks of completed clinical care. 53 (87%) completed a RTPP and 49 (92%) of those completing a RTPP returned to sport without symptom reoccurrence. Completing a RTPP, compared to those not completing a RTPP, was significantly associated with return to sport participation without symptom reoccurrence (p = 0.0000001). Of those surveyed, 32 (52%) underwent supervised exercise (SE) as part of their clinical care. Completing SE, as compared to those not undergoing SE, was significantly associated with return to sport participation without symptom reoccurrence (p = 0.017).ConclusionsOur results support recommendations for utilizing graded return-to-sport strategy demonstrating that 92% of those completing a RTPP successfully returned to sport. Our data also suggest that completion of SE was a predictor of symptom free return to sport and can be incorporated in to return to play decision making.

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The Effect of Therapeutic Exercise on Long-Standing Adductor-Related Groin Pain in Athletes: Modified Hölmich Protocol

Rehabilitation Research and Practice ◽

10.1155/2018/8146819 ◽

2018 ◽

Vol 2018 ◽

pp. 1-10 ◽

Cited By ~ 1

Author(s):

Abbas Yousefzadeh ◽

Azadeh Shadmehr ◽

Gholam Reza Olyaei ◽

Nasrin Naseri ◽

Zahra Khazaeipour

Keyword(s):

Groin Pain ◽

Recovery Period ◽

Return To Sport ◽

Step Test ◽

Return To Sports ◽

Therapeutic Exercise ◽

Sports Activity ◽

Hip Abduction ◽

Hop Test ◽

Mean Time

Objective. The Hölmich protocol in therapeutic exercise is the most appropriate method for the treatment of long-standing adductor-related groin pain (LSAGP). Herein, we evaluated a modified Hölmich protocol to resolve the possible limitations intrinsic to the Hölmich protocol in terms of the rate of return to sport and the recovery period for athletes with LSAGP. Design. The study followed a single-blind, before/after study design, where 15 athletes with LSAGP (mean age = 26.13 years; SD = 4.48) performed a 10-week modified Hölmich therapeutic exercise protocol. Results. Outcome scores related to pain, hip adductor and abductor muscle strengths, and the ratio of maximum isometric and eccentric hip adduction to abduction strength increased significantly. Likewise, hip abduction and internal rotation ROM improved significantly compared to that at baseline. Furthermore, functional records (t-test, Edgren Side Step Test, and Triple Hop Test) showed significant improvement after treatment. Finally, 13 athletes (86.6% of the participants) successfully returned to sports activity in a mean time of 12.06 weeks (SD = 3.41). Conclusion. The findings of this study objectively show that the modified Hölmich protocol may be safer and more effective than the Hölmich protocol in athletes with LSAGP in promoting their return to sports activity. This trial is registered with IRCT2016080829269N1.

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CLINICAL OUTCOMES OF OPERATIVE MANAGEMENT OF CAPITELLAR OSTEOCHONDRITIS DISSECANS IN ADOLESCENT ATHLETES

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00095 ◽

2021 ◽

Vol 9 (7_suppl3) ◽

pp. 2325967121S0009

Author(s):

Richard M. Michelin ◽

Bryn R. Gornick ◽

John A. Schlechter

Keyword(s):

Operative Treatment ◽

Osteochondritis Dissecans ◽

Return To Sport ◽

Bone Age ◽

Return To Sports ◽

Adolescent Athletes ◽

Duration Of Symptoms ◽

Marrow Stimulation ◽

Diagnostic Arthroscopy

Background: Capitellar osteochondritis dissecans (OCD) is commonly encountered in youth athletes. There are limited reports on long term outcomes using validated outcome scores following surgical treatment of elbow OCD in adolescents. Purpose: To examine the outcomes of operative treatment of elbow OCD in adolescent athletes and investigate return to sport rate as well as athletic and daily function. Methods: 17 adolescent athletes (average age 14.2 ± 1.5 years) and 18 elbows with OCD treated arthroscopically were retrospectively reviewed. The average duration of symptoms prior to surgery was 15.4 ± 12.5 months and average follow up was 4.4 ± 3.7 years. Data points examined included pre-operative lesion grade/size, range of motion (ROM), and bone age; intra-operative lesion grade/size; and post-operative ROM, Kerlan-Jobe Orthopaedic Clinic (KJOC) Overhead Athlete Shoulder and Elbow score, and Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score. Results: All patients were treated with initial diagnostic arthroscopy. 14/17 patients were definitively treated with arthroscopic debridement and marrow stimulation/microfracture. 3/17 patients required open treatment with two patients amendable to osteochondral fixation and one patient to open marrow stimulation/microfracture. 14/17 athletes returned to their sport post-operatively with 12/17 returning to the same level or higher, and 2/17 returning to a lower level of recreational play. 3/17 athletes did not return to sports but advised that this was by choice not due to their elbow OCD. Overall, there were significant improvements in elbow ROM post-operatively as well as excellent QuickDASH (average 1.9 ± 4.4) and KJOC scores (average 93 ± 8.0) seen amongst all athletes. There was no correlation between pre-operative lesion grade/size, bone age, or open versus arthroscopic treatment with outcome. Conclusion: Operative treatment of elbow OCD in adolescent athletes not only leads to high return to sports rates but also high levels of athletic and daily functional activity long term.

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