scholarly journals HEALTHY PEDIATRIC ATHLETES HAVE SIGNIFICANT BASELINE LIMB ASYMMETRIES ON COMMON RETURN TO SPORT PERFORMANCE TESTS

2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0004
Author(s):  
John Magill ◽  
Heather Myers ◽  
Valentine Esposito ◽  
Michael Messer ◽  
Trevor Lentz ◽  
...  
Keyword(s):  
Healthy Volunteers ◽  
Acl Reconstruction ◽  
Linear Regression Analysis ◽  
Return To Sport ◽  
Sport Performance ◽  
Interquartile Range ◽  
Healthy Children ◽  
Performance Tests ◽  
Limb Asymmetry ◽  
Definition Of

Purpose/Hypothesis: Return to sport (RTS) after anterior cruciate ligament (ACL) reconstruction in children is associated with a much higher risk (˜30%) of subsequent ACL injury than in adults. Most RTS testing protocols use Limb Symmetry Indices (LSI) on physical performance tests (PPTs). This assumes that both lower extremities should be equal. We hypothesized that in the pediatric population, baseline limb asymmetry exists, limiting the clinical utility of LSIs. Since LSI > 90% is often used as a clinical cutoff for RTS, we defined a test as valid if 80% of healthy volunteers had an LSI > 90%. Number of Subjects: 63 Materials/Methods: This study included healthy volunteers ages 6-18 [mean age = 10.7 +/- 3.2 years; 34 females (54%)]. Pubertal Maturity Observation Scores (PMOS), sex, age, height, weight, and body mass index (BMI) were collected. Subjects performed ten PPTs: lower quarter Y-balance, stork balance, stork balance on BOSU, single leg squat (SLS), SLS on BOSU, clockwise and counterclockwise quadrant single leg hop (SLH), forward SLH, timed SLH, and triple crossover SLH. Subjects performed the items in the same order, but were randomly assigned the starting test and the starting limb. We developed a composite score for each limb by averaging trials, then calculated the absolute value of the side-to-side difference, and normalized this difference to the test mean to obtain a percentage side-to-side difference (%STS). Multivariable linear regression analysis was performed to assess the effect of age on limb symmetry while correcting for BMI, PMOS and sex. Results: %STS were not normally distributed for any PPT, therefore data were reported as medians and interquartile ranges. All PPTs showed baseline limb asymmetry, and none met our definition of validity. The most symmetric PPT was the clockwise quadrant hop test (%STS in females, median = 9.85, interquartile range = 4.63 – 18.7; %STS in males, median = 6.9, interquartile range = 3.64 – 14.04). The stork balance on BOSU test had the greatest limb asymmetry (%STS in females, median 41.4, interquartile range 10.1 – 71.3; %STS in males, median 47.6, interquartile range 18.2 – 66.7). PMOS was strongly correlated with age (Pearson’s? = 0.83), and was excluded as a predictor variable. Age was an independent predictor of %STS only for the stork test (B = -1.15, 95% CI = -1.92 to -0.38, p = 0.004), with older subjects having less limb asymmetry. Conclusions: Healthy children have significant baseline limb asymmetries on PPTs that are commonly used for RTS decision making after ACL reconstruction. None of the PPTs evaluated in this study met our definition of clinical validity. Limb symmetry was typically not affected by subject age. Clinical Relevance: In light of these results, limb symmetry indices (LSI) should be utilized with caution in this population. Functional recovery may be better assessed by comparison to age and sex-specific norms. [Figure: see text]

scholarly journals Healthy Pediatric Athletes Have Significant Baseline Limb Asymmetries on Common Return to Sports Performance Tests

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0034
Author(s):  
John Magill ◽  
Trevor Lentz ◽  
Heather Myers ◽  
Jonathan C. Riboh
Keyword(s):  
Body Mass Index ◽  
Acl Reconstruction ◽  
Body Mass ◽  
Linear Regression Analysis ◽  
Interquartile Range ◽  
Return To Sports ◽  
Healthy Children ◽  
Performance Tests ◽  
Limb Asymmetry ◽  
Definition Of

Objectives: Return to sport (RTS) after anterior cruciate ligament (ACL) reconstruction in children is associated with a higher risk (˜30%) of subsequent ACL injury than in adults. Most RTS testing protocols use Limb Symmetry Indices (LSI) on physical performance tests (PPTs) to assess an athlete’s readiness for sport. This assumes that in a healthy state, both lower extremities are and should be equal. We hypothesized that in the pediatric population, baseline limb asymmetry exists, limiting the clinical utility of LSIs. Since LSI > 90% is often used as a clinical cutoff for RTS, we defined a test as valid if 80% of healthy volunteers had an LSI > 90% on that test. Methods: This study included healthy, uninjured volunteers (n = 63) between the ages of 6 and 18 [mean age = 10.7 +/- 3.2 years; 34 females (54%)]. Pubertal Maturity Observation Scores (PMOS) were calculated for all individuals. Demographic data including sex, chronologic age, Pubertal Maturity Observational Score (PMOS), height, weight, and body mass index (BMI) were collected. Subjects performed ten common PPT’s including the lower quarter Y-balance, stork balance, stork balance on BOSU, single leg squat (SLS), SLS on BOSU, clockwise and counterclockwise quadrant single leg hop (SLH), forward SLH, timed SLH, and triple crossover SLH. Subjects performed the 10 PPT’s in the same order (listed above), however we randomly assigned the starting test and the starting limb to avoid practice effects. We conducted two trials on each leg for each test with the exception of the forward SLH, timed SLH, and triple crossover SLH, which were performed in triplicate. For analysis, we developed a composite score for each limb by averaging trials. We then calculated the absolute value of the side-to-side difference, and normalized this difference to the test mean to obtain a percentage side-to-side difference for each test (%STS). Multivariable linear regression analysis was performed to assess the effect of age on limb symmetry while correcting for body mass index (BMI), PMOS and sex. Results: All 63 subjects successfully completed testing. %STS were not normally distributed for any of the PPTs, therefore data were reported as medians and interquartile ranges. All PPTs showed baseline limb asymmetry, and none met our definition of validity (Figure 1). The most symmetric PPT was the clockwise quadrant hop test (%STS in females, median = 9.85, interquartile range = 4.63-18.7; %STS in males, median = 6.9, interquartile range = 3.64-14.04). The stork balance on BOSU test had the greatest limb asymmetry (%STS in females, median 41.4, interquartile range 10.1 - 71.3; %STS in males, median 47.6, interquartile range 18.2-66.7, Figure 2). PMOS was strongly correlated with chronologic age (Pearson’s ⍴ = 0.83), therefore PMOS was excluded as a predictor variable in regression models to avoid multicollinearity. Age was an independent predictor of %STS only for the stork test (β = -1.15, 95% CI = -1.92 to -0.38, p = 0.004), with older subject having less limb asymmetry. Conclusion: Healthy children ages 6 - 18 years have significant baseline limb asymmetries on PPTs that are commonly used for RTS decision making after ACL reconstruction. None of the PPTs evaluated in this study met our definition of clinical validity. Limb symmetry was typically not affected by subject age. In light of these results, limb symmetry indices (LSI) should be utilized with caution in this population. Functional recovery may be better assessed by comparison to age and sex-specific norms. [Figure: see text][Figure: see text]

scholarly journals An Ecological Study of Anterior Cruciate Ligament Reconstruction, Part 2

2017 ◽  
Vol 5 (2) ◽  
pp. 232596711668844 ◽  
Author(s):  
Timothy M. McGrath ◽  
Gordon Waddington ◽  
Jennie M. Scarvell ◽  
Nick Ball ◽  
Rob Creer ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Performance Test ◽  
Functional Performance ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Performance Tests ◽  
Time To Peak ◽  
Step Down ◽  
Anterior Cruciate ◽  
Peak Speed

Background: Additional high-quality prospective studies are needed to better define the objective criteria used in relation to return-to-sport decisions after anterior cruciate ligament (ACL) reconstruction in active populations. Purpose: To investigate prospectively the relationship between functional performance test results at 24 weeks postoperative and return-to-sport activity (Tegner activity score) at 12 and 24 months, respectively, after synthetic (ligament advanced reinforcement system [LARS]) and autograft (doubled semitendinosus/gracilis [2ST/2GR]) ACL reconstructions. Study Design: Case series; Level of evidence, 4. Methods: A total of 64 patients who underwent ACL reconstruction (32 LARS, 32 2ST/2GR autograft; mean age, 27.9 years; body mass index [BMI], 24.9 kg/m2) were assessed preoperatively and at staged intervals postoperatively up to 24 weeks for isokinetic testing of quadriceps and hamstring average power per repetition at 60 deg/s and 180 deg/s, a battery of hop tests, peak vertical ground-reaction force (vGRF), and time to peak vGRF (in seconds) during a step- and jump-down task onto a force platform and peak speed (m/s) using a global positioning system (GPS unit) during a running task. A cohort of 32 healthy matched participants (mean age, 26.31 years; BMI, 25.7 kg/m2) were also tested to act as reference. Pearson correlation was calculated to assess correlation of each performance measure at 24 weeks postoperative with activity outcomes (Tegner score) at 12 and 24 months. Results: The strongest correlation between physical performance tests and return-to-sport outcomes was observed with peak speed during running. Large correlations were also observed for hamstring isokinetic power and hop test for distance. Moderate correlations were observed for timed hop, peak vGRF during a jump-down task, and quadriceps isokinetic power. No statistical correlations were observed for time to peak vGRF during a step-down and jump-down task as well as peak vGRF during a step-down task. When the performance tests were pooled together, mean postoperative improvements of 24% were observed from preoperative to 24 weeks within the surgical cohort. For each performance test, preoperative level of function strongly correlated with performance levels on the same test at 24 weeks. Discussion: The results of this study indicate that clinicians might seek to prioritize these tests and the rehabilitation themes they imply when seeking to maximize postoperative ACL activity outcomes. The observed strength between pre- and postoperative performance tests and return-to-sport outcomes within this study highlights the potential value of preoperative conditioning before undergoing ACL reconstruction. Future research should examine absolute predictive criterion thresholds for functional performance-based tests and reinjury risk reduction after ACL reconstruction.

Factors Associated With a Return to Preinjury Level of Sport Performance After Anterior Cruciate Ligament Reconstruction Surgery

2019 ◽  
Vol 47 (11) ◽  
pp. 2557-2562 ◽  
Author(s):  
Kate E. Webster ◽  
April L. McPherson ◽  
Timothy E. Hewett ◽  
Julian A. Feller
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Sport Participation ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Sport Performance ◽  
Activity Level ◽  
Age Difference ◽  
Reconstruction Surgery ◽  
Anterior Cruciate

Background: Many studies have investigated factors that predict a return to sport participation after anterior cruciate ligament (ACL) reconstruction, but it is unclear whether the same factors are associated with a return to preinjury level of sport performance. Purpose: To identify factors that contribute to an athlete’s return to preinjury level of performance after ACL reconstruction. Study Design: Cohort study; Level of evidence, 2. Methods: A cohort of 222 patients (132 male, 90 female) who had ACL reconstruction surgery and completed a 12-month postoperative assessment were followed out to a mean 3 years (range, 2-4 years) to determine whether they had returned to their self-reported preinjury levels of sport performance. Rates of return to preinjury performance were calculated. Measures that had been recorded at the 12-month postoperative review—demographic (age, sex), sport activity level (Marx Activity Rating Scale, return to competition sport), knee laxity, limb symmetry (single and triple crossover hop), subjective function/symptoms (International Knee Documentation Committee subjective), and psychological readiness (Anterior Cruciate Ligament Return to Sport After Injury scale)—were compared between patients who returned to their preinjury levels of performance and those who did not. Univariate and multivariate logistic regression models were also used to prospectively determine the association between these measures and return to preinjury level of sport performance. Results: A total of 135 (61%) patients reported that they had returned to their preinjury levels of performance, with return rates similar between males (59%) and females (63%) and between those who had returned to competition at 12 months (62%) and those who had not (60%). There was no significant age difference between patients who returned to their preinjury levels of sport performance and those who did not; however, higher psychological readiness ( P < .0001), greater limb symmetry ( P < .05), higher subjective knee scores ( P = .01), and a higher activity level ( P < .04) were all associated with a return to performance. In the multivariate model, psychological readiness was the only variable that remained a significant predictor (odds ratio = 1.03; 95% CI, 1.01-1.04; P < .0001). Conclusion: A majority of athletes who returned to sport after ACL reconstruction reported that their performance was comparable with preinjury. Having a greater psychological readiness to return during rehabilitation was the most significant predictor of a subsequent return to comparable performance.

Predictive Factors for Hamstring Autograft Diameter in Anterior Cruciate Ligament Reconstruction

2019 ◽  
Author(s):  
Willem M.P. Heijboer ◽  
Mathijs A.M. Suijkerbuijk ◽  
Belle L. van Meer ◽  
Eric W.P. Bakker ◽  
Duncan E. Meuffels
Keyword(s):  
Anterior Cruciate Ligament ◽  
Linear Regression ◽  
Multiple Linear Regression ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Linear Regression Analysis ◽  
Multiple Linear Regression Model ◽  
Gracilis Tendon ◽  
Thigh Circumference ◽  
Anterior Cruciate

AbstractMultiple studies found hamstring tendon (HT) autograft diameter to be a risk factor for anterior cruciate ligament (ACL) reconstruction failure. This study aimed to determine which preoperative measurements are associated with HT autograft diameter in ACL reconstruction by directly comparing patient characteristics and cross-sectional area (CSA) measurement of the semitendinosus and gracilis tendon on magnetic resonance imaging (MRI). Fifty-three patients with a primary ACL reconstruction with a four-stranded HT autograft were included in this study. Preoperatively we recorded length, weight, thigh circumference, gender, age, preinjury Tegner activity score, and CSA of the semitendinosus and gracilis tendon on MRI. Total CSA on MRI, weight, height, gender, and thigh circumference were all significantly correlated with HT autograft diameter (p < 0.05). A multiple linear regression model with CSA measurement of the HTs on MRI, weight, and height showed the most explained variance of HT autograft diameter (adjusted R 2 = 44%). A regression equation was derived for an estimation of the expected intraoperative HT autograft diameter: 1.2508 + 0.0400 × total CSA (mm2) + 0.0100 × weight (kg) + 0.0296 × length (cm). The Bland and Altman analysis indicated a 95% limit of agreement of ± 1.14 mm and an error correlation of r = 0.47. Smaller CSA of the semitendinosus and gracilis tendon on MRI, shorter stature, lower weight, smaller thigh circumference, and female gender are associated with a smaller four-stranded HT autograft diameter in ACL reconstruction. Multiple linear regression analysis indicated that the combination of MRI CSA measurement, weight, and height is the strongest predictor.

scholarly journals Limited evidence for return to sport testing after ACL reconstruction in children and adolescents under 16 years: a scoping review

2020 ◽  
Vol 7 (1) ◽  
Author(s):  
Martijn Dietvorst ◽  
Maarten H. Brzoskowski ◽  
Marieke van der Steen ◽  
Eugenie Delvaux ◽  
Rob P. A. Janssen ◽  
...  
Keyword(s):  
Children And Adolescents ◽  
Acl Reconstruction ◽  
Scoping Review ◽  
Return To Sport ◽  
Test Battery ◽  
Ligament Injury ◽  
Future Research ◽  
Movement Quality ◽  
Patient Reported ◽  
Strength Tests

Abstract Specific return to sport criteria for children and adolescents after anterior cruciate ligament injury and reconstruction are unknown. The aim of this scoping review is to provide an overview of current tests regarding return to sport for children and adolescents. This scoping review was performed according to the PRISMA statement. A systematic search was performed on PubMed and EMBASE. The inclusion criteria were diagnostic and prognostic studies evaluating tests regarding return to sport after ACL injury and reconstruction in children/adolescents (age < 18 years). Twenty-six studies were included, of which 22 studies evaluated tests in the age category of 16 to 18 years. All studies evaluated tests after ACL reconstruction, no studies have been conducted in non-operative patients. Strength tests, movement quality and patient reported outcomes measures (PROMs) are investigated most frequently. Clearance for return to sport should be based on a test battery including strength tests, movement quality during sport-specific tasks and (paediatric) patient reported outcome measures. There are no recommendations on which specific tests regarding quantity and quality of movement should be used. Future research should aim at at developing and validating a test battery including movement quality and neuromotor control in a sport-specific context for both younger children and adolescents after both operative and non-operative treatment.

scholarly journals Evaluation of Galectin-3 Plasma Concentration in Adolescents with Ventricular Arrhythmia

2021 ◽  
Vol 18 (5) ◽  
pp. 2410
Author(s):  
Radosław Pietrzak ◽  
Tomasz M. Książczyk ◽  
Elżbieta Górska ◽  
Łukasz A. Małek ◽  
Bożena Werner
Keyword(s):  
Plasma Concentration ◽  
Ventricular Arrhythmia ◽  
Linear Regression Analysis ◽  
Holter Monitoring ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Control Group ◽  
Healthy Children ◽  
Ventricular Ejection Fraction ◽  
Galectin 3

Galectin-3 (G3) is a biomarker known as an inflammatory state exponent. The aim of this paper was to analyze the G3 in adolescents with ventricular arrhythmia (VES) in order to evaluate its impact on myocardial tissue preservation. The study group (SG) consisted of 25 VES adolescents. The control group (CG) was 21 healthy children. G3 was assessed in the SG and CG. In the SG electrocardiography, Holter monitoring, echocardiography and CMR were performed. The G3 in SG was 13.45 ± 11.4 ng/mL and in CG 7.2 ± 2.0 ng/mL, p < 0.001. Moderate positive correlation between the G3 and z-score of the left ventricular diameter (r = 0.47, p = 0.041) and moderate negative correlation between the G3 and the left ventricular ejection fraction in cardiac magnetic resonance (CMR EF) (−0.49, p = 0.032) were found. According to the multiple linear regression analysis, CMR EF and VES were independent predictors for G3 elevation. Conclusion: Galectin-3 plasma concentration is elevated and correlates with the chosen left ventricular dysfunction parameters in adolescents suffering from ventricular arrhythmia. Further investigation is necessary to establish if elevated G3 is a useful biomarker for screening young individuals with ventricular arrhythmia who are at risk of structural cardiovascular pathology.

Timeline for Maximal Subjective Outcome Improvement After Anterior Cruciate Ligament Reconstruction

2018 ◽  
Vol 47 (10) ◽  
pp. 2501-2509 ◽  
Author(s):  
Avinesh Agarwalla ◽  
Richard N. Puzzitiello ◽  
Joseph N. Liu ◽  
Gregory L. Cvetanovich ◽  
Anirudh K. Gowd ◽  
...  
Keyword(s):  
Systematic Review ◽  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Clinical Significance ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Pubmed Database ◽  
Patient Reported ◽  
Clinically Significant ◽  
Anterior Cruciate

Background: Anterior cruciate ligament (ACL) tears are one of the most common traumatic knee injuries experienced by athletes. Return to sport is considered the pinnacle endpoint among patients receiving ACL reconstruction. However, at the time of return to sport, patients may not be participating at their previous levels of function, as defined by clinical metrics. Purpose: To establish when patients perceive maximal subjective medical improvement according to patient-reported outcome measures (PROMs). Study Design: Systematic review. Methods: A systematic review of the PubMed database was conducted to identify studies that reported sequential PROMs up to a minimum of 2 years after ACL reconstruction. Pooled analysis was conducted for PROMs at follow-up points of 3 months, 6 months, 1 year, and 2 years. Clinically significant improvement was determined between pairs of intervals with the minimal clinically important difference. Results: This review contains 30 studies including 2253 patients who underwent ACL reconstruction. Clinically significant improvement in the KOOS (Knee injury and Osteoarthritis Outcome Score) was seen up to 1 year after ACL reconstruction, but no clinical significance was noted from 1 to 2 years. Clinically significant improvement in the IKDC (International Knee Documentation Committee) and Lysholm questionnaires was seen up to 6 months postoperatively, but no clinical significance was noted beyond that. Conclusion: After ACL reconstruction, maximal subjective medical improvement is established 1 year postoperatively, with no further perceived clinical improvement beyond this time point according to current PROMs. The KOOS may be a more responsive metric to subjective improvements in this patient cohort than other patient-reported outcomes, such as the IKDC and Lysholm. Clinical Relevance: After ACL reconstruction, patients perceive interval subjective improvements until 1 year postoperatively.

Low Rates of Return to Preinjury Sport After Bilateral Anterior Cruciate Ligament Reconstruction

2018 ◽  
Vol 47 (2) ◽  
pp. 334-338 ◽  
Author(s):  
Kate E. Webster ◽  
Julian A. Feller ◽  
Alexander J. Kimp ◽  
Timothy S. Whitehead
Keyword(s):  
Quality Of Life ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Rates Of Return ◽  
Acl Injuries ◽  
Reconstruction Surgery ◽  
Anterior Cruciate

Background: Patients with bilateral anterior cruciate ligament (ACL) injuries tend to report worse results in terms of knee function and quality of life as compared with those with unilateral injury. There are limited data regarding return to preinjury sport in this group. Purpose: To report return-to-sport rates for patients who had bilateral ACL reconstruction and to compare outcomes according to age and sex. Study Design: Case series; Level of evidence, 4. Methods: A total of 107 patients (62 male, 45 female) who underwent primary ACL reconstruction surgery to both knees completed a detailed sports activity survey at a mean 5-year follow-up (range, 2.5-10 years). Follow-up also included the International Knee Documentation Committee subjective form, Marx Activity Scale, and Knee injury and Osteoarthritis Outcome Score–Quality of Life subscale. Rates of return to preinjury levels of sport were calculated for the whole cohort, and for further analysis, the group was divided according to age (<25 vs ≥25 years), sex, and time between the reconstruction procedures (<3 vs ≥3 years). Results: The rate of return to preinjury sport after bilateral ACL reconstruction was 40% (95% CI, 31%-50%), as compared with an 83% (95% CI, 74%-88%) return rate after the first reconstruction procedure. Although not statistically significant, return rates were higher for male versus female patients (47% vs 31%) and older versus younger patients (45% vs 31%). Of those who returned to their preinjury levels of sport after the second reconstruction, 72% thought that they could perform as well as before their ACL injuries. In contrast, only 20% thought that they could perform as well if they returned to a lower level. Fear of reinjury was the most common reason cited for failure to return to sport after the second reconstruction. Patient-reported outcome scores were higher for those who returned to their preinjury levels of sport but did not differ for sex and age. Conclusion: Return-to-sport rates drop markedly after a second (contralateral) ACL reconstruction, with less than half of the investigated cohort returning to its preinjury level of sport. Return-to-sport outcomes are less than ideal for patients who have ACL reconstruction surgery to both knees.

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