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

2021 ◽  
Vol 9 (1) ◽  
pp. 232596712098230
Author(s):  
John R. Magill ◽  
Heather S. Myers ◽  
Trevor A. Lentz ◽  
Laura S. Pietrosimone ◽  
Thomas Risoli ◽  
...  
Keyword(s):  
Physical Performance ◽  
Pediatric Population ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Cross Sectional Study ◽  
Performance Tests ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Anterior Cruciate ◽  
The Relationship

Background: 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 a limb symmetry index (LSI) ≥90% on physical performance tests (PPTs) to assess an athlete’s readiness for sport. This assumes that, in a healthy state, the physical performances across both lower extremities are and should be equal. Purpose: To determine the prevalence of limb asymmetries >10% in the uninjured pediatric population on common PPTs as well as to explore the relationship between athlete variables, limb preference, and LSI values. Study Design: Cross-sectional study; Level of evidence, 3. Methods: This study included healthy volunteers (N = 100) evenly distributed between the ages of 6 and 18 years (mean age, 11.7 ± 3.6 years; 52% female). Participants performed 9 common PPTs. For analysis, we developed a composite score for each limb by averaging trials. We then calculated the LSI for each test. Univariable and multivariable linear regression analyses were performed to assess the relationship between athlete variables (age, sex, height, and weight) and LSI for each PPT. Results: Instances of poor baseline limb symmetry (<90% LSI) were common across all PPTs. The single-leg timed hop had the highest percentage of participants, with LSI ≥90% at 73%, while the stork on a Bosu ball had the lowest percentage at 23%. After adjusting for age, female sex showed a significant association with LSI for the stork test ( P = .010) and the quadrant hop–counterclockwise ( P = .021). Additionally, after adjusting for sex, increasing age showed a significant association with LSI for the stork test ( P < .001), single-leg squat on a Bosu ball ( P = .010), quadrant hop–clockwise ( P = .016), and quadrant hop–counterclockwise ( P = .009). Conclusion: The majority of healthy athletes 18 years and younger demonstrated significant (<90%) limb asymmetries. Limb symmetry was not consistently affected by participant age or sex, and the effect sizes of these relationships were small. These findings should encourage clinicians and coaches to exercise caution in using the LSI as an isolated measure of RTS readiness after injury in pediatric athletes.

No Relationship Between Strength and Power Scores and Anterior Cruciate Ligament Return to Sport After Injury Scale 9 Months After Anterior Cruciate Ligament Reconstruction

2019 ◽  
Vol 48 (1) ◽  
pp. 78-84 ◽  
Author(s):  
Richard F. O’Connor ◽  
Enda King ◽  
Chris Richter ◽  
Kate E. Webster ◽  
Éanna Cian Falvey
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Effect Size ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Level Of Evidence ◽  
Cruciate Ligament Reconstruction ◽  
Anterior Cruciate ◽  
The Relationship

Background: Psychological factors including self-reported readiness to return to sport (RTS) after anterior cruciate ligament reconstruction (ACLR) measured with the Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) scale have been shown to correlate with RTS. Physical deficits have been shown to exist in the later stages after ACLR rehabilitation. No previous studies have investigated the relationship between self-reported readiness to RTS and objective physical measures of power and strength. Purpose: To investigate the relationship between ACL-RSI scores and measures of strength and power scores after ACLR. Study Design: Case control study; Level of evidence, 3. Methods: This study recruited 452 male athletes who had undergone primary ACLR. Each athlete completed the ACL-RSI questionnaire, isokinetic strength testing, and jump testing approximately 9 months after surgery. Results: ACL-RSI scores showed a trivial or weak correlation with strength and power measures at 9 months after surgery ( r = 0.06-0.16). Similar results were found for the relationship between ACL-RSI scores and limb symmetry index for strength and power measures ( r = 0.04-0.15). Comparing the strength and power measures of athletes with higher (≥90) ACL-RSI scores (n = 93) versus athletes with lower (≤75) ACL-RSI scores (n = 92) showed no significant differences except for isokinetic hamstring strength, but with a trivial effect size ( P = .040; effect size = 0.15). Conclusion: Self-reported readiness to RTS as measured by the ACL-RSI had little or no relationship with athletes’ strength and power measures, and there was no meaningful difference in strength and power between athletes with higher and lower ACL-RSI scores at 9 months after ACLR. The findings suggest that psychological recovery and physical recovery after ACLR are different constructs, and strategies to measure and address each construct separately may be necessary to ensure successful RTS after ACLR.

Psychological Readiness to Return to Sport Is Associated With Second Anterior Cruciate Ligament Injuries

2019 ◽  
Vol 47 (4) ◽  
pp. 857-862 ◽  
Author(s):  
April L. McPherson ◽  
Julian A. Feller ◽  
Timothy E. Hewett ◽  
Kate E. Webster
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Characteristic Curve ◽  
Return To Sport ◽  
Acl Injury ◽  
Short Version ◽  
Cutoff Score ◽  
Level Of Evidence ◽  
Younger Patients ◽  
Anterior Cruciate

Background: Psychological responses after anterior cruciate ligament (ACL) injury and ACL reconstruction (ACLR) have been identified as predictors of return to sport but have not been investigated in relation to further injury. Purpose/Hypothesis: To determine whether psychological readiness to return to sport is associated with second ACL injury. It was hypothesized a priori that at both preoperative and 12-month postoperative time points, patients who sustained a second ACL injury would have lower psychological readiness than patients who did not have a second injury. Study Design: Cohort study; Level of evidence, 2. Methods: Patients who had a primary ACLR procedure between June 2014 and June 2016 completed the ACL–Return to Sport after Injury (ACL-RSI) (short version) scale before their ACLR and repeated the scale at 12 months after surgery to assess psychological readiness to return to sport. Patients were followed for a minimum of 2 years (range, 2-4 years) after surgery to determine further injury. The primary outcome was the relationship between ACL-RSI scores and the incidence of second ACL injury. Results: In 329 patients who returned to sport after ACLR, 52 (16%) sustained a second ACL injury. No difference in psychological readiness was observed at the preoperative time point, but patients who sustained a second injury trended toward lower psychological readiness at 12 months compared with noninjured patients (60.9 vs 67.2 points; P = .11). Younger (≤20 years) patients with injury had significantly lower psychological readiness to return to sport than young noninjured patients (60.8 vs 71.5 points; P = .02), but no difference was found in older patients (60.9 vs 64.6 points; P = .58). In younger patients, receiver operating characteristic curve analysis revealed a cutoff score of 76.7 points with 90% sensitivity to identify younger patients who sustained a second ACL injury. Conclusion: Younger patients with lower psychological readiness are at higher risk for a second ACL injury after return to sport.

scholarly journals Reporting Skill: The Missing Ingredient in Concussion Reporting Intention Assessment

2019 ◽  
Vol 11 (5) ◽  
pp. 416-424 ◽  
Author(s):  
Dee Warmath ◽  
Andrew P. Winterstein
Keyword(s):  
Structural Equation ◽  
Age Groups ◽  
Cross Sectional Study ◽  
Equation Modeling ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Confirmatory Factor Analyses ◽  
Concussion Knowledge ◽  
The Relationship ◽  
Reporting Intentions

Background: Extant literature suggests that a substantial portion of athletes may not report a possible concussion and that concussion knowledge is insufficient to predict concussion reporting behavior. One area that has not been explored is reporting skill; that is, mastery of the actions required to report a concussion. This study evaluated the relationship between reporting skill and reporting intention, introducing a measure of the reporting skill construct. Hypotheses: Reporting intentions will be more closely associated with reporting skill than with concussion/symptom knowledge. The relationship between concussion (or symptom) knowledge and reporting intentions will differ by level of reporting skill. Study Design: Repeated cross-sectional study. Level of Evidence: Level 2. Methods: A set of items was administered to young adults aged 18 to 24 years from the Survey Sampling International panel. Exploratory/confirmatory factor analyses were conducted on 2 waves of data to develop the scale (n = 899). Hypotheses were tested using structural equation modeling on the responses from the third wave of participants (n = 406). Results: Knowing the actions to take in reporting was more important than having knowledge of concussions or concussion symptoms. Reporting skill, not concussion or concussion symptom knowledge, was associated with higher intentions to report symptoms. Among those with higher levels of reporting skill, concussion symptom knowledge (but not general concussion knowledge) was associated with higher intentions to report symptoms. Conclusion: Reporting skill is an important and, until now, missing ingredient in the concussion literature and practice. Clinical Relevance: Incorporating reporting skill development in concussion education and team activities to teach athletes how to report is likely to improve actual reporting intentions. While further study is needed with particular sports and additional age groups, reporting skill holds promise as a new avenue for increased concussion reporting.

scholarly journals Combined Intra- and Extra-Articular Technique in Revision Anterior Cruciate Ligament Reconstruction

Joints ◽  
2017 ◽  
Vol 05 (03) ◽  
pp. 156-163 ◽  
Author(s):  
Jessica Zanovello ◽  
Federica Rosso ◽  
Alessandro Bistolfi ◽  
Roberto Rossi ◽  
Filippo Castoldi
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Case Series ◽  
Return To Sport ◽  
Surgical Removal ◽  
Level Of Evidence ◽  
Anterior Cruciate ◽  
Over The Top

Purpose The aim of the study was to evaluate the “over the top” (OTT) nonanatomical technique for revision of anterior cruciate ligament (ACL) reconstruction. Methods Twenty-four patients with a mean age of 31.9 ± 11.2 years underwent revision of ACL reconstruction using OTT technique. International Knee Documentation Committee (IKDC) score, Knee Injury and Osteoarthritis Outcome Score (KOOS), Lysholm score, Tegner score, Subjective Patient Outcome for Return to Sport (SPORTS) score, Anterior Cruciate Ligament-Return to Sport After Injury (ACL-RSI) scale, and KT-1000 evaluation were recorded at a mean follow-up of 30.7 ± 18.9 months. Results Postoperatively, the IKDC objective total score significantly improved (p = 0.0046). The KOOS, Lysholm, and Tegner scores also improved, but the results were not statistically significant (62.4 vs. 72.6, 6.5 vs. 75.8, and 4.1 vs. 6.0, respectively). The subjective IKDC evaluation score improved from an average of 51.1 points to 63.7 points at the last follow-up (p = 0.0027). The RTP prevalence was 81.8%, with 44.4% of the patients returning to the same preinjury level. According to the SPORTS score, 16.6% of patients played sport without limitations in activity and performance. The average ACL-RSI score was 52.1 ± 27.0. No major complications were reported. A total of 21.5% of patients underwent surgical removal of staples. The failure prevalence was 14.3% and the cumulative survivorship, calculated using the Kaplan–Meier method, was equal to 70% at 60 months of follow-up. Conclusion The OTT technique in the revision ACL reconstruction provided improvement in objective and subjective scores, good RTP prevalence, and acceptable rate of complication and failure. One of the advantages was the possibility to avoid the femoral tunnel. Level of Evidence Level IV, therapeutic case series.

Rate of Force Development Remains Reduced in the Knee Flexors 3 to 9 Months After Anterior Cruciate Ligament Reconstruction Using Medial Hamstring Autografts: A Cross-Sectional Study

2020 ◽  
Vol 48 (13) ◽  
pp. 3214-3223
Author(s):  
Jakob Lindberg Nielsen ◽  
Kamilla Arp ◽  
Mette Lysemose Villadsen ◽  
Stine Sommer Christensen ◽  
Per Aagaard
Keyword(s):  
Functional Capacity ◽  
Cruciate Ligament ◽  
Knee Extensor ◽  
Cross Sectional Study ◽  
Healthy Controls ◽  
Sectional Study ◽  
Cross Sectional ◽  
Force Development ◽  
Anterior Cruciate ◽  
Maximal Muscle Strength

Background: Anterior cruciate ligament (ACL) rupture is a serious injury with a high prevalence worldwide, and subsequent ACL reconstructions (ACLR) appear to be most commonly performed using hamstring-derived (semitendinosus tendon) autografts. Recovery of maximal muscle strength to ≥90% of the healthy contralateral limb is considered an important criterion for safe return to sports. However, the speed of developing muscular force (ie, the rate of force development [RFD]) is also important for the performance of many types of activities in sports and daily living, yet RFD of the knee extensor and flexor muscles has apparently never been examined in patients who undergo ACLR with hamstring autograft (HA). Purpose: To examine potential deficits in RFD, maximal muscle strength (ie, maximal voluntary isometric contraction [MVIC]), and functional capacity of ACLR-HA limbs in comparison with the healthy contralateral leg and matched healthy controls 3 to 9 months after surgery. Study Design: Cross-sectional study; Level of evidence: 3. Methods: A total of 23 young patients who had undergone ACLR-HA 3 to 9 months earlier were matched by age to 14 healthy controls; both groups underwent neuromuscular screening. Knee extensor and flexor MVIC and RFD, as well as functional capacity (single-leg hop for distance [SLHD] test, timed single-leg sit-to-stand [STS] test), were assessed on both limbs. Furthermore, patient-reported knee function (Knee injury and Osteoarthritis Outcome Score) was assessed. Results: Knee extensor and flexor MVIC and RFD were markedly compromised in ACLR-HA limbs compared with healthy contralateral limbs (MVIC for extensor and flexor, 13% and 26%, respectively; RFD, 14%-17% and 32%-39%) and controls (MVIC, 16% and 31%; RFD, 14%-19% and 30%-41%) ( P < .05-.001). Further, ACLR-HA limbs showed reduced functional capacity (reduced SLHD and STS performance) compared with contralateral limbs (SLHD, 11%; STS, 14%) and controls (SLHD, 20%; STS, 31%) ( P < .01-.001). Strength (MVIC) and functional (SLHD) parameters were positively related to the duration of time after surgery ( P < .05), although this relationship was not observed for RFD and STS. Conclusion: Knee extensor and flexor RFD and maximal strength, as well as functional single-leg performance, remained substantially reduced in ACLR-HA limbs compared with noninjured contralateral limbs and healthy controls 3 to 9 months after reconstructive surgery.

scholarly journals EVALUATION OF THE UTILITY OF THE ANTERIOR CRUCIATE LIGAMENT RETURN TO SPORT AFTER INJURY (ACL-RSI) SCALE WITHIN PEDIATRIC ATHLETES

2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0003
Author(s):  
Elliot Greenberg ◽  
Miranda Dabbous ◽  
Anne Leung ◽  
Gabriella Marinaccio ◽  
Benjamin Ruley ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Pediatric Population ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
The United States ◽  
Return To Play ◽  
Return To Sports ◽  
Youth Athletes ◽  
The Mean ◽  
Anterior Cruciate

Background: The incidence of anterior cruciate ligament (ACL) injury and surgical reconstruction in youth athletes is increasing. In the United States, most athletes elect to undergo ACL reconstruction (ACLR), with the goal of returning to their previous level of athletic performance. Although surgery and rehabilitation address the underlying impairments in knee stability and function, recent literature indicates psychological or emotional factors, such as fear or confidence, may be contributing factors limiting successful return to play. The Anterior Cruciate Ligament Return to Sport after Injury (ACL-RSI) is a 12-item scale designed to assess an athlete’s psychological readiness to return to sports across three separate domains (emotions, confidence in performance and risk appraisal). In adults, the ACL-RSI is reliable and valid, and several studies have documented that athletes with higher scores are more likely to successfully return to their pre-injury level of sports participation. The predictive abilities of this scale, have led many experts to advocate for the ACL-RSI to be used as part of rehabilitation guidelines, in order to identify those athletes that may benefit from a modified course of post-operative rehabilitation or additional emotional or psychological support. Although the information from the ACL-RSI is valuable in adults, the utility of this scale has never been explored within the pediatric population. Thus, the purpose of this study is to evaluate the utility of the ACL-RSI within the pediatric population and establish normative values among healthy children. Hypothesis: As all of these subjects were currently healthy, we hypothesized that mean scores should demonstrate a positive skew towards higher levels of confidence (ceiling effect) with values of 80-100 on each question. Methods: A group of 84 healthy, youth athletes between the ages of 8-14, completed the ACL-RSI. All subjects were currently involved in competitive sports at the time of participation. The athletes were instructed to complete the 12-item ACL-RSI questionnaire and were able to seek assistance from parents as necessary. Each item is scored on a scale ranging from 0-100 and a total score is calculated from summing all responses and expressing them a percentage of 100%. Higher scores indicate a greater degree of athletic confidence or more positive psychological response to injury. Mean and variability measures for each question and total score were calculated and compared to existing literature. Results: A total of 83 subjects (mean age 11.1 ± 1.2) completed the questionnaire in full. There were slightly more females (n=46, 54.8%) than males. The majority of participants were White (70%), African American (13%) or more than one race (10%). The most frequent primary sport was soccer (38%), followed by baseball (27%) and basketball (26%). The mean ACL-RSI score for the entire sample was 79.9 (SD 14.1). Individual question analysis revealed lower than expected mean scores (<80%) with large standard deviations for 7 out of 12 questions. (Table 1) With the exception of only question #1 and #12, responses demonstrated such large variability that both the maximum and minimum (0-100) scores were selected, indicating both ceiling and floor effects. (Table 1) Conclusions/Significance: The mean ACL-RSI score (79.9) within this group of uninjured pediatric athletes was similar to previous values for post-ACLR adults that successfully return to sports. However, it was surprising that the mean score wasn’t higher, as this was a healthy population of un-injured youth athletes, and we hypothesized that our data would demonstrate a positive skew towards the upper range of this scale. Response ranges including 0 (indicating either high fear or severe lack of confidence) within nearly all questions was unexpected. Additionally, there were particularly low mean scores and high variability within 7 of the 12 questions. All of these factors raise the suspicion that children may not fully comprehend the material or have difficulty interpreting the response system of the ACL-RSI and thus calls into question the validity of this scale in youth athletes. Similar to other research efforts that have modified adult outcome scales to be utilized within the pediatric population, our results support further exploration of the utility of the ACL-RSI within pediatric athletes and may possibly suggest that a pediatric specific version should be created. [Table: see text]

Effect of Subcutaneous Tissue on Changes in Thigh Circumference Following Anterior Cruciate Ligament Reconstruction

2019 ◽  
Vol 40 (08) ◽  
pp. 544-550
Author(s):  
Ryo Yoshii ◽  
Yu Konishi ◽  
Daisuke Ando ◽  
Satoshi Ochiai ◽  
Tetsuo Hagino ◽  
...  
Keyword(s):  
Subcutaneous Tissue ◽  
Cruciate Ligament ◽  
Subcutaneous Fat ◽  
Quadriceps Muscle ◽  
Thigh Circumference ◽  
Cross Sectional ◽  
Short Period ◽  
Anterior Cruciate ◽  
Muscle Cross Sectional Area ◽  
The Relationship

AbstractCircumference measurements have been used to estimate muscle cross-sectional area (CSA) in clinical settings. Measurements of thigh circumference are affected by muscle and subcutaneous fat (SF). In fact, SF could increase over a short period. Therefore, clarifying the relationship between thigh circumference and muscle and SF following ACL reconstruction is important. This study’s primary purpose was to examine pre- and post-operative changes in thigh circumference, thigh muscles and SF CSAs in both legs. Secondary, the relationship between thigh circumference and muscle and SF CSAs was examined to demonstrate that circumference measurements could be used to detect atrophy. Quadriceps, hamstrings, and SF CSAs at 15, 10, and 5 cm proximal to the patella were measured by MRI pre- and 4 weeks postoperatively to examine how reconstruction affected those tissues in the thighs. The results showed increases in SF CSA (r=0.72 at 10 cm, r=0.67 at 15 cm) greatly affected thigh circumference in females on the surgical side. In males, increases in SF CSA (r=0.83) at 15- and 5-cm and decreases in quadriceps muscle CSA (r=0.73) at 5 cm affected thigh circumference on the surgical side. Thigh circumference measurements might not reflect actual muscle CSA in ACL patients.

scholarly journals Trends in treatment of anterior cruciate ligament injuries of the knee in the public and private healthcare systems of Brazil

2013 ◽  
Vol 131 (4) ◽  
pp. 257-263 ◽  
Author(s):  
Diego Costa Astur ◽  
Rodrigo Ferreira Batista ◽  
Gustavo Goncalves Arliani ◽  
Moises Cohen
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Treatment Options ◽  
Cross Sectional Study ◽  
Medical Decision ◽  
Cross Sectional ◽  
Public And Private ◽  
The Public ◽  
Private Healthcare ◽  
Anterior Cruciate

CONTEXT AND OBJECTIVE Orthopedic surgery implies high costs for both public and private healthcare. The aim of this study was to better understand the differences between the public and private sectors regarding treatment of a damaged anterior cruciate ligament, which is a common knee injury. DESIGN AND SETTING Descriptive cross-sectional study conducted during the Brazilian Orthopedics Congress in Brasília. METHODS We applied questionnaires during the 2010 Brazilian Orthopedics Congress, with participation by 241 knee surgeons from 24 Brazilian states. This was followed by statistical analysis on the data that were obtained. RESULTS The orthopedic surgeons who were evaluated used different approaches and treatment options in different Brazilian states, comparing between the public and private systems. CONCLUSION Both in the public and in the private systems in Brazil, because of non-medical issues surrounding the treatment, the best medical decision is not always made. This may be harmful both to patients and to physicians.

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