scholarly journals PATIENTS WHO ATTEND FORMAL PHYSICAL THERAPY FOR THE ENTIRE DURATION OF RECOVERY AFTER ACLR DEMONSTRATE EXCELLENT FUNCTIONAL OUTCOMES

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0016
Author(s):  
Meredith Link ◽  
Elliot Greenberg
Keyword(s):  
Physical Therapy ◽  
Functional Outcomes ◽  
Functional Performance ◽  
Cruciate Ligament ◽  
Current Model ◽  
Insurance Coverage ◽  
Time Frame ◽  
Hop Tests ◽  
Post Surgery ◽  
Entire Duration

Background: Limitations in insurance coverage and higher out-of-pocket expenses create challenges for physical therapists rehabilitating pediatric athletes after anterior cruciate ligament reconstruction (ACLR). While recovery may last 9-12 months, rehabilitation typically lasts <7 months. Unfortunately, research indicates many pediatric athletes have poor functional performance at the time of returning to sports. This may indicate incomplete rehabilitation within our current model of treatment. Understanding how rehabilitation utilization relates to functional outcomes may help optimize physical therapy (PT) treatment for pediatric patients post-ACLR. Purpose: To report the pattern of visit usage and functional outcomes of ACLR patients who were cared for within a large, pediatric specialty care network. Methods: A retrospective study of ACLR patients ≤18 years-old who underwent surgery between December 2016 and August 2019. All subjects must have completed rehabilitation within the sponsoring institutions PT centers and completed a functional hop testing battery, consisting of four single leg hop tests, prior to 10 months post-operative. The frequency of subjects able to achieve ≥90% limb symmetry (LS) on all hop tests was calculated and served as the main outcome of interest. Results: Out of 120 potential subjects, 53 were excluded for missing data, treatment at other facilities or care extending outside the designated time-frame, leaving 67 subjects (mean age 14.6 ± 1.5 SD, 38% female) for analysis. On average, PT began 14 days (range 5-33) post-operatively and subjects attended a mean of 40 visits (range 16-64) throughout 9 months of rehabilitation. The mean (range) number of sessions attended during rehabilitation was as follows: 0-6 weeks: 6 sessions (1-12), 7-12 weeks 10 sessions (2-15), 3 to 6 months 14 sessions (1-25), 6 to 9 months 9 sessions (0-23). Hop testing was completed 8 months post-surgery (range 5-10) with 85% of subjects achieving >90% LS on all tests. Conclusion: Physical therapy at a pediatric specialized center resulted in superior functional performance compared to existing literature. Interestingly, visit frequency was maintained throughout a 9-month period, which is not typical practice. Treatment during this latter phase of rehabilitation, involves advanced plyometric and sports conditioning, which may explain the high level of performance seen. Sampling bias and limitations is sample size, warrant caution in interpreting these results; however this data demonstrates that PT within a specialized setting, encompassing the entire duration of recovery after ACLR, yields excellent functional outcomes. Future investigations, within a larger and diverse sample are necessary to more fully understand these factors.

Evolution of Functional Recovery using Hop Test Assessment after ACL Reconstruction

2020 ◽  
Vol 41 (10) ◽  
pp. 696-704
Author(s):  
Alexandre J.M. Rambaud ◽  
Jérémy Rossi ◽  
Thomas Neri ◽  
Pierre Samozino ◽  
Pascal Edouard
Keyword(s):  
Functional Recovery ◽  
Functional Performance ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Interquartile Range ◽  
Return To Play ◽  
Symmetry Index ◽  
Limb Symmetry Index ◽  
Hop Tests ◽  
Hop Test

AbstractThe purpose of this study was to evaluate improvements in functional performance through the use of the Limb Symmetry Index of Single and Triple Hop tests between 12 and 52 weeks after anterior cruciate ligament reconstruction, and to compare these values with usual time-based and performance-based criteria used during the return to sport continuum. Repeated functional assessments using Single and Triple Hop Tests at 12, 16, 22, 26, 39 and 52 postoperative weeks were evaluated. At each session, the median and interquartile range of Limb Symmetry Index of tests were calculated and compared with the usual criteria: return to participation:≥85%, between 12–16 w; return to play:≥90%, between 26–39 w. The results indicate that the median increased over time to 39 postoperative weeks and then stabilized. For Single Hop Test, wide variability was seen at 12 and 16 weeks (interquartile range=20%); this was lower from 22 to 52 weeks (interquartile range=8–6%). At 12 weeks for Single Hop Test, the median was 83.6% and did not meet>85% criteria for return to participation. Hop tests could be interesting functional tests to follow the functional recovery and help decision-making regarding return to participation and return to play.

Hop Performance After Return to Sport in Anterior Cruciate Ligament-Reconstructed Gaelic Football and Hurling Athletes

2020 ◽  
pp. 1-10
Author(s):  
Damien Murphy ◽  
Quinette A. Louw ◽  
Colum Moloney ◽  
Dominique Leibbrandt ◽  
Amanda M. Clifford
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Functional Performance ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Severe Injuries ◽  
Cross Sectional ◽  
Hop Tests ◽  
Hop Test ◽  
Anterior Cruciate

Purpose: Anterior cruciate ligament (ACL) injuries are among the most severe injuries in the Gaelic Athletic Association. Hop tests measure functional performance after ACL reconstruction as they replicate the key requirements for a match situation. However, research examining functional recovery of ACL-reconstructed Gaelic athletes is lacking. The objective of this study is to determine if athletes restore normal hop symmetry after ACL reconstruction and to examine if bilateral deficiencies persist in hop performance following return to sport. Methods: A cross-sectional design was used to evaluate hop performance of 30 ACL-reconstructed Gaelic athletes who had returned to competition and 30 uninjured controls in a battery of hop tests including a single, 6-m, triple, and triple-crossover hop test. Results: In each test, the mean symmetry score of the ACL reconstruction group was above the cutoff for normal performance of 90% adopted by this study (98%, 99%, 97%, and 99% for the single, 6-m, triple, and triple-crossover hop, respectively). No significant differences in absolute hop scores emerged between involved and control limbs, with the exception of the single-hop test where healthy dominant limbs hopped significantly further than ACL-reconstructed dominant limbs (P = .02). No significant deficits were identified on the noninvolved side. Conclusions: The majority of ACL-reconstructed Gaelic athletes demonstrate normal levels of hop symmetry after returning to competition. Suboptimal hop performance can persist on the involved side compared with control limbs. Targeted rehabilitation may be warranted after returning to competition to restore performance to levels of healthy uninjured athletes.

scholarly journals Functional Outcomes and Hop Tests Results in ACL Reconstruction Patients with Adjustable Loop Fixation: 2 Years Follow-up

2020 ◽  
Vol 8 (5_suppl5) ◽  
pp. 2325967120S0007
Author(s):  
Sholahuddin Rhatomy ◽  
Shinta Primasara ◽  
Nicolaas C. Budhiparama ◽  
Chairul Wahjudi ◽  
Riky Setyawan ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Functional Outcomes ◽  
Cruciate Ligament ◽  
Lysholm Score ◽  
Sports Activity ◽  
Peroneus Longus Tendon ◽  
Peroneus Longus ◽  
Hop Tests ◽  
Anterior Cruciate

Background: Arthroscopic Anterior Cruciate Ligament (ACL) reconstruction is one of the most performed knee surgery, which results in early return to sport and good clinical outcomes. The outcomes are affected by various factors, namely type of grafts, graft fixation methods, tunnel orientations and diameters. If good operative results and intensive pre- and post-operative rehabilitation lead to an optimal outcome, patients can return to the pre-injury level of sports activity in the short term. Objective: Muscle strength and stability of anterior cruciate ligament in reconstructed knees have been bilaterally compared with The Peroneus Longus Tendon grafts at preoperative, 6 month and 2 years following surgery. Methods: Forty-seven patients, 40 men, and 7 women, participated in the study. The outcome measures using IKDC, Cincinnati and Tegner-Lysholm score. Hop tests were evaluated on 6th month after the surgery. Results: Results of preoperative and 2-years postoperative functional outcomes are shown the IKDC score, Tegner-Lysholm score, and Cincinnati score yielded statistically significant differences (p<0.001) between their pre- and postoperative score from 56,3% until 98,0%. The median of the hop tests were 92, 94, 94, and 95, for the single, triple, cross over, and timed tests, respectively Conclusion: In this retrospective study of 47 patients undergoing ACL reconstruction with adjustable loop fixation (GraftMax™ Button, CONMED) on the femoral site and peroneus longus tendon autograft, we found that in 2 years of follow up, the functional outcomes and hop tests were favorable. Good surgery technique and intensive pre- and post-surgery rehabilitation are very important. Six months after surgery patients are allowed to go back to sports activity.

Clinical Implications of Bone Bruise Patterns Accompanying Anterior Cruciate Ligament Tears

2021 ◽  
pp. 194173812110295
Author(s):  
Patrick Ward ◽  
Peter Chang ◽  
Logan Radtke ◽  
Robert H. Brophy
Keyword(s):  
Magnetic Resonance Imaging ◽  
Anterior Cruciate Ligament ◽  
Magnetic Resonance ◽  
Functional Outcomes ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Bone Bruise ◽  
Resonance Imaging ◽  
Bone Bruises ◽  
Anterior Cruciate

Background: Anterior cruciate ligament (ACL) tears are common injuries; they are often associated with concomitant injuries to other structures in the knee, including bone bruises. While there is limited evidence that bone bruises are associated with slightly worse clinical outcomes, the implications of bone bruises for the articular cartilage and the risk of developing osteoarthritis (OA) in the knee are less clear. Recent studies suggest that the bone bruise pattern may be helpful in predicting the presence of meniscal ramp lesions. Evidence Acquisition: A literature review was performed in EMBASE using the keyword search phrase (acl OR (anterior AND cruciate AND ligament)) AND ((bone AND bruise) OR (bone AND contusion) OR (bone AND marrow AND edema) OR (bone AND marrow AND lesion) OR (subchondral AND edema)). Study Design: Clinical review. Level of Evidence: Level 4. Results: The literature search returned 93 articles of which 25 were ultimately included in this review. Most studies identified a high prevalence of bone bruises in the setting of acute ACL injury. Individual studies have found relationships between bone bruise volume and functional outcomes; however, these results were not supported by systematic review. Similarly, the literature has contradictory findings on the relationship between bone bruises and the progression of OA after ACL reconstruction. Investigations into concomitant injury found anterolateral ligament and meniscal ramp lesions to be associated with bone bruise presence on magnetic resonance imaging. Conclusion: Despite the ample literature identifying the prevalence of bone bruises in association with ACL injury, there is little evidence to correlate bone bruises to functional outcomes or progression of OA. Bone bruises may best be used as a marker for concomitant injury such as medial meniscal ramp lesions that are not always well visualized on magnetic resonance imaging. Further research is required to establish the longitudinal effects of bone bruises on ACL tear recovery. Strength of Recommendation Taxonomy: 2.

scholarly journals Evaluation of Deep Vein Thrombosis Risk Factors After Arthroscopic Posterior Cruciate Ligament Reconstruction: A Retrospective Observational Study

2021 ◽  
Vol 27 ◽  
pp. 107602962110305
Author(s):  
Pu Ying ◽  
Wenge Ding ◽  
Xiaowei Jiang ◽  
Yue Xu ◽  
Yi Xue ◽  
...  
Keyword(s):  
Risk Factors ◽  
Posterior Cruciate Ligament ◽  
Color Doppler ◽  
Cruciate Ligament ◽  
Color Doppler Ultrasound ◽  
Pcl Reconstruction ◽  
Vein Thrombosis ◽  
Post Surgery ◽  
Pcl Injury ◽  
D Dimer

We evaluated the risk factors of deep venous thrombosis (DVT) after knee arthroscopic posterior cruciate ligament (PCL) reconstruction in patients with only PCL injury. From August 2014 to December 2020, a total of 172 patients who had accepted knee arthroscopic PCL reconstruction underwent the color Doppler ultrasound of bilateral lower-extremities deep veins on 3 days postoperatively. Based on the inspection results, patients were divided into DVT group (18 males and 8 females, mean age 43.62 years) and non-DVT group (108 males and 38 females, mean age 33.96 years). The potential associations of DVT risk and age, gender, body mass index (BMI), diabetes, hypertension, smoking and other factors were analyzed. An old age (OR = 1.090; 95% CI = 1.025-1.158; P = 0.006), a high BMI (OR = 1.509; 95% CI = 1.181-1.929; P = 0.001) and an increased post-surgery D-dimer (OR = 5.034; 95% CI = 2.091-12,117; P ≤ 0.001) value were significantly associated with an elevated DVT risk after knee arthroscopic PCL reconstruction. Increased age, BMI, and postoperative D-dimer were risk factors of DVT following knee arthroscopic PCL reconstruction in patients with only PCL injury.

scholarly journals Hop Testing Provides a Reliable and Valid Outcome Measure During Rehabilitation After Anterior Cruciate Ligament Reconstruction

2007 ◽  
Vol 87 (3) ◽  
pp. 337-349 ◽  
Author(s):  
Andrea Reid ◽  
Trevor B Birmingham ◽  
Paul W Stratford ◽  
Greg K Alcock ◽  
J Robert Giffin
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Outcome Measure ◽  
Cruciate Ligament ◽  
Measurement Properties ◽  
Global Rating ◽  
Symmetry Index ◽  
Limb Symmetry Index ◽  
Hop Tests ◽  
Anterior Cruciate

Background and Purpose Although various hop tests have been proposed as performance-based outcome measures following anterior cruciate ligament (ACL) reconstruction, limited reports of their measurement properties exist. The purpose of this study was to investigate the reliability and longitudinal validity of data obtained from hop tests during rehabilitation after ACL reconstruction. Subjects Forty-two patients, 15 to 45 years of age, who had undergone ACL reconstruction participated in the study. Methods and Measures The study design was prospective and observational with repeated measures. The subjects performed a series of 4 hop tests on 3 separate occasions within the 16th week following surgery and on a fourth occasion 6 weeks later. The tests were a single hop for distance, a 6-m timed hop, a triple hop for distance, and crossover hops for distance. Performance on the ACL-reconstructed limb was expressed as a percentage of the performance on the nonoperative limb, termed the “limb symmetry index.” Subjects also completed the Lower Extremity Functional Scale and a global rating of change questionnaire. Results Intraclass correlation coefficients for limb symmetry index values ranged from .82 to .93. Standard errors of measurement were 3.04% to 5.59%. Minimal detectable changes, at the 90% confidence level, were 7.05% to 12.96%. Changes in hop test scores on the operative limb were statistically greater than changes on the nonoperative limb. Pearson correlations (r) between change in hop performances and self-reported measures ranged from .26 to .58. Discussion and Conclusion The results show that the described series of hop tests provide a reliable and valid performance-based outcome measure for patients undergoing rehabilitation following ACL reconstruction. These findings support the use and facilitate the interpretation of hop tests for research and clinical practice.

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