scholarly journals Outcomes Following Arthroscopy for Anterior Impingement in the Ankle Joint: Need for Gender as a Variable in Analysis

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0022
Author(s):  
Arianna L. Gianakos ◽  
Axel Ivander ◽  
Christopher W. DiGiovanni ◽  
John G. Kennedy
Keyword(s):  
Systematic Review ◽  
Gender Differences ◽  
Functional Outcome ◽  
Demographic Variable ◽  
Demographic Data ◽  
Return To Sport ◽  
Return To Play ◽  
Complication Rates ◽  
Ankle Impingement ◽  
Anterior Ankle Impingement

Category: Ankle; Arthroscopy Introduction/Purpose: To provide an overview of the clinical outcomes of arthroscopic procedures used as a treatment strategy for anterior ankle impingement and to determine if gender affects outcome. Methods: A systematic literature search of the Medline, Embase, and Cochrane databases was performed during June of 2019. The combination of search terms utilized included the following: ankle, impingement, syndrome, talus, compression, osteophyte, arthroscopy, surgery, procedures, and treatment. Two reviewers independently performed data extraction consisting of demographic data, intraoperative arthroscopic data, functional outcome scores, patient satisfaction, complications, return to play, and gender differences. Results: Twenty-eight articles evaluating 1,506 patients were included in this systematic review [Table 1]. Sixty percent and 14% of studies assessed anterolateral and anteromedial impingement, respectively. All studies (16/16, 100%) that evaluated functional outcome reported improvements in AOFAS, VAS, and FFI Scores [Table 2]. The average complication rate was 3.89% [Table 3]. Average return to sport was 8 months. The most common associated pathologies found during arthroscopic evaluation were synovitis, osteophytes, and meniscoid lesions. Four studies (15%) failed to report gender as a demographic variable. Only 5 (17%) studies reported gender analysis, with one demonstrating that male patients had worse outcomes at 6-year follow-up. Conclusion: Our systematic review suggests that arthroscopic treatment for anterior ankle impingement provides good to excellent functional outcomes and low complication rates in the majority of patients. However, current analyses lack outcome evaluations that compare male and female populations. Future studies should perform such assessments to determine whether gender differences play a role in outcomes following arthroscopic intervention. [Table: see text][Table: see text][Table: see text]

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 Return to Sport After Proximal Hamstring Tendon Repair: A Systematic Review

2019 ◽  
Vol 7 (6) ◽  
pp. 232596711985321 ◽  
Author(s):  
John W. Belk ◽  
Matthew J. Kraeutler ◽  
Omer Mei-Dan ◽  
Darby A. Houck ◽  
Eric C. McCarty ◽  
...  
Keyword(s):  
Systematic Review ◽  
Surgical Intervention ◽  
Return To Sport ◽  
Hamstring Tendon ◽  
Activity Level ◽  
Return To Play ◽  
Rate Of Return ◽  
Cochrane Library ◽  
Level Of Evidence ◽  
Proximal Hamstring

Background: Previous studies have evaluated functional outcomes and return-to-sport rates after proximal hamstring tendon (HT) repair. Purpose: To systematically review the literature in an effort to evaluate return-to-sport rates after proximal HT repair. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was performed by searching PubMed, the Cochrane Library, and Embase to identify studies that evaluated postoperative lower extremity function and return-to-sport rates in patients after proximal HT repair. Search terms used were “hamstring,” “repair,” “return to sport,” and “return to play.” Patients were assessed based on return to sport, return to preinjury activity level, type of HT tear (complete or partial), and interval from injury to surgery. Patients were also divided into subgroups depending on timing of the surgical intervention: early, <1 month; delayed, 1 to 6 months; and late, >6 months from the time of injury. Results: Sixteen studies (one level 2, five level 3, ten level 4) met the inclusion criteria, including 374 patients with a complete proximal HT tear (CT group) and 93 patients with a partial proximal HT tear (PT group), with a mean follow-up of 2.9 years. Overall, 93.8% of patients (438/467) returned to sport, including 93.0% (348/374) in the CT group and 96.8% (90/93) in the PT group ( P = .18). The mean time to return to sport was 5.7 months, and 83.5% of patients (330/395) returned to their preinjury activity level. The early group demonstrated the greatest rate of return to sport at 94.4% (186/197) as well as the quickest time to return at a mean of 4.8 months, although this was not found to be statistically significant. Conclusion: Over 90% of patients undergoing repair of a complete or partial proximal HT tear can be expected to return to sport regardless of the tear type. Early surgical interventions of these injuries may be associated with a quicker return to sport, although the rate of return to sport does not differ based on timing of the surgical intervention.

scholarly journals Weightbearing Protocols After Posterolateral Corner Reconstruction: A Systematic Review

2021 ◽  
Vol 9 (3) ◽  
pp. 232596712098827
Author(s):  
Brandon L. Morris ◽  
Tanner Poppe ◽  
Kenneth Kim ◽  
Brandon Barnds ◽  
Paul Schroeppel ◽  
...  
Keyword(s):  
Systematic Review ◽  
Knee Injuries ◽  
Return To Sport ◽  
Posterolateral Corner ◽  
Complication Rates ◽  
Knee Reconstruction ◽  
Rehabilitation Programs ◽  
Significant Difference ◽  
Outcome Scores ◽  
Posterolateral Corner Injury

Background: Multiligamentous knee injuries with a posterolateral corner injury represent a devastating insult to the knee. Purpose: To evaluate multiligamentous knee reconstruction rehabilitation programs and recommend a rehabilitation program based on a review of published outcomes studies. Study Design: Systematic review; Level of evidence, 4. Methods: A MEDLINE (PubMed), OVID, and Embase database search was conducted using the terms “posterolateral corner” and “rehabilitation.” All articles obtained were examined to confirm their rehabilitation programs for multiligamentous knee injuries. These injuries included a posterolateral corner injury plus an isolated anterior or posterior cruciate ligament injury or a combined cruciate injury. Results: Ten publications representing 245 patients with multiligamentous knee reconstruction were analyzed. Rehabilitation protocols were divided by weightbearing (WB) status: in 2 studies, patients were non-WB until postoperative 4 weeks (delayed WB; n = 61); 5 studies permitted progressive WB until postoperative 6 weeks (progressive WB; n = 123); and 3 studies allowed WB immediately after surgery (immediate WB; n = 61). No significant difference in outcome scores among the 3 WB groups was found. Arthrofibrosis requiring manipulation under anesthesia was the most common complication (11%) in the delayed WB group, followed by the immediate WB group (3%) and the progressive WB group (0%; P < .01). Overall complication rates were highest in the delayed WB group (44%), followed by the immediate and progressive WB groups (25% and 3%, respectively; P < .00001). The delayed WB group was permitted to return to sport at a mean of 10.5 months from the index procedure; the progressive WB group, at 6.0 months; and the immediate WB group, at 9.0 months ( P < .05). Conclusion: This review revealed no significant difference in outcome scores when comparing immediate, progressive, and delayed WB protocols. Time to permitted return to sport was not significantly different among the groups, but there existed a trend toward earlier return in the progressive WB group. Patients in the delayed and immediate WB groups experienced a higher overall complication rate. Progressive WB postoperative protocols may decrease the risk of complications without compromising outcomes; however, more research is needed to identify the optimal postoperative rehabilitation protocol, given the significant data heterogeneity currently available in the literature.

scholarly journals Return to Play After Revision Anterior Shoulder Stabilization: A Systematic Review

2021 ◽  
Vol 9 (3) ◽  
pp. 232596712098205
Author(s):  
Brian C. Lau ◽  
Lorena Bejarano Pineda ◽  
Tyler R. Johnston ◽  
Bonnie P. Gregory ◽  
Mark Wu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Return To Play ◽  
Rate Of Return ◽  
Bone Block ◽  
Complication Rates ◽  
Weighted Mean ◽  
Shoulder Stabilization ◽  
Level Of Evidence ◽  
Patient Goals ◽  
Open Stabilization

Background: Revision shoulder stabilizations are becoming increasingly common. Returning to play after revision shoulder stabilizations is important to patients. Purpose: To evaluate the return-to-play rate after revision anterior shoulder stabilization using arthroscopic, open, coracoid transfer, or free bone block procedures. Study Design: Systematic review; Level of evidence, 4. Methods: All English-language studies published between 2000 and 2020 that reported on return to play after revision anterior shoulder stabilization were reviewed. Clinical outcomes that were evaluated included rate of overall return to play, level of return to play, and time to return to play. Study quality was evaluated using the Downs and Black quality assessment score. Results: Eighteen studies (1 level 2; 17 level 4; mean Downs and Black score, 10.1/31) on revision anterior shoulder stabilization reported on return to play and met inclusion criteria (7 arthroscopic, 5 open, 3 Latarjet, and 3 bony augmentation), with a total of 564 revision cases (mean age, 27.9 years; 84.1% male). The weighted mean length of follow-up was 52.5 months. The overall weighted rate of return to play was 80.1%. The weighted mean rate of return to play was 84.0% (n = 153) after arthroscopic revision, 91.5% (n = 153) after open revision, 88.1% (n = 149) after Latarjet, and 73.8% (n = 65) after bone augmentation. The weighted mean rate of return to same level of play was 69.7% for arthroscopic revision, 70.0% for open revision, 67.1% for Latarjet revision, and 61.8% after bone block revision. There were 5 studies that reported on time to return to play, with a weighted mean of 7.75 months (4 arthroscopic) and 5.2 months (1 Latarjet). The weighted mean rates of complication (for studies that provided it) were 3.3% after arthroscopic revision (n = 174), 3.5% after open revision (n = 110), 9.3% after Latarjet revision (n = 108), and 45.8% after bone block revision (n = 72). Conclusion: Revision using open stabilization demonstrated the highest return-to-play rate. Revision using Latarjet had the quickest time to return to play but had higher complication rates. When evaluated for return to same level of play, arthroscopic, open, and Latarjet had similar rates, and bone block had lower rates. The choice of an optimal revision shoulder stabilization technique, however, depends on patient goals. Higher-quality studies are needed to compare treatments regarding return to play after revision shoulder stabilization.

scholarly journals Outcomes of revision anterior cruciate ligament reconstruction in soccer players

2021 ◽  
Vol 2 (12) ◽  
pp. 1043-1048
Author(s):  
Keyword(s):  
Cruciate Ligament ◽  
Demographic Data ◽  
Return To Sport ◽  
Knee Surgery ◽  
Return To Play ◽  
Soccer Players ◽  
Limited Information ◽  
Ancillary Data ◽  
Graft Choice ◽  
Anterior Cruciate

Aims There is limited information on outcomes of revision ACL reconstruction (rACLR) in soccer (association football) athletes, particularly on return to sport and the rate of additional knee surgery. The purpose of this study was to report return to soccer after rACLR, and to test the hypothesis that patient sex and graft choice are associated with return to play and the likelihood of future knee surgery in soccer players undergoing rACLR. Methods Soccer athletes enrolled in a prospective multicentre cohort were contacted to collect ancillary data on their participation in soccer and their return to play following rACLR. Information regarding if and when they returned to play and their current playing status was recorded. If they were not currently playing soccer, they were asked the primary reason they stopped playing. Information on any subsequent knee surgery following their index rACLR was also collected. Player demographic data and graft choice were collected from their baseline enrolment data at rACLR. Results Soccer-specific follow-up was collected on 76% (33 male, 39 female) of 95 soccer athletes. Subsequent surgery information was collected on 95% (44 male, 46 female). Overall, 63% of athletes returned to soccer a mean 9.6 months (SD 5.8) after index revision surgery but participation in soccer decreased to 19% at a mean of 6.4 years (SD 1.3) after surgery. There was no significant association of patient sex or graft choice with return to play, time of return to play, or long-term return to play. Females were more likely than males to have subsequent knee surgery following rACLR (20% (9/46) vs 5% (2/44); p = 0.050). The rate of recurrent graft tear (5.6%; 5/90) was similar between males and females. Conclusion Approximately two-thirds of soccer players return to sport after rACLR, but the rate of participation drops significantly over time. Neither patient sex nor graft choice at the time of rACLR were associated with return to play. Female soccer players face a higher risk for additional knee surgery after rACLR than male soccer players. Cite this article: Bone Jt Open 2021;2(12):1043–1048.

scholarly journals Surgical Outcomes of Inguinal-, Pubic-, and Adductor-Related Chronic Pain in Athletes: A Systematic Review Based on Surgical Technique

2021 ◽  
Vol 9 (9) ◽  
pp. 232596712110231
Author(s):  
Munif Hatem ◽  
RobRoy L. Martin ◽  
Srino Bharam
Keyword(s):  
Systematic Review ◽  
Surgical Treatment ◽  
Surgical Technique ◽  
Return To Sport ◽  
Pubic Symphysis ◽  
Ice Hockey ◽  
Return To Play ◽  
Chronic Groin Pain ◽  
Level Of Evidence ◽  
Duration Of Symptoms

Background: Controversies remain regarding the surgical treatment of inguinal-, pubic-, and adductor-related chronic groin pain (CGP) in athletes. Purpose: To investigate the outcomes of surgery for CGP in athletes based on surgical technique and anatomic area addressed. Study Design: Systematic review; Level of evidence, 4. Methods: The PubMed and Embase databases were searched for articles reporting surgical treatment of inguinal-, pubic-, or adductor-related CGP in athletes. Inclusion criteria were level 1 to 4 evidence, mean patient age >15 years, and results presented as return-to-sport, pain, or functional outcomes. Quality assessment was performed with the CONSORT (Consolidated Standards of Reporting Trials) statement or MINORS (Methodological Index for Non-randomized Studies) criteria. Techniques were grouped as inguinal, adductor origin, pubic symphysis, combined inguinal and adductor, combined pubic symphysis and adductor, or mixed. Results: Overall, 47 studies published between 1991 and 2020 were included. There were 2737 patients (94% male) with a mean age at surgery of 27.8 years (range, 12-65 years). The mean duration of symptoms was 13.1 months (range, 0.3-144 months). The most frequent sport involved was soccer (71%), followed by rugby (7%), Australian football (5%), and ice hockey (4%). Of the 47 articles reviewed, 44 were classified as level 4 evidence, 1 study was classified as level 3, and 2 randomized controlled trials were classified as level 1b. The quality of the observational studies improved modestly with time, with a mean MINORS score of 6 for articles published between 1991 and 2000, 6.53 for articles published from 2001 to 2010, and 6.9 for articles published from 2011 to 2020. Return to play at preinjury or higher level was observed in 92% (95% CI, 88%-95%) of the athletes after surgery to the inguinal area, 75% (95% CI, 57%-89%) after surgery to the adductor origin, 84% (95% CI, 47%-100%) after surgery to the pubic symphysis, and 89% (95% CI, 70%-99%) after combined surgery in the inguinal and adductor origin. Conclusion: Return to play at preinjury or higher level was more likely after surgery for inguinal-related CGP (92%) versus adductor-related CGP (75%). However, the majority of studies reviewed were methodologically of low quality owing to the lack of comparison groups.

scholarly journals Surgical Management of Proximal Fifth Metatarsal Fractures in Elite Athletes: A Systematic Review

2021 ◽  
Vol 9 (9) ◽  
pp. 232596712110376
Author(s):  
J. Brett Goodloe ◽  
William M. Cregar ◽  
Alexander Caughman ◽  
Evan P. Bailey ◽  
William R. Barfield ◽  
...  
Keyword(s):  
Systematic Review ◽  
Surgical Management ◽  
Complication Rate ◽  
Elite Athletes ◽  
Return To Play ◽  
Treatment Modalities ◽  
Iliac Crest Bone Graft ◽  
Complication Rates ◽  
Exclusion Criteria ◽  
Metatarsal Fractures

Background: As a result of the high physical demand in sport, elite athletes are particularly prone to fifth metatarsal fractures. These injuries are typically managed surgically to avoid high rates of delayed union and allow for quicker return to play (RTP). Purpose: To review studies showing clinical and radiographic outcomes, RTP rates, and complication rates after different surgical treatment modalities for fifth metatarsal fractures exclusively in elite-level athletes. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic search was conducted within the PubMed, Scopus, and Cochrane databases from January 2000 to January 2020. Inclusion criteria consisted of clinical outcome studies after operative management of fifth metatarsal fractures in elite athletes. Exclusion criteria consisted of nonoperative management, high school or recreational-level athletic participation, nonclinical studies, expert opinions, and case series with <5 patients. Results: A total of 12 studies met inclusion and exclusion criteria, comprising 280 fifth metatarsal fractures treated surgically. Intramedullary screw fixation was the most common fixation construct (47.9%), and some form of intraoperative adjunctive treatment (calcaneal autograft, iliac crest bone graft, bone marrow aspirate concentrate, demineralized bone matrix) was used in 67% of cases. Radiographic union was achieved in 96.7% of fractures regardless of surgical construct used. The overall mean time to union was 9.19 weeks, with RTP at a mean of 11.15 weeks. The overall reported complication rate was 22.5%, with varying severity of complications. Refracture rates were comparable between the different surgical constructs used, and the overall refracture rate was 8.6%. Conclusion: Elite athletes appeared to have a high rate of union and reliably returned to the same level of competition after surgical management of fifth metatarsal fractures, irrespective of surgical construct used. Despite this, the overall complication rate was >20%. Specific recommendations for optimal surgical management could not be made based on the heterogeneity of the included studies.

Iliopsoas Tenotomy During Hip Arthroscopy: A Systematic Review of Postoperative Outcomes

2020 ◽  
pp. 036354652092255
Author(s):  
Kyle Gouveia ◽  
Ajay Shah ◽  
Jeffrey Kay ◽  
Muzammil Memon ◽  
Nicole Simunovic ◽  
...  
Keyword(s):  
Systematic Review ◽  
Functional Outcome ◽  
Demographic Data ◽  
Treatment Success ◽  
Arthroscopic Surgery ◽  
Return To Sports ◽  
Iliopsoas Tendon ◽  
Outcome Scores ◽  
Hip Flexion ◽  
Flexion Strength

Background: Arthroscopic iliopsoas tendon release is a surgical treatment option for painful snapping hips, although it has been associated with controversy surrounding potential complications including decreased hip flexion strength, iatrogenic hip instability, and iliopsoas atrophy. Purpose: To systematically assess the efficacy and safety of arthroscopic iliopsoas tenotomy during hip arthroscopic surgery as an intervention for painful snapping hips. Study Design: Systematic review; Level of evidence, 4. Methods: A total of 3 online databases (Embase, PubMed, and MEDLINE) were searched from database inception until September 2019 for studies investigating iliopsoas tenotomy during hip arthroscopic surgery. Studies were screened by 2 reviewers independently and in duplicate, and studies investigating arthroscopic iliopsoas tendon release were included. Demographic data as well as data on treatment success, functional outcome scores, and radiological outcomes were recorded. A risk of bias assessment was performed for all included studies. Results: Overall, 21 studies were identified with a total of 824 patients (875 hips). These patients were 82.5% female (680/824), with a mean age of 28.1 years (range, 12-62 years) and mean follow-up of 32.1 months (range, 3-73 months). Arthroscopic iliopsoas tenotomy was performed at the level of the labrum in 811 hips (92.7%) or the lesser trochanter in 64 hips (7.3%). The overall reported success rate of the procedure in resolving snapping hips was 93.0% (266/286), and all studies reported an improvement in functional outcome scores. Only 6 studies (93 hips) discussed postoperative hip flexion strength, with complete recovery of strength reported in 4 studies (47 hips) and mild decreases reported in the other 2 studies (46 hips). Iliopsoas atrophy was evaluated radiologically (3 studies; 66 hips) and was found postoperatively in 92.4% (61/66) of hips. No major complications were reported. Conclusion: Arthroscopic release of the iliopsoas tendon was effective in alleviating pain and persistent clicking associated with a snapping hip. Although patients demonstrated some early postoperative weakness and iliopsoas atrophy on radiological imaging, the results from studies to date showed satisfactory clinical function and return to sports/activities. High-quality comparative studies are needed to further assess arthroscopic iliopsoas tendon release to determine the optimal technique and location of tendon release.

Reverse the Trend for Proximal Humeral Fractures: A Review of the Evidence for the Use of Reverse Shoulder Replacement in Acute Trauma

2012 ◽  
Vol 4 (4) ◽  
pp. 237-243
Author(s):  
Clare Taylor ◽  
Thomas Cosker ◽  
Christopher Smith
Keyword(s):  
Systematic Review ◽  
Functional Outcome ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures ◽  
Complication Rates ◽  
Shoulder Replacement ◽  
Acute Trauma ◽  
Outcome Scores ◽  
Reverse Shoulder Replacement

Background Proximal humeral fractures in the elderly population represent a particularly demanding subset of fractures. These have been traditionally treated with Hemi-arthroplasty (HA). Recently there has been a trend towards using a Reverse shoulder replacement (RSR) in some of these patients. The primary aim of the study was to systematically review the literature on the functional outcome scores for RSR in proximal humeral fractures and compare it with the best quality literature available for HA. Secondarily to compare range of movement, complication rates, re-operation rates and x-ray changes. Methods A systematic review of the literature was performed using the keywords: Delta, inverse, shoulder, trauma, and fracture. Only studies with 10 patients or more, presenting new data on the functional outcome scores of RSR for acute trauma were included. Studies reporting the use of RSR for fracture sequalae were excluded. These results were compared to the most comprehensive and up to date literature available for HA for proximal humeral fractures. Results Eight papers met the full inclusion and exclusion criteria. Data was available for 178 patients with a minimum follow-up of only 3 months. The mean absolute constant score for RSR patients was 54% and 57% for HA patients. RSR had an infection rate of 3%, a dislocation rate of 4% and an overall re-operation rate of 5.6%. Conclusion Functional outcomes and range of movements achieved by RSR seem to be similar to those achieved by HA and may eventually be proven to have better outcomes in a certain sub-group of patients. However, there is currently less than 200 patients reported in the literature with a very short term follow-up. RSR is more expensive than HA, and there is a definite learning curve associated with this prosthesis. Although RSR may be valuable in patients where a traditional HA is deemed not suitable, caution must be used until better quality research is available. Level of evidence: Level III systematic review of Level III studies

scholarly journals Risk of Secondary Injury in Younger Athletes After Anterior Cruciate Ligament Reconstruction

2016 ◽  
Vol 44 (7) ◽  
pp. 1861-1876 ◽  
Author(s):  
Amelia J. Wiggins ◽  
Ravi K. Grandhi ◽  
Daniel K. Schneider ◽  
Denver Stanfield ◽  
Kate E. Webster ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cruciate Ligament ◽  
Meta Analysis ◽  
Return To Sport ◽  
Injury Rate ◽  
Acl Injury ◽  
Return To Play ◽  
Review Of The Literature ◽  
Anterior Cruciate ◽  
Meta Analyses

Background: Injury to the ipsilateral graft used for reconstruction of the anterior cruciate ligament (ACL) or a new injury to the contralateral ACL are disastrous outcomes after successful ACL reconstruction (ACLR), rehabilitation, and return to activity. Studies reporting ACL reinjury rates in younger active populations are emerging in the literature, but these data have not yet been comprehensively synthesized. Purpose: To provide a current review of the literature to evaluate age and activity level as the primary risk factors in reinjury after ACLR. Study Design: Systematic review and meta-analysis. Methods: A systematic review of the literature was conducted via searches in PubMed (1966 to July 2015) and EBSCO host (CINAHL, Medline, SPORTDiscus [1987 to July 2015]). After the search and consultation with experts and rating of study quality, 19 articles met inclusion for review and aggregation. Population demographic data and total reinjury (ipsilateral and contralateral) rate data were recorded from each individual study and combined using random-effects meta-analyses. Separate meta-analyses were conducted for the total population data as well as the following subsets: young age, return to sport, and young age + return to sport. Results: Overall, the total second ACL reinjury rate was 15%, with an ipsilateral reinjury rate of 7% and contralateral injury rate of 8%. The secondary ACL injury rate (ipsilateral + contralateral) for patients younger than 25 years was 21%. The secondary ACL injury rate for athletes who return to a sport was also 20%. Combining these risk factors, athletes younger than 25 years who return to sport have a secondary ACL injury rate of 23%. Conclusion: This systematic review and meta-analysis demonstrates that younger age and a return to high level of activity are salient factors associated with secondary ACL injury. These combined data indicate that nearly 1 in 4 young athletic patients who sustain an ACL injury and return to high-risk sport will go on to sustain another ACL injury at some point in their career, and they will likely sustain it early in the return-to-play period. The high rate of secondary injury in young athletes who return to sport after ACLR equates to a 30 to 40 times greater risk of an ACL injury compared with uninjured adolescents. These data indicate that activity modification, improved rehabilitation and return-to-play guidelines, and the use of integrative neuromuscular training may help athletes more safely reintegrate into sport and reduce second injury in this at-risk population.

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