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

2021 ◽  
Vol 38 (5) ◽  
pp. 253-260
Author(s):  
Pavel Loeza-Magaña ◽  
Héctor R. Quezada-González ◽  
Pedro I. Arias-Vázquez

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

2020 ◽  
Vol 8 (9_suppl7) ◽  
pp. 2325967120S0055
Author(s):  
Alli Gokeler ◽  
Francesco Della Villa ◽  
Wouter Welling ◽  
Jochen Baumeister

Despite the development of return to sport (RTS) guidelines over recent years, there is a lack of a scientific consensus on the RTS criteria used to release a patient to unrestricted sport activity after ACL reconstruction (ACLR). A proportional meta-analysis, showed that only 23% of patients after ACLR passed RTS test batteries before RTS. Although passing RTS criteria reduce the risk of subsequent graft rupture by 60%, it increases the risk of a contralateral ACL rupture by 235%. These equivocal findings in terms of validity of RTS tests after ACLR leaves clinicians with high level of uncertainty in clinical decision-making. Dingenen & Gokeler proposed that RTS should be viewed as continuum after ACL injury and ACLR. Moreover, one of the possible solutions why patients do not meet the RTS criteria is simply due to the lack of implementation of evidence- based rehabilitation in terms of specificity and training load. Too often, the end phase of the rehabilitation is not extensive or specific enough, thereby exposing athletes to specific training loads and training characteristics that they cannot handle from a physical, neurocognitive as well as from a psychological perspective. Della Villa et al. introduced the concept of an On Field Rehabilitation (OFR) model to bridge the gap between standard rehabilitation and return to training. This allows for a gradual progression of each part and thus ensures correct function and that no adverse knee reaction is noted before moving on to the next level. Returning an athlete to full participation should be a graduated continuum and not based on a set of tests at one single point in time. The above findings pertaining to the high incidence of recurrent injuries, question whether the current RTS tests provide relevant information for guiding the decision making. There is a need for more ecological valid research approaches to test an athlete returning to sports after an ACLR in more complex sports-specific demanding tests, which are more reflective of the demands while on the field. Based on a RTS continuum approach, training and tests should include physical, cognitive and psychological loads in a gradual fashion that prepare the athlete for a safer RTS


2017 ◽  
Vol 5 (3_suppl3) ◽  
pp. 2325967117S0010
Author(s):  
Kotaro Shibata ◽  
Marc R. Safran

Objectives: 1) To compare ability to return to prior competitive sports activity after arthroscopic hip surgery by gender, with an emphasis on the rate of return to the same level of competition. 2) To compare gender differences in type of sports activities, diagnosis and treatment in athletes requiring hip arthroscopy. Methods: Prospectively obtained data on all high-level elite athletes (professional, NCAA collegiate and/or Olympic) treated between 2007 and 2014 were retrospectively reviewed. The clinical and surgical records of 547 hips in 484 consecutive patients who underwent primary hip arthroscopy by the senior author for non-arthritic hip pain during the study period were included. Elite athletes who had a Hip Sports Activity Score (HSAS) of over 6 were identified. Patients completed a pre-operative questionnaire that included medical and sports activity history and level of competition, hip-specific outcome scores (Modified Harris Hip Score [MHHS] and International Hip Outcome Tool-33 [iHOT-33]) at baseline and most recent follow-up. Surgical findings and time to return to competitive sports activity were documented. Results: A total of 98 elite athletes with a mean follow up period of 18.8 months (±12.7) were identified. There were 49 females and 49 males. 27 athletes had bilateral hip arthroscopy, 5 of which had 1 operation elsewhere. All patients were available for follow up. Of the 80 patients desiring to return to their original competitive activity, 38 were female (42 hips) (Female Athlete group [FA]) and 42 were male (54 hips) (Male Athlete group [MA]) their mean ages were 21.5(±3.9) and 20.5(±1.9), duration of pain prior to surgery was 12.1 (±10.3) months and 15.1 (±1.9) months, respectively. 84.2% of FA and 83.3% of MA were able to return to the same level of competition at a mean of 8.3 (±3) and 8.8 (±2.9) months, respectively. Statistically significant improvements between pre- and post-operative mean MHHS and iHOT-33 scores were seen in both groups (p <.0001; p <.0001). FA had significantly higher proportions of hips that were diagnosed with Pincer type FAI (p =.0004), and Instability (p <.0001). Conversely, the MA had significantly higher proportions of hips that were diagnosed with Combined type FAI (p <.0001), had more extensive acetabular cartilage rim damage (p =.0002), and in particularly had more hips that required microfracture treatment (p =.001). When comparing cam lesions (includes Cam and Combined type FAI) the alpha angle was statistically greater in MA (mean 74°±6.7) compared to FA (mean 65.4°±6.8) (p <.0001). The category of sports the FA participated in were more flexibility (11%) and endurance (24%) type sports. MA participated more in cutting (33%), contact (14%) and asymmetric (31%) type sports. Patients who were able to return to same level of competitive activity had a significantly shorter duration of pre-operation symptoms compared to those who could not (p < 0.05). Microfracture treatment did not affect the ability to return to sports. Conclusion: A similar high percentage of both female and male elite athletes were able to return to competitive sports activity after arthroscopic treatment of FAI and/or hip instability. Distinct differences in diagnosis, treatment and participating type of sports activities were seen when comparing female and male athletes. Duration of symptoms negatively correlated with outcomes. Extensive cartilage damage and Microfracture did not affect outcome / return to sports.


2020 ◽  
pp. 036354652097518
Author(s):  
Mary K. Mulcahey ◽  
Arianna L. Gianakos ◽  
Angela Mercurio ◽  
Scott Rodeo ◽  
Karen M. Sutton

The outbreak of the novel coronavirus (COVID-19) has resulted in upward of 14 million confirmed cases and >597,000 deaths worldwide as of July 19, 2020. The current disruption in sports activities caused by COVID-19 presents a challenge to physicians, coaches, and trainers in discerning best practices for a safe return to sport. There is a distinct need to develop and adopt consistent measures for resumption of sports activities, including training and competition, in a way that places the health and well-being of athletes at the forefront while also protecting coaches, allied staff, and spectators. This article provides an overview of the effects of COVID-19 in the athletic population and presents considerations for training during the pandemic, as well as guidelines for return to sports as restrictions are lifted.


2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0027
Author(s):  
William L. Johns ◽  
Christopher Sowers ◽  
Kempland C. Walley ◽  
J. Ben Jackson ◽  
David B. Thordarson ◽  
...  

Category: Ankle Arthritis; Ankle; Other Introduction/Purpose: There is no consensus regarding participation in sports and recreational activities following total ankle replacement (TAR) and ankle arthrodesis (AA). Better understanding on this topic will allow orthopaedic foot and ankle surgeons to set evidence-based goals and expectations with their patients in regards to postoperative activity recommendations and quality of life. We aimed to summarize the evidence on return to sport and activity after surgical management with either TAR or AA for ankle osteoarthritis (OA). Methods: A literature search of PubMed, MEDLINE, EMBASE, CINAHL, and Cochrane Library databases was performed in January 2020. The bibliographies of all relevant publications were searched for further applicable studies. Included studies were required to report sport and activity outcomes in patients undergoing TAR and AA, with primary outcomes being percentage of sport participation and level of sport participation. Excluded studies were non-English and did not assess level of sport activity after TAR or AA. Results: Twelve studies met inclusion criteria for analysis. There were 1,270 ankle procedures, of which 923 TAR and 347 AA were performed. Mean reported patient age was 59.2 years old and mean BMI was 28 kg/m2. Mean follow-up was 43 months. Fifty-four percent of patients were active in sports preoperatively compared to 63.7% postoperatively (Figure 1). Mean preoperative activity participation rate was 41% in the TAR cohort, but improved to 59% after TAR, whereas preoperative activity participation rate of 73% was similar to postoperative rate of 70% in the AA cohort. The most common sports in TAR and AA groups were swimming, hiking, cycling, and skiing. Conclusion: Participation in sports activity is nearly 10% improved after surgical management of ankle OA. The existing literature demonstrated a large improvement in pre-to postoperative activity levels after TAR, with minimal change in activity after AA, however, AA patients were more active at baseline. The most frequent postoperative sports activities after surgical management of ankle OA are: swimming, hiking, cycling, and skiing. Despite preoperative participation in high-impact sports such as tennis, soccer, and running, these were consistently limited after surgery. This review of the literature will equip patients and physicians with the knowledge to appropriately establish realistic expectations for postoperative physical activity and return to sport goals. [Table: see text]


2021 ◽  
Vol 9 (9) ◽  
pp. 232596712110246
Author(s):  
Yi-jun Zhang ◽  
Xiao Long ◽  
Jing-yu Du ◽  
Quan Wang ◽  
Xiang-jin Lin

Background: There is disagreement as to whether early controlled motion and weightbearing confer a beneficial effect for nonoperatively treated acute Achilles tendon rupture (ATR) compared with immobilization and late weightbearing. Purpose: To conduct a meta-analysis of randomized controlled trials (RCTs) to determine whether early controlled motion and weightbearing results in different outcomes compared with immobilization and late weightbearing for nonoperatively treated patients with acute ATR. Study Design: Systematic review; Level of evidence, 1. Methods: We conducted a search in the PubMed, Web of Science, and EMBASE databases for relevant RCTs in humans from January 1981 to August 2020. The primary outcome was the Achilles Tendon Total Rupture Score (ATRS) at 1-year follow-up. The secondary outcomes were the rerupture rate, return to sports activity and work, and the heel-rise work (limb symmetry index [LSI]). Study quality was assessed using the Cochrane Collaboration risk of bias tool. Results: Included were 7 RCTs involving 424 participants (n = 215 treated with early controlled motion and weightbearing [early group], n = 209 treated with immobilization and late weightbearing [late group]). The quality assessment indicated a low risk of bias in all included RCTs. There was no difference between the early and late groups regarding the ATRS (mean difference [MD], -0.220; 95% CI, -4.489 to 4.049; P = .920). Likewise, we found no difference between the 2 groups in terms of the rerupture rate (odds ratio [OR], 1.107; 95% CI, 0.552 to 2.219; P = .775), the number of patients who returned to sports (OR, 0.766; 95% CI, 0.438 to 1.341; P = .351) and returned to work (OR, 0.706; 95% CI, 0.397 to 1.253; P = .234), the time to return to work (MD, -2.802 days; 95% CI, -6.525 to 0.921 days; P = .140), or the heel-rise work LSI (MD, -0.135; 95% CI, -6.243 to 5.973; P = .965). Conclusion: No significant differences were found between early controlled motion and weightbearing compared with immobilization and late weightbearing regarding the ATRS, the rerupture rate, return to sports activity and work, and the heel-rise work in nonoperatively treated patients with acute ATR.


2019 ◽  
Vol 11 (2) ◽  
pp. 123-133 ◽  
Author(s):  
Alberto Grassi ◽  
James R. Bailey ◽  
Giuseppe Filardo ◽  
Kristian Samuelsson ◽  
Stefano Zaffagnini ◽  
...  

Context: Meniscal injuries are common among both sport- and non–sport-related injuries, with over 1.7 million meniscal surgeries performed worldwide every year. As meniscal surgeries become more common, so does meniscal allograft transplantation (MAT). However, little is known about the outcomes of MAT in active patients who desire to go back to preinjury activities. Objective: The purpose of this systematic review and meta-analysis was to evaluate return to sport, clinical outcome, and complications after MAT in sport-active patients. Data Sources: A systematic search of MEDLINE, EMBASE, and CINAHL electronic databases was performed on February 25, 2018. Study Selection: Studies of level 1 through 4 evidence looking at MAT in physically active patients with reported return to activity outcomes and at least 2-year follow-up were included. Study Design: Systematic review and meta-analysis. Level of Evidence: Level 4. Data Extraction: Details of sport-related outcomes and reoperations were extracted and pooled in a meta-analysis. Results: Nine studies were included in this systematic review. A majority (77%) of athletes and physically active patients were able to return to sport after MAT; two-thirds were able to perform at preinjury levels. Graft-related reoperations were reported in 13% of patients, while the joint replacement rate with partial or total knee prosthesis was 1.2%. Conclusion: Physical activity after MAT appears possible, especially for low-impact sports. However, because of the limited number of studies, their low quality, and the short-term follow-up, the participation recommendation for high-impact and strenuous activities should be considered with caution until high-quality evidence of long-term safety becomes available.


2018 ◽  
Vol 2018 ◽  
pp. 1-10 ◽  
Author(s):  
Abbas Yousefzadeh ◽  
Azadeh Shadmehr ◽  
Gholam Reza Olyaei ◽  
Nasrin Naseri ◽  
Zahra Khazaeipour

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


2017 ◽  
Vol 5 (1_suppl) ◽  
pp. 2325967117S0002
Author(s):  
Gonzalo Magi ◽  
Juan Pablo Carucci ◽  
Manuel Berro ◽  
Sebastián Bergues

Introduction: Hip pathology is being recognized with more frequency as source of disability and functional limitation in athletes. It has been stated that the overload made with certain positions during some sports activities can develop condral damage. Moreover, the sum of bone deformity and repetitive movements of the hip requiered in sports may increase the risk of causing injuries. These can be treated with hip arthroscopy. Despite of this, there is a lack of evidence about the time taken to return to sports activity and the level reached afterwards by those patients treated with this procedure. Objective: Describe the clinical evolution, the time taken to return to sports activity and the level reached a year after the treatment of femoroacetabular impingement (FAI) with hip arthroscopy in 23 athletes. Method: 23 athletes were included in the study, defined as those patients with a minimum of 6 hours a week of sports practice, who were treated for FAI with hip arthroscopy between 2010 and 2015 by the same surgeon at our institution. The diagnosis was clinical (positive impingement test, hip pain and functional limitation of the hip), radiological (cam and pincer) and with magnetic nuclear resonance (labral tears). Preoperative modified Harris hip score was registered in all cases. Tonnis radiographic score was used. All patients had type 0 or 1 Tonnis hips. After 3 months of ineffective non operative treatment the arthroscopy was performed. Patients were treated in dorsal decubitus with orthopedic table. Labral reconstruction with anchors and femoral and acetabular osteoplasty was made. After surgery, patients were able to walk with support for 4 weeks and began physiotherapy. A year after surgery, all patients were questioned about the time taken to return to sports activity and the level of activity reached at that time compared to the one they had before symptoms appeared. The modified Harris hip score was also registered. Results: Ten patients played soccer as a main sport activity (44%), 3 basketball (13%), 3 martial arts (13%), 3 rugby (13%), 2 running (9%), 1 bicycling (4%) and 1 motocross (4%). The average time taken to return to sports activity was 4.7 months. 12 patients returned at 4 months (52%), 6 patients at 5 months (26%) and 5 patients at 6 months (22%). All patients were able to return to sports activity. Twenty patients reached the same level of activity they had before symptoms appeared (87%). Three patients did not get to previous activity level (13%). The averaged postoperative modified Harris hip score was 92 points (excellent). 20 patients (87%) scored excellent results and 3 patients (13%) regular ones. The average improvement after surgery of this score was 26 points. Conclusion: The treatment of FAI with hip arthroscopy in athletes allowed us to achieve excellent clinical results in 87% of the patients (modified Harris hip score). They took an average of 4.7 months to return to sports activities. 87% of them returned to the same level of practice they had before symptoms appeared.


2020 ◽  
Author(s):  
Juan Miguel Rodríguez-Roiz ◽  
Sergi Sastre-Solsona ◽  
Andrés Combalia Aleu ◽  
Dragos Popescu ◽  
Jordi Montañana Burillo

Abstract Objective few studies approach with long follow up meniscal repair at amateur level, specially studying variables as quality of life and failure rate. We study medium to long-term clinical results in patients at amateur sports level, that have required meniscal sutures at our centre, with or without ACL reconstruction. We evaluate the objective function of the knee, as well as the patients’ return to sports activities, quality of life and the rate of failed repair and study the possible reasons. Methods We design an observational retrospective study, assessed 92 patients that required a meniscal repair in our centre from april 2007 until april 2018, who regularly perform amateur sports activities (Tegner 4 to 7), minimum follow-up period of 2 years, divided into 2 groups: group 1 isolated meniscal suture (43 cases), group 2 associated to ACL reconstruction (49 cases). Every patient have this tests in 2019: Lysholm and Tegner (validated for spanish) before the injury and after the surgical procedure, motivation to return to sports activity (Likert scale with 3 items: low, regular or high), quality of life (through SF-12 test). Results high return to amateur sports rate (92%), which was even higher in the isolated reconstruction group in comparison to the group with associated ACL, at a minimun follow-up of 2 years. We have not found statistically significant differences between sports return and: age, gender, injured meniscus, chondral injuries, preoperative Tegner score, or motivation. No significant differences in physical or mental health fields between both groups. Meniscal repair failed in 12 patients (13%,)and they finally required a partial meniscectomy, as complications just one debridement for superficial infection of ACL donor zone. Higher rate of failure in isolated bucket-handle tear injuries (p < 0.0062). We have not found a statistically significant association between the other variables studied. Conclusions 92% of sports return and low meniscal repair failure rate, even lower when is associated to ACL reconstruction.


Author(s):  
Carlijn S ter Laak Bolk ◽  
Jari Dahmen ◽  
Kaj T A Lambers ◽  
Leendert Blankevoort ◽  
Gino M M J Kerkhoffs

ImportanceAlthough a large number of Lisfranc injuries occur during sports, data on sports outcomes, such as return to sport (RTS) rates and times as well as level of sports activities after treatment of this injury remain limited.ObjectiveThe aim is to assess the RTS rates, times and the sports activity levels after different treatments of Lisfranc injuries.Evidence reviewThe electronic databases PubMed (MEDLINE), EMBASE, CDSR, DARE and CENTRAL were searched to identify relevant articles from January 1985 to July 2020. The mean RTS rates (to any level and preinjury level of sports) and times were extracted per study, and pooled wherever methodologically possible. Methodological quality of the included studies was assessed using the Methodological Index for Non-Randomized Studies criteria (MINORS).FindingsFifteen studies were included in this review. Methodological quality of the studies was poor. The treatments reported in the studies were conservative treatment, surgical fixation and primary partial arthrodesis. For conservative treatment, the RTS rate regardless of sports level was 93% (95% CI 81% to 98%; n=42) and for return to preinjury level of sports was 88% (95% CI 75% to 95%; n=42). The fixation group showed a RTS percentage of 94% (95% CI 91% to 97%; n=270) to each level of sports and for return to the level before injury was 86% (95% CI 80% to 90%; n=188). In the primary partial arthrodesis group, the return to any level of sports was 94% (95% CI 85% to 98%; n=65) and for return to preinjury level was 74% (95% CI 62% to 83%; n=65). Mean time to RTS ranged from 7 to 33 weeks across all treatment groups. No data pooling was possible for this outcome measure. From the different studies, a total of 43 different sports and 440 physical activities were reported before treatment. After treatment, patients participated in 37 different sports (88%) and 391 different physical activities (89%).Conclusions and relevanceThe different treatment options for Lisfranc injuries allow for good sport-specific outcomes with 93% to 94% of athletes returning to any level of sports, and 74% to 88% of athletes returning to their preinjury level of sport. These sport-specific outcomes can be used to inform patients about their expected sport-specific outcomes after different treatments of Lisfranc injuries.Level of evidenceSystematic review and meta-analysis.


Sign in / Sign up

Export Citation Format

Share Document