Behandlung von Sportverletzungen bei Frauen – Anders? Öfter? Länger?

Female Athletes ◽

Sports Injuries ◽

Cruciate Ligament ◽

Return To Play ◽

Associated Injuries ◽

Acl Injuries ◽

Women In Sport ◽

Long Time ◽

Women in sport – an almost inexhaustible topic that has been neglected for a long time. Female Athletes conquer discipline after discipline – including the associated injuries. Common sports injuries in female athletes include stress fractures, anterior cruciate ligament (ACL) injuries and sport related concussions (SRC). Less commonly recognized are the specific sex differences that lead to these injuries. An understanding of these factors can improve their clinical management including surgical treatment, the rehabilitation phase and return to play.

Anterior Cruciate Ligament Reconstruction in Skeletally Immature Patients: Early Results Using a Hybrid Physeal-Sparing Technique

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118755330 ◽

2018 ◽

Vol 6 (2) ◽

pp. 232596711875533 ◽

Cited By ~ 5

Author(s):

Robert G. Willson ◽

Regina O. Kostyun ◽

Matthew D. Milewski ◽

Carl W. Nissen

Keyword(s):

Skeletal Maturity ◽

Cruciate Ligament ◽

Return To Play ◽

Hybrid Technique ◽

Skeletally Immature ◽

Acl Injuries ◽

Outcome Scores ◽

Anterior Cruciate ◽

Physeal Sparing

Background: Reconstruction of the anterior cruciate ligament (ACL) in the skeletally immature patient is frequently performed in hopes of preventing new or additional chondral damage and meniscal injuries. Patients within a few years of skeletal maturity are more at risk for ACL injuries than prepubescent patients, about whom several physeal-sparing techniques have been described. Reconstruction techniques in the former higher risk group need to be better understood. Purpose: To review a series of adolescent patients with ACL injuries surgically treated with the hybrid physeal-sparing technique. Study Design: Case series; Level of evidence, 4. Methods: Surgical logs of ACL reconstructions (ACLRs) performed at a single pediatric/adolescent sports medicine center over a 6-year period were reviewed. Patients with open physes who had undergone ACLR with a femoral physeal-sparing tunnel and transphyseal tibial tunnel were identified. Their demographics, operative reports, rehabilitative course, time to return to play, outcome scores, and postoperative radiographs were collected and analyzed. Results: Twenty-three patients with a mean chronological age and bone age of 13.0 and 13.6 years, respectively, were identified. Examination and subjective outcome scores were obtained at a mean of 19 months and overall demonstrated positive results, with a mean Pediatric International Knee Documentation Committee (Pedi-IKDC) score of 96.0 and a mean Anterior Cruciate Ligament–Return to Sport after Injury (ACL-RSI) score of 89.1. Full-length mechanical axis films obtained at a mean 21 months postoperatively demonstrated no leg-length discrepancies or angular deformities in 21 of 23 patients. Two patients had an identified growth disturbance in the form of femoral and tibial growth acceleration on the ACL-reconstructed limb. Conclusion: The femoral physeal-sparing with transphyseal tibial drilling “hybrid” technique in skeletally maturing patients appears to have a high rate of success with low morbidity. However, the possibility of physeal abnormalities does exist, which demonstrates the importance of a close postoperative follow-up and evaluation until skeletal maturity is achieved. ACLR in skeletally immature patients is performed on an increasingly regular basis. Establishing the best and safest technique to do so is therefore important.

Finite Element Analysis of the Knee: Development of a Failure Locus for the Anterior Cruciate Ligament

ASME 2010 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2010-19200 ◽

2010 ◽

Author(s):

A. Homyk ◽

A. Orsi ◽

S. Wibby ◽

N. H. Yang ◽

H. N. Hashemi ◽

...

Keyword(s):

Articular Cartilage ◽

Sports Injuries ◽

Cruciate Ligament ◽

Epidemiology Study ◽

Collateral Ligament ◽

Element Analysis ◽

Acl Injuries ◽

Failure Locus ◽

A full or partial tear of the anterior cruciate ligament (ACL) is a common and painful injury that has been estimated to occur approximately 250,000 times annually in the U.S. [1]. Articular cartilage and meniscal injuries are also associated with ACL injuries [2]. ACL injuries can often lead to degenerative osteoarthritis of the articular cartilage [2]. An epidemiology study of athletic injuries by Majewski et al. [3] determined that out of 19,530 sports injuries, 20% were ACL injuries and 8% were medial collateral ligament (MCL) injuries.

Optimizing Return to Play After Anterior Cruciate Ligament Reconstruction in Soccer Players: an Evidence Based Approach

10.20944/preprints202012.0447.v1 ◽

2020 ◽

Author(s):

Florian FORELLI ◽

Clément SANSONNET ◽

Steeve CHIAPOLINI ◽

Jean MAZEAS ◽

Amaury VANDEBROUCK ◽

...

Keyword(s):

Cruciate Ligament ◽

Return To Sport ◽

Return To Play ◽

Preventive Program ◽

Acl Injuries ◽

Personal Lives ◽

Clinical Criteria ◽

Muscle Strengthening ◽

Anterior Cruciate Ligament (ACL) tear is currently a main issue in all of sports communities. Although the number of ACL injuries in football remains low, it’s consequences on both professional and personal lives remain a major concern of rehabilitation. If practitioners often require more time to bring athletes in the best condition, the fact remains that this concept of time before return to sport is nowadays considered as obsolete. Indeed, the better understanding of the mechanisms of lesion and the strains placed on the graft after reconstruction, allow us to establish a personalized program based on clinical criteria and the patient's objectives. The current scientific literature allows us today to optimize the return to play and performance by the use of neuromotor and neurocognitive approaches, muscle strengthening methods and a preventive program necessary to cover the previous level of the players while taking into account physiological and psychological changes due to ACL reconstruction. Indeed, it is important to have a systemic approach centered on the patient, the sports movement, as close as possible to the field in order to find an optimal function of the knee in interaction with its environment.If there is a risk of reinjury of the ACL, it appears important to be able to identify the risk factors so that the player can return to play in optimal conditions.

The Development of a Three Dimensional Anterior Cruciate Ligament Failure Locus: A Finite Element Analysis

ASME 2011 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2011-53124 ◽

2011 ◽

Author(s):

A. Orsi ◽

N. H. Yang ◽

H. N. Hashemi ◽

P. K. Canavan

Keyword(s):

Articular Cartilage ◽

Sports Injuries ◽

Cruciate Ligament ◽

Three Dimensional ◽

Element Analysis ◽

Acl Injuries ◽

Ligament Failure ◽

Failure Locus ◽

Return to Play Following Isolated and Combined Anterior Cruciate Ligament Reconstruction: 25+ Years of Experience Treating National Football League Athletes

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120959004 ◽

2020 ◽

Vol 8 (10) ◽

pp. 232596712095900

Author(s):

Michael Khair ◽

Jonathan Riboh ◽

Jaicus Solis ◽

Jim Maurer ◽

J. Britt Brown ◽

...

Keyword(s):

Multivariate Analysis ◽

Ligament Reconstruction ◽

National Football League ◽

Cruciate Ligament ◽

Case Series ◽

Return To Play ◽

Collateral Ligament ◽

Acl Injuries ◽

Background: The first case series to report on return to play (RTP) in National Football League (NFL) players after primary anterior cruciate ligament (ACL) reconstruction (ACLR) published an RTP rate of 63%. Other studies that have attempted to estimate RTP after ACLR in these elite athletes have been largely based on secondary sources. This study is the second to report the authors’ own results in treating ACL injuries in NFL players spanning a study period of 25+ years. Purpose: To report the senior authors’ experience treating ACL injuries in NFL players as well as revisit the concept of RTP as it is currently used to measure successful surgical outcomes in professional athletes. Study Design: Case series; Level of evidence, 4. Methods: A total of 47 NFL players were treated at our institution for knee injuries that included a complete tear of the ACL; of these, 41 were primary ACLR and 6 were revision ACLR. Of the primary ACLRs, 6 were classified as ACL plus additional ligament and 3 were classified as multiligament. Return to game play (RTGP) was defined as returning to play in a regular-season game. Successful return to previous participation (RTPP) was defined as return to a level of participation equal to the level the player had reached before injury. Multivariate analysis was used to assess predictors of successful RTPP. Results: Using the RTGP criteria proposed by prior authors, the RTGP after primary ACLR was 73%. Using our proposed RTPP criteria, 87.8% of players successfully returned to the same level of participation after primary ACLR. RTGP percentage for all NFL players after ACLR (including multiligament injuries) was 67.6%, and the overall RTPP for those patients was 87.8%. In multivariate analysis, age ≤25 years was predictive of successful RTPP. High draft picks and offensive players played more seasons after primary ACLR. ACL graft rupture occurred in 4.3% of this cohort. Contralateral ACL tear occurred in 8.5%. Conclusion: Regardless of which definition is used to measure a successful outcome after ACLR surgery, the findings of this study suggest that successful return after primary ACLR in NFL athletes is higher than previously reported. While concomitant reconstruction of a single collateral ligament did not affect RTPP, revision ACLR or bicruciate plus collateral ligament reconstruction was associated with a lower RTPP rate. Age ≤25 years predicted successful RTPP. The risk of a future ACL tear of either knee after index reconstruction was approximately 13%.

Psychological and Social Components of Recovery Following Anterior Cruciate Ligament Reconstruction in Young Athletes: A Narrative Review

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18179267 ◽

2021 ◽

Vol 18 (17) ◽

pp. 9267

Author(s):

Emil Vutescu ◽

Sebastian Orman ◽

Edgar Garcia-Lopez ◽

Justin Lau ◽

Andrew Gage ◽

...

Keyword(s):

Acl Reconstruction ◽

Cruciate Ligament ◽

Acl Injury ◽

Narrative Review ◽

Acl Rupture ◽

Return To Play ◽

Young Athletes ◽

Acl Injuries ◽

Anterior cruciate ligament (ACL) rupture is a common injury in young athletes. To restore knee stability and function, patients often undergo ACL reconstruction (ACLR). Historically, there has been a focus in this population on the epidemiology of ACL injury, the technical aspects of ACL reconstruction, and post-operative functional outcomes. Although increasingly recognized as an important aspect in recovery, there remains limited literature examining the psychological aspects of post-operative rehabilitation and return to play following youth ACL reconstruction. Despite technical surgical successes and well-designed rehabilitation programs, many athletes never reach their preinjury athletic performance level and some may never return to their primary sport. This suggests that other factors may influence recovery, and indeed this has been documented in the adult literature. In addition to restoration of functional strength and stability, psychological and social factors play an important role in the recovery and overall outcome of ACL injuries in the pediatric population. Factors such as psychological readiness to return-to-play (RTP), motivation, mood disturbance, locus of control, recovery expectations, fear of reinjury, and self-esteem are correlated to the RTP potential of the young athlete. A better understanding of these concepts may help to maximize young patients’ outcomes after ACL reconstruction. The purpose of this article is to perform a narrative review of the current literature addressing psychosocial factors associated with recovery after ACL injury and subsequent reconstruction in young athletes. Our goal is to provide a resource for clinicians treating youth ACL injuries to help identify patients with maladaptive psychological responses after injury and encourage a multidisciplinary approach when treating young athletes with an ACL rupture.

Compliance With Neuromuscular Training and Anterior Cruciate Ligament Injury Risk Reduction in Female Athletes: A Meta-Analysis

Journal of Athletic Training ◽

10.4085/1062-6050-47.6.10 ◽

2012 ◽

Vol 47 (6) ◽

pp. 714-723 ◽

Cited By ~ 93

Author(s):

Dai Sugimoto ◽

Gregory D. Myer ◽

Heather M. Bush ◽

Maddie F. Klugman ◽

Jennifer M. Medina McKeon ◽

...

Keyword(s):

Confidence Interval ◽

Rate Ratio ◽

Female Athletes ◽

Incidence Rate Ratio ◽

Cruciate Ligament ◽

Acl Injury ◽

Neuromuscular Training ◽

Acl Injuries ◽

Context No consensus exists about the influence of compliance with neuromuscular training programs on reduction of the risk of anterior cruciate ligament (ACL) injury. Objective To systematically review and synthesize the published literature to determine if compliance with neuromuscular training is associated with reduced incidence of ACL injury in young female athletes. Data Sources We searched PubMed, SPORTDiscus, CINAHL, and MEDLINE for articles published from 1995 to 2010 using the key words anterior cruciate ligament prevention, ACL prevention, knee prevention, prospective knee prevention, neuromuscular training, and neuromuscular intervention. Study Selection Criteria for inclusion required that (1) the number of ACL injuries was reported, (2) a neuromuscular training program was used, (3) females were included as participants, (4) the study design was prospective and controlled, and (5) compliance data for the neuromuscular training program were provided. Data Extraction Extracted data included the number of ACL injuries, total number of participants per group, observation time period, number of participants who completed each session, number of sessions completed by an entire team, and number of total sessions. Attendance was calculated as the number of participants who completed each session converted into a percentage of the total number of participants. Intervention completion was calculated as the number of sessions completed by an entire team converted into a percentage of the total number of training sessions. These data were used to calculate an overall rate of compliance. Data Synthesis Six of 205 identified studies were included. Incidence rates of ACL injury were lower in studies with high rates of compliance with neuromuscular training than in studies with low compliance rates (incidence rate ratio = 0.27 [95% confidence interval = 0.07, 0.80]). Tertile analysis indicated rates of ACL injury incidence were lower in studies with high compliance rates than in studies with moderate and low compliance rates (incidence rate ratio = 0.18 [95% confidence interval = 0.02, 0.77]). Conclusions A potential inverse dose-response relationship exists between compliance with neuromuscular training and incidence of ACL injury. Attending and completing recommended neuromuscular sessions appears to be an important factor for preventing ACL injuries.

Anterior Cruciate Ligament Injury Incidence in Adolescent Athletes: A Systematic Review and Meta-analysis

The American Journal of Sports Medicine ◽

10.1177/0363546520959619 ◽

2020 ◽

pp. 036354652095961

Author(s):

Joshua T. Bram ◽

Lacey C. Magee ◽

Nishank N. Mehta ◽

Neeraj M. Patel ◽

Theodore J. Ganley

Keyword(s):

Female Athletes ◽

Cruciate Ligament ◽

Meta Analysis ◽

Cochrane Library ◽

Injury Incidence ◽

Adolescent Athletes ◽

Male Athletes ◽

Acl Injuries ◽

Background: The incidence of anterior cruciate ligament (ACL) injuries among adolescent athletes is steadily increasing. Identification of the highest risk sports for ACL injuries by sex and competitive setting (ie, practice vs match) is important for targeting injury prevention programs. Purpose: To identify the risk of ACL injuries in adolescent athletes by sport, sex, and setting across a variety of common US and international sports. Study Design: Meta-analysis. Methods: Essentially, 3 online databases (PubMed, Embase, and Cochrane Library) were searched for all studies of ACL injuries per athlete-exposure (AE) or hours of exposure in adolescent athletes. Injuries were then pooled and incidence rates (IRs) reported per 1000 AEs or hours of exposure, with the relative risk (RR) of injuries calculated for sex-comparable sports. IRs per competitive setting (match vs practice) were also calculated. Results: A total of 1235 ACL injuries over 17,824,251 AEs were identified (IR, 0.069 [95% CI, 0.065-0.074]), with 586 of these injuries in girls across 6,986,683 AEs (IR, 0.084 [95% CI, 0.077-0.091]) versus 649 injuries in boys over 10,837,568 AEs (IR, 0.060 [95% CI, 0.055-0.065]). Girls had a higher overall rate of ACL injuries (RR, 1.40 [95% CI, 1.25-1.57]), with the most disproportionate risk observed in basketball (RR, 4.14 [95% CI, 2.98-5.76]). The risk of ACL injuries by sex was highest in girls’ soccer (IR, 0.166 [95% CI, 0.146-0.189]) and boys’ football (IR, 0.101 [95% CI, 0.092-0.111]). ACL injuries were over 8 (RR, 8.54 [95% CI, 6.46-11.30]) and 6 (RR, 6.85 [95% CI, 5.52-8.49]) times more likely to occur in a match versus a practice setting for female and male athletes, respectively. Conclusion: The risk of ACL injuries overall approached nearly 1 per 10,000 AEs for female athletes, who were almost 1.5 times as likely as male athletes to suffer an ACL injury across all adolescent sports. A multisport female athlete was estimated to have a nearly 10% risk of ACL injuries over her entire high school or secondary school career. Specifically, male and female adolescents playing soccer, basketball, lacrosse, and football appeared at particular risk of injuries, a finding that can be used to target an injury intervention.

Management of the female anterior cruciate ligament: current concepts

Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine ◽

10.1136/jisakos-2019-000332 ◽

2020 ◽

Vol 5 (3) ◽

pp. 123-127

Author(s):

Nicholas Vaudreuil ◽

Justin Roe ◽

Lucy Salmon ◽

Elvire Servien ◽

Carola van Eck

Keyword(s):

Sports Medicine ◽

Female Athletes ◽

Cruciate Ligament ◽

Return To Sport ◽

Acl Injury ◽

Acl Injuries ◽

Unique Challenge ◽

Increased Risk ◽

Female athletes represent a unique challenge for sports medicine providers. Care for skeletally mature female athletes requires an understanding of the distinct physiology, risk factors and injury patterns that have been described in this population. Anterior cruciate ligament (ACL) injuries are commonly observed in female athletes, especially in high-risk sports such as soccer, basketball, lacrosse and volleyball. Women have been shown to be at a higher risk for ACL injury compared with their male peers, even competing in the same sport. Several factors must be considered when discussing the increased risk of ACL injuries in women. Anatomic factors and altered landing mechanics alignment contribute to increased forces seen at the ACL. A variety of other factors including altered neuromuscular profiles, hormonal factors and genetic factors may all play a role in increased predisposition towards ACL injury. Prevention strategies for ACL such as proprioceptive training may be helpful, especially for at-risk activities such as landing and cutting drills. Optimal surgical management including graft choice is an area of debate. Postoperatively, return to sport protocols are not well standardised for female athletes. Women have a lower return to sport frequency, and psychological factors such as fear of reinjury are often cited as a predominant factor. Overall, the influence of female gender on ACL injury treatment has been an area of heavy research recently. However, more research is needed to elicit the reasons for physical and psychological differences between men and women in order to clarify optimal postoperative management.

Anterior Cruciate Ligament Injury Risk in Sport: A Systematic Review and Meta-Analysis of Injury Incidence by Sex and Sport Classification

Journal of Athletic Training ◽

10.4085/1062-6050-407-16 ◽

2019 ◽

Vol 54 (5) ◽

pp. 472-482 ◽

Cited By ~ 6

Author(s):

Alicia M. Montalvo ◽

Daniel K. Schneider ◽

Kate E. Webster ◽

Laura Yut ◽

Marc T. Galloway ◽

...

Keyword(s):

Systematic Review ◽

Female Athletes ◽

Cruciate Ligament ◽

Acl Injury ◽

Injury Incidence ◽

Male Athletes ◽

Acl Injuries ◽

Sport Type ◽

Objective To evaluate sex differences in incidence rates (IRs) of anterior cruciate ligament (ACL) injury by sport type (collision, contact, limited contact, and noncontact). Data Sources A systematic review was performed using the electronic databases PubMed (1969–January 20, 2017) and EBSCOhost (CINAHL, SPORTDiscus; 1969–January 20, 2017) and the search terms anterior cruciate ligament AND injury AND (incidence OR prevalence OR epidemiology). Study Selection Studies were included if they provided the number of ACL injuries and the number of athlete-exposures (AEs) by sex or enough information to allow the number of ACL injuries by sex to be calculated. Studies were excluded if they were analyses of previously reported data or were not written in English. Data Extraction Data on sport classification, number of ACL injuries by sex, person-time in AEs for each sex, year of publication, sport, sport type, and level of play were extracted for analysis. Data Synthesis We conducted IR and IR ratio (IRR) meta-analyses, weighted for study size and calculated. Female and male athletes had similar ACL injury IRs for the following sport types: collision (2.10/10 000 versus 1.12/10 000 AEs, IRR = 1.14, P = .63), limited contact (0.71/10 000 versus 0.29/10 000 AEs, IRR = 1.21, P = .77), and noncontact (0.36/10 000 versus 0.21/10 000 AEs, IRR = 1.49, P = .22) sports. For contact sports, female athletes had a greater risk of injury than male athletes did (1.88/10 000 versus 0.87/10 000 AEs, IRR = 3.00, P < .001). Gymnastics and obstacle-course races were outliers with respect to IR, so we created a sport category of fixed-object, high-impact rotational landing (HIRL). For this sport type, female athletes had a greater risk of ACL injury than male athletes did (4.80/10 000 versus 1.75/10 000 AEs, IRR = 5.51, P < .001), and the overall IRs of ACL injury were greater than all IRs in all other sport categories. Conclusions Fixed-object HIRL sports had the highest IRs of ACL injury for both sexes. Female athletes were at greater risk of ACL injury than male athletes in contact and fixed-object HIRL sports.