scholarly journals Return to Sport Following Anterior Cruciate Ligament Reconstruction: Women's Lacrosse

2021 ◽  
Vol 1 (1) ◽  
pp. 6-16
Author(s):  
Rachel Lampros ◽  
Isabella Sprague
Keyword(s):  
Anterior Cruciate Ligament ◽  
Physical Therapists ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Neuromuscular Control ◽  
Rehabilitation Program ◽  
Strength And Conditioning ◽  
Functional Rehabilitation ◽  
Cardiovascular Training ◽  
Anterior Cruciate

Participation in women’s lacrosse has increased in popularity over the last 20 years with a subsequent rise in sports-related injuries. Despite this increase, there is a paucity of research examining this population, particularly regarding guidelines for safe return to lacrosse after anterior cruciate ligament (ACL) reconstruction.  A lacrosse-specific functional rehabilitation program is critical to the success of the athlete.  The athlete must be prepared and demonstrate the ability to cut, pivot, jump, pass, and shoot with the incidental contact required for sport clearance.  A criterion-based program delineating a progression of range of motion, mobility, strength, neuromuscular control, agility, and cardiovascular training is an essential part of ACL rehabilitation.  Early incorporation of lacrosse-specific skills emphasizing multiplanar neuromuscular control should gradually progress to more challenging field-based tasks as the athlete transitions through their rehabilitation program.  A multidisciplinary team of physicians, physical therapists, athletic trainers, strength and conditioning specialists, coaches, and parents must collaborate effectively to reduce the athlete’s risk for reinjury, meet the demands of the sport, and facilitate returning to the field without complications.  Associated video content

scholarly journals Funcionalidade e Componente Psicológica após Reconstrução do Ligamento Cruzado Anterior em Atletas

2021 ◽  
Vol 12 (3) ◽  
pp. 15-17
Author(s):  
Amílcar Cordeiro ◽  
◽  
António Araújo ◽  
Vítor Simões ◽  
Pedro Pereira ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Essential Element ◽  
Acl Injury ◽  
Rehabilitation Program ◽  
Functional Rehabilitation ◽  
Confidence Levels ◽  
Anterior Cruciate

The anterior cruciate ligament (ACL) is an essential element in the dynamic stability of the knee and in the structural protection of the joint. Thirty patients were included who underwent ACL ligamentoplasty and a functional rehabilitation program. There was a significant reduction in the competitive level (p <0.001) and a correlation was identified between the levels of functionality after return to sport with the athletes’ confidence levels (p <0.01). It is concluded that the ACL injury caused a loss of competitive level and that the management of the psychological condition may be an important tool in the rehabilitation program and return to sport of athletes submitted to ACL ligament reconstruction.

scholarly journals Tegner level is predictive for successful return to sport 2 years after anterior cruciate ligament reconstruction

2020 ◽  
Author(s):  
Antonio Klasan ◽  
Sven Edward Putnis ◽  
Samuel Grasso ◽  
Vikram Kandhari ◽  
Takeshi Oshima ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Regression Analysis ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Rehabilitation Program ◽  
Cruciate Ligament Reconstruction ◽  
Anterior Cruciate

Abstract Purpose For a successful return to sport (RTS) after an anterior cruciate ligament reconstruction (ACLR), patients are recommended to attend a comprehensive rehabilitation program, followed by an RTS assessment, that is a combination of tests. The purpose of this study was to predict a successful return to sport using the results of the RTS assessment and self-reported questionnaires at minimum 2 years after ACLR. Methods A total of 123 consecutive ACLR patients undertook an intensive rehabilitation program followed by a comprehensive RTS assessment that included an established combination of balance and strength tests, the ACL-return to sport after Injury scale (ACL-RSI) questionnaire and a KT1000 laximetry test. Preinjury and expected Tegner and Lysholm were collected at baseline, at RTS and prospectively collected at minimum 2-year follow-up. The patients were asked if they returned to their previous sport and at which level. All variables were included in a regression analysis predicting a successful return to previous sport, return to the same level of sport as well as the Tegner level at 2 years. Results Sixty-two patients (50%) returned to their previous sport by the 2-year follow-up, without a difference in preinjury Tegner between these two groups (n.s.). Expected preoperative Tegner was the only significant predictor of a successful return to previous sport (p = 0.042; OR 1.300, 95% CI 1.010–1.672). Out of the 62 patients returning to their previous sport, 38 (61%) reported to be on the same or higher level. The only predictive variable for returning to the same level was the higher preinjury Tegner level (p = 0.048; OR 1.522). Multivariate regression analysis of Tegner level at 2 years found younger age to be the only predictive value. From the RTS assessment tests, the ACL-RSI questionnaire and the posterolateral balance test were predictive variables for Tegner at 2-year follow-up, albeit in the univariate regression analysis. Conclusions Preoperative Tegner and expected Tegner level collected prior to an ACL reconstruction can aid in the objective prediction of patients’ return to sport after 2 years. High-level athletes are more likely to return to their previous sport and to the previous level. Younger patients achieve a higher Tegner level at 2 years. Level of evidence Level III study.

scholarly journals Current Concepts for Injury Prevention in Athletes After Anterior Cruciate Ligament Reconstruction

2012 ◽  
Vol 41 (1) ◽  
pp. 216-224 ◽  
Author(s):  
Timothy E. Hewett ◽  
Stephanie L. Di Stasi ◽  
Gregory D. Myer
Keyword(s):  
Risk Factors ◽  
Anterior Cruciate Ligament ◽  
High Risk ◽  
Knee Injury ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Neuromuscular Control ◽  
Injury Incidence ◽  
Anterior Cruciate

Ligament reconstruction is the current standard of care for active patients with an anterior cruciate ligament (ACL) rupture. Although the majority of ACL reconstruction (ACLR) surgeries successfully restore the mechanical stability of the injured knee, postsurgical outcomes remain widely varied. Less than half of athletes who undergo ACLR return to sport within the first year after surgery, and it is estimated that approximately 1 in 4 to 1 in 5 young, active athletes who undergo ACLR will go on to a second knee injury. The outcomes after a second knee injury and surgery are significantly less favorable than outcomes after primary injuries. As advances in graft reconstruction and fixation techniques have improved to consistently restore passive joint stability to the preinjury level, successful return to sport after ACLR appears to be predicated on numerous postsurgical factors. Importantly, a secondary ACL injury is most strongly related to modifiable postsurgical risk factors. Biomechanical abnormalities and movement asymmetries, which are more prevalent in this cohort than previously hypothesized, can persist despite high levels of functional performance, and also represent biomechanical and neuromuscular control deficits and imbalances that are strongly associated with secondary injury incidence. Decreased neuromuscular control and high-risk movement biomechanics, which appear to be heavily influenced by abnormal trunk and lower extremity movement patterns, not only predict first knee injury risk but also reinjury risk. These seminal findings indicate that abnormal movement biomechanics and neuromuscular control profiles are likely both residual to, and exacerbated by, the initial injury. Evidence-based medicine (EBM) strategies should be used to develop effective, efficacious interventions targeted to these impairments to optimize the safe return to high-risk activity. In this Current Concepts article, the authors present the latest evidence related to risk factors associated with ligament failure or a secondary (contralateral) injury in athletes who return to sport after ACLR. From these data, they propose an EBM paradigm shift in postoperative rehabilitation and return-to-sport training after ACLR that is focused on the resolution of neuromuscular deficits that commonly persist after surgical reconstruction and standard rehabilitation of athletes.

scholarly journals Psychosocial Barriers After Anterior Cruciate Ligament Reconstruction: A Clinical Review of Factors Influencing Postoperative Success

2019 ◽  
Vol 11 (6) ◽  
pp. 528-534
Author(s):  
Julie P. Burland ◽  
Jennifer L. Toonstra ◽  
Jennifer S. Howard
Keyword(s):  
Anterior Cruciate Ligament ◽  
Clinical Review ◽  
Psychosocial Factors ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Neuromuscular Control ◽  
Ample Evidence ◽  
Rehabilitation Process ◽  
Anterior Cruciate ◽  
Return To Activity

Context: Psychosocial factors arising after anterior cruciate ligament (ACL) injury may have a direct influence on an individual’s decision to return to sport after ACL reconstruction (ACLR). While there is ample evidence to suggest that deficits in quadriceps strength, neuromuscular control, and clinical functional tasks exist after ACLR, the root and contribution of psychological dysfunction to an individual’s success or return to sport after ACLR is still largely uncertain and unexplored. Given the discrepancy between successful functional outcomes and the percentage of athletes who return to sport, it is important to thoroughly address underlying factors, aside from physical function, that may be contributing to these lower return rates. Evidence Acquisition: Articles that reported on return to sport, psychological factors, and psychosocial factors after ACLR were collected from peer-reviewed sources available on Medline (1998 through August 2018). Search terms included the following: anterior cruciate ligament OR ACL AND return-to-sport OR return-to-activity, anterior cruciate ligament OR ACL AND psychological OR psychosocial OR biopsychosocial OR fear OR kinesiophobia OR self-efficacy, return-to-activity AND psychological OR psychosocial. Study Design: Clinical review. Level of Evidence: Level 5. Results: Psychosocial factors relative to injury are important components of the rehabilitation process. To fully understand how psychosocial factors potentially influence return to sport, an athlete’s emotions, experiences, and perceptions during the rehabilitation process must be acknowledged and taken into consideration. Conclusion: Acknowledgment of these psychosocial factors allows clinicians to have a better understanding of readiness to return to sport from a psychological perspective. Merging of the current ACLR rehabilitation protocols with knowledge related to psychosocial factors creates a more dynamic, comprehensive approach in creating a positive and successful rehabilitation environment, which may help improve return-to-sport rates in individuals after ACLR.

scholarly journals Periodization in Anterior Cruciate Ligament Rehabilitation: A Novel Framework

2020 ◽  
pp. 1-8
Author(s):  
George Kakavas ◽  
Nikolaos Malliaropoulos ◽  
Georgios Bikos ◽  
Ricard Pruna ◽  
Xavier Valle ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Injury Risk ◽  
Physical Therapists ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Cost Effective ◽  
Psychological Trauma ◽  
Training Methods ◽  
The Usa ◽  
Anterior Cruciate

More than 250,000 anterior cruciate ligament (ACL) injuries occur each year in the USA, and approximately 65% of these injuries undergo reconstructive surgery. Appropriate rehabilitation after ACL reconstruction can yield predictably good outcomes, with return to previous levels of activity and high knee function. At present, periodization is used at all levels of sports training. Whether conceptualized and directed by coaches, or by athletes themselves, competitors structure their training in a cyclic fashion, enabling athletes to best realize their performance goals. In practical application, sport physical therapists use periodization: postoperative “protocols” serve as rudimentary forms of periodization, albeit implemented over shorter time frames than that typically employed in preparation for competition. An ACL injury should not be considered a “simple” musculoskeletal pathology with only local mechanical or motor dysfunctions. Together with the psychological trauma and reduction in physical capacity, there is a cascade of events, including neurological insult to the central nervous system and reduction in afferences to the sensorimotor system. Rehabilitation should consider all these issues, and periodization would allow to better define and to plan aims and objectives to return athletes to their sport. Technological resources including advanced neuroimaging methods, virtual reality for injury risk screening and return to sport assessment, and interactive artificial reality-based neuromuscular training methods offer new approaches and tools to address this important biomedical problem. The cost and availability of many of these technologies will continue to decrease, providing greater availability, scientific rigor, and ultimately, utility for cost-effective and data-driven assessments.

Altered Knee Laxity and Stiffness in Response to a Soccer Match Simulation in Players Returning to Sport Within 12 Months After Anterior Cruciate Ligament Reconstruction

2021 ◽  
pp. 036354652110130
Author(s):  
Stefano Nuccio ◽  
Luciana Labanca ◽  
Jacopo Emanuele Rocchi ◽  
Pier Paolo Mariani ◽  
Paola Sbriccoli ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Knee Laxity ◽  
Activity Level ◽  
Soccer Players ◽  
Control Group ◽  
Soccer Match ◽  
Anterior Cruciate ◽  
Anterior Knee

Background: The acute effects of exercise on anterior knee laxity (AKL) and anterior knee stiffness (AKS) have been documented in healthy participants, but only limited evidence has been provided for athletes cleared to return to sports after anterior cruciate ligament (ACL) reconstruction (ACLR). Purpose/Hypothesis: The purpose was to determine if 45 minutes of a soccer match simulation lead to acute changes in AKL and AKS in soccer players returning to sport within 12 months after ACLR. We hypothesized that the reconstructed knee of the ACLR group would exhibit an altered response to sport-specific exercise. Study Design: Controlled laboratory study. Methods: A total of 13 soccer players cleared to return to sport after ACLR and 13 healthy control soccer players matched for age, physical activity level, limb dominance, and anthropometric characteristics were recruited. To assess the effects of a standardized soccer match simulation (Soccer Aerobic Field Test [SAFT45]) on AKL and AKS, an arthrometric evaluation was carried out bilaterally before and immediately after SAFT45. To conduct a comprehensive examination of the force-displacement curve, the absolute and side-to-side difference (SSD) values of both AKL and AKS were extracted at 67, 134, and 200 N. Results: The ACLR and control groups showed similar AKL and AKS at baseline ( P > .05). In response to SAFT45, laxity increased bilaterally at all force levels by 14% to 17% only in the control group ( P < .025). Similarly, AKS at 134 and 200 N decreased in response to SAFT45 only in the control group (10.5% and 20.5%, respectively; P < .025). After SAFT45, the ACLR group had 1.9 and 2.5 times higher SSDs of AKS at 67 and 134 N compared with the control group, respectively ( P < .025), as well as a 1.9 times higher SSD of AKS at 134 N compared with baseline ( P = .014). Conclusion: Soccer players at the time of return to sport after ACLR showed an altered mechanical response to a sport-specific match simulation consisting of bilaterally unchanged AKL and AKS. Clinical Relevance: Soccer players showing altered AKL and AKS in response to exercise after ACLR may not be ready to sustain their preinjury levels of sport, thus potentially increasing the risk of second ACL injuries.

scholarly journals Rehabilitation and Return to Sport Assessment after Anterior Cruciate Ligament Injury: Quantifying Joint Kinematics during Complex High-Speed Tasks through Wearable Sensors

Sensors ◽  
2021 ◽  
Vol 21 (7) ◽  
pp. 2331
Author(s):  
Stefano Di Paolo ◽  
Nicola Francesco Lopomo ◽  
Francesco Della Villa ◽  
Gabriele Paolini ◽  
Giulio Figari ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Excellent Agreement ◽  
High Speed ◽  
Cruciate Ligament ◽  
Wearable Sensors ◽  
Return To Sport ◽  
Acl Injury ◽  
Wearable Sensor ◽  
Anterior Cruciate ◽  
Full Body

The aim of the present study was to quantify joint kinematics through a wearable sensor system in multidirectional high-speed complex movements used in a protocol for rehabilitation and return to sport assessment after Anterior Cruciate Ligament (ACL) injury, and to validate it against a gold standard optoelectronic marker-based system. Thirty-four healthy athletes were evaluated through a full-body wearable sensor (MTw Awinda, Xsens) and a marker-based optoelectronic (Vicon Nexus, Vicon) system during the execution of three tasks: drop jump, forward sprint, and 90° change of direction. Clinically relevant joint angles of lower limbs and trunk were compared through Pearson’s correlation coefficient (r), and the Coefficient of Multiple Correlation (CMC). An excellent agreement (r > 0.94, CMC > 0.96) was found for knee and hip sagittal plane kinematics in all the movements. A fair-to-excellent agreement was found for frontal (r 0.55–0.96, CMC 0.63–0.96) and transverse (r 0.45–0.84, CMC 0.59–0.90) plane kinematics. Movement complexity slightly affected the agreement between the systems. The system based on wearable sensors showed fair-to-excellent concurrent validity in the evaluation of the specific joint parameters commonly used in rehabilitation and return to sport assessment after ACL injury for complex movements. The ACL professionals could benefit from full-body wearable technology in the on-field rehabilitation of athletes.

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