ACL Reconstruction In Athletes Research Articles

Podium Presentation Title: Soft Tissue Quadriceps Autograft is a Reliable Option in Revision ACL Reconstruction in Athletes

Podium Presentation Title: Soft Tissue Quadriceps Autograft is a Reliable Option in Revision ACL Reconstruction in Athletes

Functional outcome and single hop test results of ACL reconstruction in athletes at a follow-up of 6 and 12 months: modified all-inside versus conventional hamstring autograft

reconstruction (ACLR) is a surgical treatment orthopedists perform. This study aims to compare the 6 and 12 months post-op results of single leg hop tests (SLHT) performed in multidirectional conventional semitendinosus/gracilis (ST/G) and modified all inside (MAI) ACLR techniques on both sides and the limb symmetry indexes (LSI) of both techniques. This study evaluated a retrospective cohort of 50 male athletes who applied MAI (n = 23) and traditional ACLR ST/G (n = 27) techniques. Functional knee strength of the participants on both sides was measured with different SLHTs at 6 and 12 months postoperatively. The SLHT included medial side (MSTH), triple hop (TH), medial rotation (90◦) (MRH), crossover triple (CH) ve the single hop (SH) hop for distance. Both ACLR techniques showed significant improvement in mean Tegner, International Knee Documentation Committee (IKDC) and Lysholm scores preoperatively and at 6 and 12 months postoperatively (p < 0.05). For MAI and ST/G techniques, there was no significant difference in the results of SLHTs at 6 and 12 months for both the operated and non-operated sides (p < 0.05). Significance was found only in the MRH test of the non-operated side (p < 0.05). There was no significant difference in SLHT scores between the operated and non-operated sides at 6 and 12 months postoperatively (p > 0.05). There was no difference in LSI scores between techniques (p < 0.05). Our study revealed similar LSI rates in ST/G and MAI techniques at 6 and 12 months, suggesting that MAI technique can be used as a functional ACLR technique for athletes.

Joint awareness and return to pre-injury level of activities after ACL reconstruction in athletes vs non-athletes.

The outcome of arthroscopic anterior cruciate ligament reconstruction (ACLR) in the non-athlete population is under-reported. The study aimed to compare the functional outcomes of ACLR in the non-athlete and athlete population by patient reported outcome measures (PROMs)- International Knee Documentation Committee score (IKDC), Lysholm knee scoring scale, Forgotten joint score (FJS-12) and return to pre-injury activity level. The study also correlated the FJS-12 score with other commonly used PROM's (IKDC and Lysholm). This was a prospective comparative study including patients undergoing ACLR. Patients were divided into two groups. Group-1 (non-athletes) and Group-2 (athletes, defined as those with pre-injury Tegner activity level > 5). Demographic profile, management of associated meniscal injury, perioperative and midterm complications were noted. All patients had 24months follow-up. Knee laxity assessment by pivot shift test, functional outcome scores (Lysholm and IKDC) and FJS-12 were assessed preoperatively and postoperatively at 12 and 24months. Group 1 and 2 included 69 and 47 participants, respectively, (total 116 patients). The mean age of group 1 was significantly higher than group 2 (33.1 ± 8.0 vs 25.0 ± 4.9years; p < 0.005). There was no statistically significant difference in PROMs and FJS-12 scores between the groups at any follow-up. Return to pre-injury Tegner activity level post-ACLR was 88.4% (n = 61) and 46.8% (n = 22) in group 1 and 2, respectively (p). The ceiling effect in FJS-12, IKDC, and Lysholm scores were achieved by 9.3%, 19.5%, and 34.7% of patients (n = 116), respectively, at 2-year follow-up. The ceiling effect of FJS-12, Lysholm, and IKDC scores between the groups at final follow-up was not statistically significant (p = 1, p = .524, p = .09, respectively). The functional outcome of ACLR was comparable between athletes and non-athletes. FJS-12 has a lower ceiling effect and better discriminatory power than Lysholm and IKDC scores. FJS-12 score can be satisfactorily used in ACLR to observe and monitor changes in patient satisfaction and outcome. II, Prospective comparative study.

Symmetry in Triple Hop Distance Hides Asymmetries in Knee Function After ACL Reconstruction in Athletes at Return to Sports

Background: After anterior cruciate ligament reconstruction (ACLR), a battery of strength and hop tests is frequently used to determine the readiness of an athlete to successfully return to sports. However, the anterior cruciate ligament reinjury rate remains alarmingly high. Purpose: To evaluate the lower limb function of athletes after ACLR at the time when they had been cleared to return to sports (RTS). We aimed to evaluate if passing discharge criteria ensures restoration of normal lower limb biomechanics in terms of kinematics, kinetics, work, and percentage work contribution during a triple hop for distance. Study Design: Controlled laboratory study. Methods: Integrated 3-dimensional motion analysis was performed in 24 male athletes after ACLR when cleared to RTS and 23 healthy male controls during the triple-hop test. The criteria for RTS were (1) clearance by the surgeon and the physical therapist, (2) completion of a sports-specific on-field rehabilitation program, and (3) limb symmetry index >90% after quadriceps strength and hop battery tests. Lower limb and trunk kinematics, as well as knee joint moments and work, were calculated. Between-limb differences (within athletes after ACLR) and between-group differences (between ACLR and control groups) were evaluated using mixed linear models. Results: Although achieving 97% limb symmetry in distance hopped and displaying almost 80% symmetry for knee work absorption in the second rebound and third landing, the ACLR cohorts demonstrated only 51% and 66% limb symmetry for knee work generation in the first and second rebound phases, respectively. During both work generation phases of the triple hop, the relative contribution of the involved knee was significantly smaller, with a prominent compensation from the hip joint (P < .001, for all phases) as compared with the uninvolved limb and the controls. In addition, patients deployed a whole body compensatory strategy to account for the between-limb differences in knee function, mainly at the hip, pelvis, and trunk. Conclusion: Symmetry in the triple hop for distance masked important deficits in the knee joint work. These differences were more prominent during work generation (concentric-propulsive) than work absorption (eccentric-landing). Clinical Relevance: Symmetry in hop distance during the triple hop test masked significant asymmetries in knee function after ACLR and might not be the appropriate outcome to use as a discharge criterion. Differences between limbs in athletes after ACLR were more prominent during the power generation than the absorption phase.

Sleep and psychological factors are associated with meeting discharge criteria to return to sport following ACL reconstruction in athletes.

This study aimed to determine if sleep quality and psychological factors were associated with time to meet the discharge criteria to return to sport (RTS) following anterior cruciate ligament reconstruction (ACL-R) among athletes. A cohort-study design included 89 athletes following ACL-R. Each participant completed a battery of questionnaires at 6 different time points: within 3 days of injury occurrence and at post-surgery (1.5 m, 3 m, 4.5 m, 6 m and when discharge criteria were met). Assessment included sleep quality and quantity, symptoms of depression, anxiety, stress, psychological readiness to RTS and fear of re-injury. The primary outcome was the time needed to meet all discharge criteria to RTS. Sleep parameters and psychological factors were not associated with time to meet the discharge criteria to RTS. However, athletes that had lower scores of anxiety (OR 1.2 (95% CI 1.0, 1.3) and insomnia (OR 1.2 (95% CI 1.0, 1.3) at baseline were more likely to meet the RTS discharge criteria. Athletes with better sleep quality at 3m, 4.5m and 6m were more likely to meet the RTS discharge criteria OR 1.3 (95% CI 1.1, 1.7), 2.0 (95% CI 1.1–3.4) and 1.4 (95% CI 1.0, 1.9) respectively. Sleep quality and psychological factors were not associated with time to meet the discharge criteria to RTS but impacted whether athletes adhered and completed their rehabilitation program or not. Monitoring sleep quality and psychological factors of athletes before and following ACL-R surgery is important to identify athletes who could have difficulties in adhering to and completing their rehabilitation program to RTS.

Influence of immobilization mode on postoperative clinical data a month after an ACL reconstruction in athletes admitted to rehabilitation center

To determine the influence of immobilization mode on postoperative clinical data a month after an ACL reconstruction in athletes admitted to rehabilitation center. We analyzed post-operative data from a recorded cohort between 4 and 6 weeks after ACL ligamentoplasty. Were included patients with first ACL reconstruction on complete rupture in athlete came to the “Centre européen de rééducation du sportif” and aged at least 15 years 9 months. They follow a specialized rehabilitation protocol from 1st February 2008 to 30th October 2010. Clinical results were analyzed at hospital release between 4 and 6 weeks. The rehabilitation protocol was common to all patients. Clinical outcome parameters were quantitative (patella mobility, quadriceps atrophy, pain measurement by EVA, range of motion and scores: subjective IKDC and PPLP1) and qualitative (trophicity by measurement of the knee effusion and subquadricipital bursa flexibility, functional assessment quadriceps lock, walk evaluation). The patients were divided according to immobilization mode: orthosis articulated rigid or no brace. We have found no significant difference between each of three groups for each parameter studied ( P < 0.05). We do not have rupture in the three groups. There was not difference among the three groups for the qualitative and quantitative parameters, markers of decreasing inflammation and functional improvement at 4–6 week. In specialized center, orthosis establishment whatever the type or not put it, does not influence the early postoperative clinical results and evolution in patients with an ACL ligamentoplasty of the athlete. These results lead us to wonder about the value of the orthotics prescription, particularly articulated very expensive compared to simple rigid splints.

Return to play following ACL reconstruction: survey among experienced arthroscopic surgeons (AGA instructors)

There is a lack of consensus regarding appropriate criteria attesting patient's unrestricted sports activities after ACL reconstruction. The purpose of this study was to perform a survey among experienced arthroscopic surgeons regarding their return to play guidelines in these patients. A six-item questionnaire was distributed among experienced arthroscopic surgeons (instructors of the German speaking society of arthroscopy, AGA). Study participants were asked to choose from multiple choice answers and had the possibility answering in an open discussion field. The response rate of the survey was 85.7 %. A total of 83.5 % used autologous hamstring grafts for ACL reconstruction in athletes followed by BPTB (37.2 %) and quadriceps tendon graft (12 %). Approximately 63.5 % recommended a time point later than 6 months allowing return to play after ACL reconstruction in the athlete (after 4 and 6 months 2.3 and 35.3 %, respectively). 76.6 % recommended starting with sports specific rehabilitation after 4 months (21.6 % after 6 months). The most frequent criterion (multiple answers) to allow return to play was negative Lachman test (81.7 % positive answers) followed by free range of motion (78.4 %), negative pivot shift (60.1 %), anterior drawer (45.4 %), proprioception test (43.1 %), muscular strength analysis (40.8 %), single-leg hop jump test (39.0 %), KT 1000 measurement (16.1 %), and MRI (4.1 %). Of the surgeons 85.8 % did not use any of the given scores as criterion to allow return to competitive sports (subjective IKDC score 10.6 %, Lysholm score 8.3 %, objective IKDC score 7.4 %, Tegner activity scale 3.7 %). In conclusion, the majority of surgeons do not consider muscle function, jump tests, alignment tests, and proprioception as relevant return to sports criterion. However, these are two crucial parameters for return to sports.

Anterior cruciate ligament reconstruction: Comparison of male and female athletes using the patellar tendon and hamstring autografts

Few authors have studied the effects of gender on the outcome of ACL reconstruction in athletes. This retrospective-prospective study compared the treating results using the patellar tendon (LP) and hamstring (StG) techniques in men and women. We followed 40 athletes (23 males, 17 females) from population of 120 patients operated at Institute for Orthopaedic Surgery Banjica. There were 13 males and 7 females in the LP group and 11 males and 9 females in the StG group. Patients were operated by the same surgeons within 6 month from injury and underwent the same rehabilitation program. After an average of 24 months they were assesed by clinical evaluation, knee laxity analysis and standard knee scores. Among LP patients there were no significant differences between males and females regarding knee evaluation form, laxity or functional tests. Females in the hamstring group had significantly grater laxity and significantly higher deficit in flexion and extension. We suggest further studies on the clinical significance of these findings, particularly on their ramifications of return to sports and rehabilitation of female athletes.