Anterior Cruciate Ligament Reconstruction In Athletes Research Articles

Bilateral Dynamic Strength Index In Healthy- Versus Anterior Cruciate Ligament Reconstruction Athletes

Bilateral Dynamic Strength Index In Healthy- Versus Anterior Cruciate Ligament Reconstruction Athletes

Return to Play After an Anterior Cruciate Ligament Reconstruction in the Collegiate Athlete: A Systematic Review Evaluating Return to Play Proportions and Associated Factors.

OBJECTIVE: To estimate anterior cruciate ligament reconstruction (ACLR) return-to-play (RTP) factors and proportions across all National Collegiate Athletics Association (NCAA) sports. DESIGN: Systematic review with prognosis and etiology components. LITERATURE SEARCH: Two independent reviewers searched PubMed, Cochrane Library, and Embase databases using terms related to RTP, ACLR, and NCAA for articles published up to June 30, 2023. STUDY SELECTION CRITERIA: Articles were included if RTP proportions or factors affecting RTP were reported and if the study population included NCAA collegiate athletes recovering from an ACLR. DATA SYNTHESIS: The proportion represents the total number of athletes who returned to play after ACLR over the total number of ACLR athletes from each cohort. The cumulative proportion represents the aggregated total from each included study. When eligibility information was available (ie, athletes in their final year of eligibility), RTP proportions were adjusted. The Newcastle-Ottawa Scale (NOS) was used to assess the study quality and scored by 2 raters. RESULTS: Nine studies were included. RTP criteria varied across the studies. Proportions of RTP ranged from 69% to 92%, with a cumulative RTP proportion after ACLR of 84% (628/745). The primary factors associated with the proportion of RTP were scholarship status, competitive eligibility remaining, depth chart position, and surgical graft type. CONCLUSIONS: The cumulative proportion of RTP was 84% and was associated with patient-specific and operative factors. Psychological and functional factors were not routinely reported, and rehabilitation protocols were unknown. Data were not explicitly available for any athletes outside of Division I. The criteria for RTP after ACLR varied. J Orthop Sports Phys Ther 2024;54(10):1-9. Epub 10 September 2024. https://doi.org/10.2519/jospt.2024.12483.

A Review on Rehabilitation and Return to Sport Criteria Post ACL Reconstruction in Athletes

Background: Anterior Cruciate Ligament (ACL) injuries are most often found in young active athletes. They range from mild (small tears or sprain) to severe (complete tear of ligament) and are mostly seen in sports like football, basketball, cricket, gymnastics, skiing, etc ACL reconstruction is a surgical knee procedure that requires intensive postoperative rehabilitation by the athlete to be able to return to sport. Methods: A systematic review was conducted considering the data sources PubMed (MEDLINE), Cochrane Library, PEDro, Google Scholar, EBSCO, Medscape, and Scopus databases using the keywords ACL reconstruction, rehabilitation, and return to sport criteria. The time frame ranged between 2017-2022 Results: The study selection process is presented according to PRISMA guidelines. After title and abstract screening, 50 full-text articles were assessed for eligibility 20 were excluded; the remaining 30 articles were deemed to meet the inclusion criteria and were included. The total number of RCTs included was thirty Conclusion: The thirty included RCTs offer convincing results on post-operative outcomes of muscular strength, function, patient reported symptoms and determination of return to sport criteria. There is limitation in holistic evidence that looks into the psychological as well as physical components of rehabilitation of an athlete that will also accelerate the return to sport duration. Keywords: ACL reconstruction, rehabilitation, return to sport criteria

Postural Control During Single-Leg Landing in Female Athletes After Anterior Cruciate Ligament Reconstruction.

Secondary anterior cruciate ligament (ACL) injury is a complication of ACL reconstruction (ACLR), which may result from altered neuromuscular control affecting anticipatory postural adjustments (APAs) and compensatory postural adjustments (CPAs) required for maintaining balance during movement. However, it remains unclear how APAs and CPAs differ in single-leg landings post-ACLR compared to healthy subjects. The purpose of this study was to clarify the differences in muscle activities of APAs and CPAs, lower limb kinematics, and kinetics between athletes with a history of ACLR and healthy athletes during single-leg landing. Cross-sectional study. Eighteen female athletes were recruited and divided into ACLR (n = 9) and control groups (n = 9). The experimental task involved a single-leg landing from a 30 cm box. Joint angles and moments were determined using a 3-dimensional motion analysis system, while muscle activity was assessed using surface electromyography. Analysis intervals were divided into two phases: the APA phase (-150 ms to 50 ms) and the CPA phase (50 ms to 250 ms), with initial contact (0 ms) as the reference point. Muscle activity onset time was defined as the time when the baseline exceeded by the sum of mean values and 2 standard deviations. No significant differences were observed in muscle activity or onset time between the ACLR and control groups. However, an increased hip external rotation moment was observed during the CPA phase in the ACLR group. These findings suggest that APAs and CPAs of athletes who returned to sports more than 1 year post-ACLR may be similar. The increased hip external rotation moment in the ACLR group during the CPA phase could represent a specific compensatory strategy to decrease the hip internal rotation angle post-ACLR. III.

Effects of Kinesio taping on lower limb biomechanical characteristics during the cutting maneuver in athletes after anterior cruciate ligament reconstruction.

To determine the effects of Kinesio taping (KT) on the biomechanical characteristics of the lower limbs during the 90° cutting maneuver in anterior cruciate ligament (ACL) reconstruction (ACLR) athletes. Eighteen ACLR athletes were recruited and subjected randomly to three taping conditions, KT, placebo taping (PT), and no taping (NT), followed by a 90° cutting test. A nine-camera infrared high-speed motion capture system (Vicon, T40, 200 Hz) was used to record the kinematic parameters of the lower limbs during the cutting maneuver, and a three-dimensional dynamometer (Kistler, 1000 Hz) was used to record the kinetic parameters of the lower limbs. A one-way repeated measures analysis of variance was conducted to compare the differences in the lower limb kinematic and kinetic characteristics of ACLR athletes subjected to these interventions. During the landing phase, the knee valgus angle reduced significantly with KT than with NT (95% confidence interval = -1.399 to -0.154; P = 0.025), whereas no significant difference was observed between PT and NT (95% confidence interval = -1.251 to 0.217; P = 0.236). No significant differences were observed in the other kinematic variables among the three taping conditions (P > 0.05). During the landing phase, no significant differences in the kinetic variables were observed among the three taping conditions (P > 0.05). Although KT does not improve the kinetic variables of athletes after ACLR during the 90° cutting maneuver, it reduces the knee valgus angle, which could reduce the risk of secondary ACL injury.

Risk Factors for Ipsilateral Versus Contralateral Reinjury After ACL Reconstruction in Athletes: A Systematic Review and Meta-analysis.

Anterior cruciate ligament (ACL) reinjury after ACL reconstruction (ACLR) can occur on the ipsilateral or contralateral side. Limited evidence exists regarding the difference between the incidence of reinjury to either knee, which is important in developing interventions to prevent ACL reinjury. To compare the reinjury rate of the ACL on the ipsilateral side versus the contralateral side in athletes after ACLR and investigate the risk factors that may cause different reinjury rates between the sides. Systematic review; Level of evidence, 4. A systematic review was performed based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies that involved ACL reinjury in athletes after ACLR were reviewed. Considering several risk factors, including age and sex, a comparison of ACL reinjury incidence on the ipsilateral and contralateral sides was performed using a meta-analysis. Of the 17 selected studies, 3 were found to be at high risk of bias, and thus, 14 (n = 3424 participants) studies were included in the meta-analysis. In this athletic population, the contralateral ACL had a significantly higher rupture rate than the ipsilateral graft (risk ratio [RR], 1.41; P < .0001). Female athletes were found to have a greater risk of ACL reinjury on the contralateral versus the ipsilateral side (RR, 1.65; P = .0005), but different results were found in male athletes. (RR, 0.81; P = .21). There was no statistical difference in the incidence rate of ACL reinjury to either side in adolescent athletes (RR, 1.15; P = .28). The contralateral ACL was more vulnerable to reinjury than the ipsilateral side in athletes after ACLR. Female athletes were more likely to reinjure their contralateral native ACL, while the same trend was not found in their male counterparts. The reinjury rate was comparable in both knees in adolescent athletes.

The relationship between knee function and psychology on sports readiness, overuse conditions, and physical activity post anterior aruciate ligament reconstructions: a literature review

Background : Anterior cruciate ligament (ACL) injuries are injuries that result from a tear in the ligament that connects the femur and tibia. This injury can be treated with anterior cruciate ligament reconstruction (ACLR), which is an operation in the form of replacing the ACL ligament with other tissue grafts. ACLR can affect knee function so that it has an impact on readiness to return to sports, physical activity levels and the emergence of overuse conditions.&#x0D; Objective : To determine the relationship between knee function and psychology on readiness to return to sports, overuse conditions, and physical activity after Anterior Cruciate Ligament Reconstructions.&#x0D; Method : The method used is a literature review study using secondary data from published literature. The literature search was conducted online through PubMed, Pedro, Garuda and Google Scholar, using the “key words” Anterior cruciate ligament reconstructions (ACLR), ACL injury, psychological factors, physical activity of ACL athletes, and overuse injuries and selected based on inclusion and exclusion criteria.&#x0D; Results : From the literature used, it is stated that poor knee function can cause severe pain and fear of re-injury so that it has an impact on readiness to return to sports and decreased levels of physical activity after ACLR. Poor knee function due to surgical factors such as the ipsilateral ACL autograft surgical technique can result in an overuse condition characterized by the emergence of patellofemoral pain syndrome.&#x0D; Conclusion : There is a relationship between knee function on psychological readiness to return to sports, level of physical activity and overuse conditions in athletes after ACL reconstruction.&#x0D; Keywords : ACL Reconstruction, Psychological Readiness and Physical Activity of ACLR Athletes.&#x0D;

Discriminative sEMG-based features to assess damping ability and interpret activation patterns in lower-limb muscles of ACLR athletes

ObjectiveThe main goal of the athletes who undergo anterior cruciate ligament reconstruction (ACLR) surgery is a successful return-to-sport. At this stage, identifying muscular deficits becomes important. Hence, in this study, three discriminative features based on surface electromyographic signals (sEMG) acquired in a dynamic protocol are introduced to assess the damping ability and interpret activation patterns in lower-limb muscles of ACLR athletes. MethodsThe features include the median frequency of the power spectrum density (PSD), the relative percentage of the equivalent damping or equivalent stiffness derived from the median frequency, and the energy of the signals in the time–frequency plane of the pseudo-Wigner-Ville distribution (PWVD). To evaluate the features, 11 healthy and 11 ACLR athletes (6 months post-reconstruction surgery) were recruited to acquire the sEMG signals from the medial and the lateral parts of the hamstrings, quadriceps, and gastrocnemius muscles in pre- and post-fatigue single-leg landings. ResultsA significant damping deficiency is observed in the hamstring muscles of ACLR athletes by evaluating the proposed features. This deficiency indicates that more attention should be paid to this muscle of ACLR athletes in pre-return-to-sport rehabilitations. ConclusionThe quality of electromyography-based pre-return-to-sport assessments on ACLR subjects depends on the sEMG acquisition protocol, as well as the type and nature of the extracted features. Hence, combinatorial application of both energy-based features (derived from the PWVD) and power-based features (derived from the PSD) could facilitate the assessment process by providing additional biomechanical information regarding the behavior of the muscles surrounding the knee.

The effects of core stabilization exercises on the neuromuscular function of athletes with ACL reconstruction

Athletes who have undergone anterior cruciate ligament reconstruction (ACLR) often exhibit persistently impaired kinematics and strength. Core stability training appears to be effective for reducing high-risk landing mechanics and preventing primary anterior cruciate ligament (ACL) injuries; however, there have been few attempts to examine their effects in athletes who have undergone ACLR. This study aimed to investigate the effect of eight weeks of simple core stability training on core endurance, hip strength, and knee kinematics in ACLR athletes. Twenty-six male athletes (20–30 years old) with a history of ACL surgery with hamstring tendon autograft were randomly divided into training (n = 13) and control groups (n = 13). The training group performed core stability exercises for eight weeks before starting their team training; the control group did not receive any intervention. Both groups continued their regular team schedule. The core endurance, hip muscle strength, and knee kinematics were assessed by the McGill test, a hand-held dynamometer, and video-taping, respectively. Analysis of covariance test was used for data analysis. The training group showed a significant increase in core endurance, hip abductor and external rotator strength, knee flexion angle, and a significant decrease in the knee valgus angle during single-leg landing in post-training tests compared to their baseline tests (P < 0.05). Our results demonstrated that core stability exercise alters neuromuscular function to a level that is clinically acceptable and statistically significant. Because of the high incidence rate of secondary ACL injury after ACLR, it is recommended that athletes with a history of ACLR benefit from adding core stability exercises to warm-up routines or tertiary prevention programs even after completing post-operative rehabilitation. It is fast and not time-consuming to perform for athletes to reduce the risk factors of re-injury.Trial registration: This study was registered in the Iranian Registry of Clinical Trials with the number IRCT20190224042827N2, registered on 19 December 2019.

All-Soft Tissue Quadriceps Tendon Autograft in Revision Anterior Cruciate Ligament Reconstruction in Athletes: Comparison to Bone-Patellar Tendon-Bone Autograft With at Least a 2-Year Follow-up

Background: Revision anterior cruciate ligament (ACL) reconstruction is being performed at an increasing rate. Previous literature has suggested that autograft ACL reconstruction is a better option than allograft in revision surgery, although the optimal autograft choice remains unknown. The all–soft tissue quadriceps tendon (ASTQT) autograft has been found to be an effective option for primary ACL reconstruction. However, few studies have evaluated ASTQT autograft in revision ACL reconstruction. Purpose/Hypothesis: The purpose of this study was to evaluate the ASTQT autograft in revision ACL reconstruction in athletes compared with bone–patellar tendon–bone (BTB) autograft. We hypothesized that the ASTQT autograft would lead to similar return to play, time to return to play, retear rate, and patient-reported outcomes compared with BTB autograft. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective study was performed on all athletes undergoing revision ACL reconstruction between August 2013 and December 2019 at a single institution. Patients participating in high school or college athletics undergoing first-time revision with either ASTQT or BTB autograft with ≥2 years of follow-up were included. Demographic variables, complications, return to sports, and outcome scores including the International Knee Documentation Committee (IKDC) and Lysholm were collected and compared between the 2 cohorts. Results: A total of 58 revision ACL reconstructions were included, with 32 in the ASTQT cohort and 26 in the BTB cohort. Return to sports at the same level occurred in 62.5% of the ASTQT group and 53.8% of the BTB group. The ASTQT group returned to sports significantly faster than the BTB group (8.9 vs 10.3 months; P = .020). There was no difference in retear rates (3.1%, ASTQT; 7.7%, BTB) or other complications between the 2 groups. The IKDC scores were significantly higher at the 6- and 12-month follow-up for the ASTQT autograft group compared with the BTB group (6 months: ASTQT, 71.3; BTB, 61.7, P = .001; 12 months: ASTQT, 82.7; BTB, 78.6; P = .021). Lysholm scores were also greater in the ASTQT cohort at these time points (6 months: ASTQT, 75.1; BTB, 63.6; P < .001; 12 months: ASTQT, 82.0; BTB, 74.5; P < .001). However, IKDC and Lysholm scores were similar between both groups at final follow-up (IKDC: ASTQT, 82.9; BTB, 81.7; P = .344; Lysholm: ASTQT, 83.0; BTB, 81.0; P = .104) There was no significant clinical difference in the absolute difference in scores or rate of achieving clinical thresholds between the 2 cohorts. Conclusion: ASTQT autograft for revision ACL in athletes has similar outcomes compared with BTB autograft. However, the ASTQT may possibly afford quicker return to sports and better early improvements in patient-reported outcomes that normalize by 1 year. The soft tissue quadriceps autograft should be considered a viable graft option in revision ACL reconstruction in athletes.

Osteoarthritis Progression after ACL Reconstruction Was Significantly Higher Than That of the Healthy Contralateral Knees: Long-Term Follow Up Study of Mean 16.4 Years.

Background: This study aimed to assess long-term progression of osteoarthritis (OA) after isolated anterior cruciate ligament (ACL) reconstruction in athletes compared to the healthy contralateral side. Methods: The study included 15 patients and 30 knees with a mean age of 40 years (range, 35–46) years, none of whom had had revision surgery or an injury to the contralateral side. The mean follow-up period was 16.4 years (range, 13–22). Clinical and radiographic assessment included the Tegner activity scale (TAS), International Knee Documentation Committee (IKDC) score, Knee injury and Osteoarthritis Outcome Score (KOOS), and Kellgren and Lawrence (KL) grade. The long-term results of the injured knees were compared with the status of the healthy contralateral side and compared with previously published mid-term results of the same cohort of patients. Results: Patients generally remained clinically asymptomatic or mildly symptomatic at final follow-up, which is reflected by a KOOS pain score of 33 points (maximum 36 points) and an IKDC total subjective score of 87% (maximum 100%). There was a significant difference between mid-term and final follow-up in terms of the function score of the IKDC subjective questionnaire (p = 0.031), compartment findings and donor site morbidity of the IKDC functional examination (both p = 0.034), and the total KOOS score (p = 0.047). The KL score indicated significant progression of OA from mid-term to final follow-up in the injured knees (p = 0.004) and healthy contralateral knees (p = 0.014). Mean OA grades of the injured knees were significantly higher compared with the healthy contralateral side (p = 0.006) at final follow-up, and two patients showed moderate to severe signs of OA in the injured knee. Conclusions: Although most patients remained clinically asymptomatic or mildly symptomatic, long-term progression of OA after isolated ACL reconstruction in athletes was significantly higher compared with the healthy contralateral knee.

Return-to-sport following anterior cruciate ligament reconstruction in team sport athletes. Part I: From initial injury to return-to-competition

There is a high incidence of non-contact anterior cruciate ligament (ACL) injury in team sports, especially among adolescent females. This injury is associated with an increased risk of developing osteoarthritis later in life and a decrease in lifetime physical activity. Traditionally, return-to-sport (RTS) programs following ACL injury have focused on restoring the athlete's general health and tissue healing. We will propose a framework that views RTS as a two-part process: first, recovery of general health after ACL reconstruction (ACL-R) (rehabilitation) and then return to competition (RTC) after ACL-R, all of which occurs on a continuum. The objective of Part I is to stablish the foundation to propose an evidence- and experience-based guide on RTS following ACL reconstruction in athletes participating in team sports, specifically for later phases. First, we describe the causes of and risk factors associated with ACL injury. Next, we describe the specific characteristics of team sports that predispose athletes to ACL injury. Finally, we present a progressive framework to successfully return athletes to a pre-injury level of competition that also minimizes risk of reinjury. In Part II we will focus on how to put the proposed framework into practice when return team sport athletes to play following ACL-R.

REHABILITATION OF NEUROMUSCULAR FUNCTION BY PHYSICAL EXERCISE

ABSTRACT Introduction In long-term sports, especially in explosive sports such as accelerated starting, athletes are prone to rupture the anterior cruciate ligament (ACL). It is the ultimate goal of ACL reconstruction for athletes to restore the stability (static and dynamic) and mechanical structure of the knee joint through reconstruction surgery. Object This article uses ACL reconstruction to repair patients’ ACL and explores the effect of athletes’ nerve recovery after sports. Methods We collected 35 ACL reconstruction athletes and randomly divided them into two groups (experimental group, 18; control group, 17). After reconstruction, the athletes in the experimental group were treated with sports rehabilitation. Results The experimental and control groups had great differences in knee joint exercise indexes and nerve function recovery. Conclusion Sports rehabilitation training can effectively improve the nerve function of the knee joint after ACL reconstruction. Level of evidence II; Therapeutic studies - investigation of treatment results.

A longitudinal investigation of landing biomechanics following anterior cruciate ligament reconstruction

ObjectiveAbnormal movement patterns have been shown during landing in patients who have undergone anterior cruciate ligament (ACL) reconstruction surgery. The purpose of this study was to investigate landing biomechanics over time in this patient group to determine whether asymmetry between limbs reduced with time and after a return to physical activity. DesignProspective longitudinal study. SettingBiomechanics laboratory. ParticipantsFourteen patients who had undergone ACL reconstruction surgery. Main outcome measureSingle limb landing assessments were made at two time points; within the first year (mean of 10 months) and at 3 years (after patients had returned to sport) following ACL reconstruction. Three-dimensional motion analysis was used to record kinematic and kinetic variables, which were compared across time and limb using ANOVA models. ResultsMost biomechanical variables showed little change over time except for the external knee adduction moment at the operated knee, which increased (effect size d = 0.5), but remained less than the contralateral side. In the sagittal plane, asymmetrical landing patterns were seen at both assessments. Patients landed with reduced knee flexion angles (effect size range 0.76–0.9) and moments (effect size range 0.56–0.9) compared to the uninjured limb and made compensations for this by increasing the hip flexion moment (effect size range d = 0.6–0.75). ConclusionsAsymmetrical landing biomechanics persisted at three years after ACL reconstruction in athletes who returned to sporting activity. Long term implications of controlling the landing by increasing the hip moment are unknown and require further investigation.

Electromechanical delay of the hamstrings following semitendinosus tendon autografts in return to competition athletes.

Knee flexor electromechanical delay (EMD) has been proposed as a contributing factor to non-contact anterior cruciate ligament (ACL) injury risk and the semitendinosus (ST) autograft technique has been shown to impair knee flexor torque at large angles of knee flexion. The purpose of this study was to analyse the effects of ACL reconstruction (ACLR) using the ST tendon autograft technique on knee flexor EMD across the knee flexion range of motion, in athletes who had returned to competition. Athletes with ACLR (n = 8 females, n = 3 males, 1.7 ± 0.5years post-surgery) and non-injured control athletes (n = 6 females, n = 4 males) performed rapid maximal voluntary contractions of isometric knee flexion and extension at 30°, 50°, 70°, 90°,and 105° of knee flexion. Electrical activity of the ST, biceps femoris (BF), vastus lateralis, and vastus medialis was recorded using surface electromyography. No change in EMD for the knee flexors or extensors was observed across joint angles. Greater EMD was found only for the BF in the ACLR limb of injured athletes compared to the contralateral limb (P < 0.05). In post-hoc analysis, evidence of ST tendon regrowth was noted for only 2/11 athletes. While the EMD-joint angle relationship appeared to be unaffected by ST tendon harvest for ACLR, the absence of ST tendon regrowth should be considered. Despite return to competition, greater BF EMD was found, which may impair knee joint stabilization capacity by delaying the transfer time of muscle tension to the tibia after ST autograft.

Recommendations for Hamstring Function Recovery After ACL Reconstruction.

It is important to optimise the functional recovery process to enhance patient outcomes after major injury such as anterior cruciate ligament reconstruction (ACLR). This requires in part more high-quality original research, but also an approach to translate existing research into practice to overcome the research to implementation barriers. This includes research on ACLR athletes, but also research on other pathologies, which with some modification can be valuable to the ACLR patient. One important consideration after ACLR is the recovery of hamstring muscle function, particularly when using ipsilateral hamstring autograft. Deficits in knee flexor function after ACLR are associated with increased risk of knee osteoarthritis, altered gait and sport-type movement quality, and elevated risk of re-injury upon return to sport. After ACLR and the early post-operative period, there are often considerable deficits in hamstring function which need to be overcome as part of the functional recovery process. To achieve this requires consideration of many factors including the types of strength to recover (e.g., maximal and explosive, multiplanar not just uniplanar), specific programming principles (e.g., periodised resistance programme) and exercise selection. There is a need to know how to train the hamstrings, but also apply this to the ACLR athlete. In this paper, the authors discuss the deficits in hamstring function after ACLR, the considerations on how to restore these deficits and align this information to the ACLR functional recovery process, providing recommendation on how to recover hamstring function after ACLR.

Return to Play and Performance in the Women's National Basketball Association After Anterior Cruciate Ligament Reconstruction.

Background:The incidence of anterior cruciate ligament (ACL) injuries in Women’s National Basketball Association (WNBA) athletes continues to increase. There is a paucity of data regarding return-to-play (RTP) rates and performance after ACL reconstruction in these athletes.Purpose:To quantify RTP rates and performance after ACL reconstruction in WNBA athletes.Study Design:Cohort study; Level of evidence, 3.Methods:All ACL tears sustained in the WNBA from 1997 through 2018 were identified. Body mass index (BMI), age, and position at the time of injury were collected for each player. RTP rates were calculated, and performance data were collected for each player before and after injury to determine changes in playing time and statistical performance. Players who successfully returned to play after ACL reconstruction were compared with a group of healthy controls who were matched by age, years of experience, position, height, and BMI. Statistics at 1 and 3 years after injury were compared to assess acute and longitudinal changes in performance relative to preinjury baseline.Results:A total of 59 WNBA players sustained ACL tears during the study period, and 41 (69.5%) were able to successfully RTP. Players played a mean of 7.5 ± 12.8 fewer games, played 5.0 ± 9.2 fewer minutes per game, and scored 3.7 ± 5.0 fewer points per game in their first year after RTP compared with the year before injury. Athletes with ACL reconstruction demonstrated significantly decreased performance measures regarding games played, games started, minutes, rebounds, assists, and blocks per game in their first season after RTP compared with control athletes in the same indexed year; however, these differences resolved by year 3 after surgery.Conclusion:WNBA athletes have a high RTP rate after ACL reconstruction. Players may experience an initial decrease in playing time and performance when returning to play; however, these variables were found to return to baseline over time.

Are Anterior Cruciate Ligament-reconstructed Athletes More Vulnerable to Fatigue than Uninjured Athletes?

Fatigue has a negative impact on lower extremity neuromuscular and biomechanical control. Because anterior cruciate ligament reconstruction (ACLR) athletes show already neuromuscular/biomechanical deficits in an unfatigued state, the negative impact of fatigue may magnify these deficits or help expose other deficits. So far, this has only scarcely been assessed warranting further research. Twenty-one athletes who had an ACLR and 21 uninjured controls performed five unilateral landing tasks before and after a match simulation protocol, whereas muscle activation (vastus medialis, vastus lateralis, hamstrings medialis, hamstrings lateralis, gastrocnemius medialis, gastrocnemius lateralis, gluteus medius) and landing kinematics and kinetics of the hip, knee, and ankle joint were recorded. A two-way ANOVA with a mixed-model design (main effects for group and fatigue) was used to compare landing kinematics, kinetics, and muscle activation between groups, and prefatigue and postfatigue. To avoid unjustified reduction of the data to discrete values, we used one-dimensional Statistical Parametric Mapping. Only two interaction effects were found: an increased postfatigue knee abduction moment and an increased postfatigue thorax flexion angle was found in the ACL injured legs but not in the uninjured legs of the ACL group or in the control group, during the lateral hop and the vertical hop with 90° medial rotation, respectively. This study showed that overall ACLR athletes and uninjured athletes have similar biomechanical and neuromuscular responses to fatigue. For two biomechanical parameters, however, we did find an interaction effect, suggesting that landing deficits in ACLR athletes may become clearer in certain tasks when fatigued.

Associations between Distance and Loading Symmetry during Return to Sport Hop Testing

Hop tests are widely used to quantify recovery from anterior cruciate ligament reconstruction (ACLR) surgery. However, there is evidence that simply measuring hop distance may not be indicative of the quality of movement or representative of potential limitations in hopping mechanics, particularly during landing. The first purpose of the present study was to compare hop distance and loading symmetry between ACLR athletes and healthy uninjured recreational athletes. The second was to determine the association between hop distance and loading symmetry. Twenty-five ACLR patients and 30 healthy controls completed the single hop, triple hop, and crossover hop test on each limb while the loadsol®, a single-sensor force insole, collected impact forces (100 Hz). A limb symmetry index (LSI) was calculated for hop distance, peak impact force, loading rate, and impulse from the final landing of each trial. LSI values were compared between groups using Mann-Whitney U tests, and distance and loading LSI values were compared using Spearman rank correlations. ACLR patients had reduced symmetry in hop distance and loading relative to healthy controls for every hop test and outcome measure (P < 0.05), except peak impact force on the single hop. Hop distance symmetry was significantly related to each loading symmetry measure on the crossover hop test (P < 0.01) and to peak impact force and impulse symmetry on the single hop test (P < 0.05) in each group. This study demonstrates that ACLR patients both hop further and generate larger forces when hopping on their nonsurgical limb relative to their surgical limb. In addition, hop distance and loading symmetry provide clinicians and researchers with different information and therefore should be considered together when making return to sport decisions.

Return to play following anterior cruciate ligament reconstruction: incorporating fatigue into a return to play functional battery. Part A: treadmill running

BackgroundThe risk of reinjury and other sequelae following anterior cruciate ligament reconstruction (ACLR) remains high. Lack of knowledge regarding factors contributing to these risks limits our ability to develop sensitive...