Level Of Recreational Activity Research Articles

The impact of recreational activities on the current state of the state landscape reserve «Baydarsky», Mountain Crimea, Ukraine

Ukraine is taking measures to continue monitoring of the natural environment in the temporarily occupied territory of Crimea. In particular, natural territories and objects subject to special protection, the state of the natural environment, and recording the facts of environmental offenses and crimes are carried out. The issue of the current state of the objects of the nature reserve fund of the Crimea in the conditions of unregulated recreation has not been investigated. We chose a tract the «Bizyuk» of the state landscape reserve «Baydarsky» as an object of research. The state landscape reserve is located on the southwestern north of the macroslope of the Crimean Mountains (height 200–900 m) on the territory of the Sokolinsky, Kuibyshivskyi, Chornorichenskyi, Orlynivskyi and Ternivskyi forest divisions within the Baydar Valley. The purpose of the study was to analyse the ecological, phytocenotic and spatial features of recreational changes in the tract «Bizyuk» of the reserve «Baydarsky». The ecological profile was carried out according to the gradient of the intensity of the recreational load from three experimental plots (EP1 – intensive; EP2 – medium; EP3 – moderate as a control; areas without violations were not detected) in accordance with the principles of ecosystem, comparative analyzes and forestry methods in the last decade of June 2021. Forestry taxation, sanitary and vitality structures of the tree stand were studied. Biomorphological and ecomorphic structure of the herbaceous layer were studied too. The stages of recreational transformation of the soil surface were determined. It was established that changes in the ecological conditions of the «Bizyuk» tract were caused by unregulated recreational activities. The main consequences of recreational activities were the change in the hydrological regime of the soil due to the trampling of the litter and herbaceous layer, clogging, mechanical damage to tree trunks, stripping and trimming of the bark, woodfires, collecting plants, which led to a significant weakening of the stands (III category of state). The state of the soil surface changed along the gradient of recreational transformation from the 1st stage of digression (zone of moderate recreational activities) to the 4th stage of digression of the soil surface (zone of intensive recreational activities). A change in the species composition of the herbaceous cover was recorded. Adventitious, ruderal plants were widespread in all zones of the tract, but most in the zone of intensive recreational transformation. The max share of perennial plants was established in the zone of moderate recreational transformation, the min – in the zone of intensive recreational transformation. Rosetteless herbaceous plants and plants without specialized modifications of underground shoots were predominated. Hemicryptophytes and phanerophytes were dominated. The proportion of therophytes and chamephytes did not correlate with the level of recreational activities. Forest and ruderal plants in various proportions were dominated in all zones. It has been proven that the ecomorphic composition of the herbaceous cover also reflects recreational transformation in the tract. Hydromesophytes and mesophytes were prevailed among hydromorphs. The phytocoenotic contribution of mesophytes was increased in the most transformation plots. Hemistenotopic and hemieurytopic subacidophilous plants were dominated. The share of hemiaerophobes gradually was decreased along the transformation gradient. The intense recreational impact was caused a certain nitrification of ecotopes (distribution by nitromorphs).

Mid‐ to late‐life physical and recreational activities: Associations with late‐life cognition

AbstractBackgroundPhysical and cognitively stimulating recreational activities are lifestyle factors that may modify risk of late‐life cognitive decline. We sought to examine the role of retrospective ratings of mid‐life (age 40) physical and recreational activity engagement – and change in these activities from age 40 to study entry – in predicting late‐life cognition. We hypothesized that higher self‐reported levels of physical and recreational activities at age 40, and less decline in these activities over time, would be associated with higher levels of late‐life cognition and less rapid cognitive decline.MethodData were obtained from 898 participants in the University of California Davis Aging and Diversity Cohort, a longitudinal study of cognitive aging in demographically and cognitively diverse older adults. Participants ranged in age from 49‐93 years (M = 75, SD = 7.19). Self‐reported physical and recreational activity participation at age 40 and at study entry were quantified using the Life Experiences Assessment Form. Confirmatory factor analysis established the unidimensionality and longitudinal measurement invariance of physical and recreational activity levels at age 40 and at study entry. Change in activities was modeled using latent change scores. Cognitive outcomes were obtained annually (range = 0‐17 years) using the Spanish and English Neuropsychological Assessment Scales, which measures episodic memory, semantic memory, visuospatial processing, and executive functioning. Multilevel structural equation modeling was used to regress four cognitive intercepts and one global cognitive slope onto age 40 and change factors for physical and recreational activities, in separate models.ResultPhysical activity engagement at age 40 was strongly associated with cognitive performance in all four domains at study entry and with global cognitive slope. However, change in physical activities was not associated with cognitive outcomes. In contrast, recreational activity engagement – both at age 40 and change after age 40 – was predictive of cognitive intercepts and slope.ConclusionMid‐life physical and recreational activity engagement were strongly associated with late‐life cognition – both level of performance and rate of future decline. However, the data suggest that maintenance of recreational activity engagement (e.g., writing, taking classes, reading, arts & crafts) after age 40 is more strongly associated with late‐life cognition than continued maintenance of physical activity levels.

Recreational activity after open hip abductor repair

BackgroundHip abductor tear (HAT) is an increasingly diagnosed cause of refractory lateral hip pain and dysfunction, affecting 10–25% of the general population.Purpose(1) to determine the rate of return to activity and to assess the physical and recreational activity of patients undergoing open hip abductor repair (oHATr) and (2) to describe the modification or initiation of new sports disciplines.Study designCase series; Level of evidence, 4.MethodsA total of 28 patients (29 hips) who underwent an oHATr were prospectively analyzed at a midterm follow-up of 3.5 (range 2–5) years. The sports and recreational activity levels, as well as type of sports practiced before and after surgery, and The Veterans RAND 12 Item Health Survey (VR-12) were assessed via questionnaire.ResultsAt the final follow-up, all patients were active in sports after surgery. The duration and frequency of sports activities showed a slight decrease (48–42 min per week and 3.2–2.9 sessions per week, respectively) (p = 0.412 and 0.135, respectively). The VR-12 had a score of 45 (13.12–63.18) points for the physical component and 41 (32–53.8) points for the mental component. 100% of the patients would undergo the surgery again. 95% of patients were satisfied with the overall results of the surgical outcome, with 98% satisfied with their hip pain relief and ability to undertake daily and work activities. Moreover, 94% were satisfied with their ability to return to recreational activities. The failure rate in our cohort was approximately 14%.ConclusionAll patients who underwent an oHATr were able to return at least to one type of sport. This cohort was highly satisfied with their sports involvement and recreational activity achievement. In addition, 88% of patients reported that oHATr improved sports activity. There was a shift from higher to lower impact sports. Furthermore, just 3 hips present a retear after surgery.

Patients older than 55years regain sporting and recreational activities after arthroscopic anterior cruciate ligament reconstruction.

(1) To compare sporting and recreational activity levels before and at a minimum 6year follow-up, and (2) to assess the clinical and functional outcomes after anterior cruciate ligament (ACL) reconstruction in patients older than 55years. A retrospective evaluation of prospectively collected data of 150 patients with a mean age of 64 ± 4.5 (57-74) years was evaluated 8.6 ± 1.4 (6-11) years after primary ACL reconstruction using hamstring autograft. All patients were assessed using the International Knee Documentation Committee scoring system (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS), Tegner activity level, and visual analog scale (VAS) for pain. The level of recreational activities was assessed using a sport-specific questionnaire. All patients were categorized according to Isolated and Combined ACL injury groups. The data of 125 patients were analyzed at the last follow-up. While 25 patients were lost to follow-up, 117 of 125 patients were active before their injury in at least one sports discipline compared to 121 of 125 patients after ACL reconstruction. One hundred and two (82%) patients had returned to their recreational activities at the final follow-up. The mean IKDC subjective score increased from 49.5 ± 23.2 (11.5-100) to 76.2 ± 14.8 (33.3-100) (p < 0.0001). The mean KOOS sport increased significantly from 36 ± 36.2 (0-100) to 74.1 ± 25.5 (0-100) (p < 0.0001). The mean VAS score improved from 6.0 ± 2.6 (0-10) to 1.0 ± 1.4 (0-6) (p < 0.0001). There was no significant difference in the median Tegner activity level (preoperative 5 (2-8) vs. follow-up 5 (2-8) (n.s). There was no significant difference in the number of sports disciplines and duration when comparing pre-injury and mid-term follow-up activity after ACL reconstruction. High-impact activities experienced a significant decline, while a significant increase in participation in low-impact activities was recorded. The majority of patients with symptomatic instability regained their pre-injury recreational activity level with excellent clinical and functional outcomes after arthroscopic ACL reconstruction. Nevertheless, a change from high-to low-impact activities has been observed. Level IV.

Arthroscopic Posterior Labral Repair in Active-Duty Military Patients: A Reliable Solution for an At-Risk Population, Regardless of Anchor Type

Background: Active-duty servicemembers are a population at risk for the development of posterior shoulder instability. While short-term outcomes after arthroscopic posterior labral repair for posterior shoulder instability are promising, there is a paucity of longer term follow-up data for this procedure. Purposes: The primary purpose was to report midterm outcomes after arthroscopic posterior labral repair in active-duty military patients for posterior shoulder instability without bone loss. The secondary purpose was to determine if outcomes varied between anchor types used. Study Design: Cohort study; Level of evidence, 3. Methods: Preoperative and postoperative outcomes, with a minimum 3-year follow-up, for a visual analog scale for pain, the Single Assessment Numeric Evaluation (SANE), the American Shoulder and Elbow Surgeons (ASES) score, and the Rowe score were collected and analyzed. A separate subgroup analysis was performed comparing the outcomes of patients who underwent repair with biocomposite anchors versus those who underwent repair with all-suture anchors. Results: A total of 73 patients with a mean follow-up of 82.55 ± 24.20 months met the inclusion criteria and were available for analysis. As a whole, the cohort demonstrated statistically and clinically significant improvements in outcome scores at final follow-up. Preoperative and postoperative range of motion did not vary significantly. While the difference in final outcome scores between the 2 anchor types did not reach statistical significance, a statistically significantly larger proportion of patients who underwent repair with all-suture anchors versus those who underwent repair with biocomposite anchors met the Patient Acceptable Symptom State for the SANE (97.14% vs 78.95%, respectively; P = .0180) and the ASES score (88.57% vs 68.42%, respectively; P = .0171). The proportion of patients who achieved the substantial clinical benefit or surpassed the minimal clinically important difference, however, did not vary by anchor type. Overall, 70 patients (95.89%) remained on active duty and were able to return to preinjury work and recreational activity levels. There were 3 patients (4.11%) who had recurrent posterior instability. Conclusion: This population of active-duty servicemembers undergoing posterior labral repair for posterior labral instability without bone loss demonstrated a statistically and clinically significant improvement in midterm outcomes, a low recurrence rate, and a rate of return to active duty of 95.89%, regardless of the anchor type used.

Meeting the need for a rational basis for open space and recreation planning in new high density residential areas: the Recreational Activity Benchmark model

ABSTRACT The development of new high-density residential precincts in Australian cities, notably in association with new public transport nodes (Transit-Oriented Developments – TODs), presents challenges for planners in creating living environments, including provision for open space and recreation. The traditional ‘standards’ method and other existing approaches to planning for open space and recreation have significant limitations in coping with the challenges presented by high-density developments. It is argued in this paper that a planning approach focused on recreation participation as the key performance criterion can provide a solution. The Recreational Activity Benchmark (RAB) model is presented and shown to be capable of providing for appropriate levels of recreational activity while making savings in land requirements.

Sports Activity and Patient-Related Outcomes after Cementless Total Hip Arthroplasty in Patients Younger than 40 Years.

Background: The management of degenerative hip diseases in young patients remains a challenge. Despite the improvement of hip-preserving procedures, total hip arthroplasty (THA) may be required in some instances. In addition, young patients undergoing THA have high expectations concerning their postoperative level of activity. Purpose: (1) to define the sports activity level and the return to sports after THA, (2) to describe the modification or initiation of new sports disciplines, and (3) to report the clinically meaningful outcomes after THA in patients younger than 40 years. Methods: A total of 36 patients (40 hips) were prospectively analyzed at a midterm follow-up of 3.9 years. The modified Harris Hip Score (mHHS); the Visual Analog Scale (VAS) for pain; the University of California, Los Angeles (UCLA) activity scale; and sports and recreational activity levels were assessed via questionnaire. The minimal clinically important difference (MCID) was determined by calculating half of the standard deviation, and the substantial clinical benefit (SCB) as well as patient acceptable symptomatic state (PASS), were calculated by the anchor method for the mHHS. Results: At the final follow-up, there was a significant improvement in mHHS (34.1 to 92.6; p < 0.0001), UCLA (3.2 to 7.6; p < 0.0001), and VAS for pain (8 to 1; p < 0.0001). More patients were active in sports at follow-up than before surgery (44% to 92%, p < 0.0001). In addition, the duration and frequency of sports activities showed a significant increase (p < 0.0001). The MCID, SCB and PASS for mHHS were 89% and 58%, respectively. No revision surgery had to be performed. Conclusion: This study showed that a large proportion of patients under 40 years of age who underwent THA increased their physical activity. Eighty-six percent of the patients were highly active, with a UCLA score ≥ 7. Furthermore, the reported MCID, SCB, and PASS for mHHS were achieved by more than 80% of patients.

Recreational activity after cementless total hip arthroplasty in patients older than 75 years

IntroductionThis retrospective study aimed to compare activity levels before and at mid-term follow-up after primary cementless total hip arthroplasty (THA) in patients older than 75 years.Materials and methodsA cohort of 79 patients with a mean age at surgery of 78 years (range 76–84 years) was evaluated 6.3 years (range 4–8 years) after cementless THA due to osteoarthritis and was followed up with a questionnaire to determine their activity level. Pre- and post-operative recreational activities were assessed at routine follow-up using the University of California, Los Angeles activity score, and the Schulthess Clinic sports and activity questionnaire. Post-operative health-related quality of life was measured using Veterans Rand 12-item survey (VR-12).ResultsSix years after THA, 72% of preoperatively active patients had returned to activity. Comparing activity preoperatively (before the onset of symptoms) and 6 years after THA, the number of disciplines and session length has decreased significantly. A significant decline in high-impact activities was observed, while participation in low-impact activities significantly increased.ConclusionThe majority of patients maintained a recreational activity level in the mid-term after primary cementless THA. However, a change in disciplines toward low-impact activities was observed.

A Cross-Sectional Examination of Physical Activity, Sedentary Time, and Sleep Between Adults With and Without Children in the Home Using the National Health and Nutrition Examination Survey.

Physical activity (PA), sedentary behavior, and sleep are interconnected, promoting optimal health. Few studies have examined these factors holistically. Therefore, the purpose of this study was to capture the 24-hour activity cycles of the US population by examining PA, sedentary behavior, and sleep based on the presence of a child within the home, as well as gender and weight. Cross-sectional health-related variables from the National Health and Nutrition Examination Survey were used for analysis. The primary variables were the total and type of PA (recreation, work, and active transportation), sedentary behavior, and sleep. Chi-square and regression models were applied to compare the outcomes across participants' characteristics. The adults with children within the home reported less recreational PA, more work activity, less sedentary activity, and less sleep, but no differences in total PA. The females with children in the home not only had the lowest levels of recreational activity and sleep, but also the lowest levels of sedentary behavior. The obese individuals with children in the home had less sedentary time than the adults without children in the home, regardless of weight status. Unhealthy sleep and PA behaviors are prevalent in adults with children living at home, and women are particularly impacted.

Investigation of the Relationship between Satisfaction and Self Perception Levels of Recreational Activities of Elite Level Bocce Athletes Studying in University

Bu araştırma üniversitede öğrenim gören elit düzey bocce sporcularının rekreasyon faaliyetlerine yönelik tatmin ve benlik algısı düzeyleri arasındaki ilişkinin incelenmesi amacıyla yapılmıştır. Araştırmaya üniversitelerde öğrenim gören, 106 (57 kadın ve 49 erkek) gönüllü elit düzey bocce sporcuları katılım sağlamıştır. Araştırmada, katılımcıların benlik algı düzeylerinin ölçülmesi amacıyla Marsh, Hey, Johnson ve Perry (1997) tarafından geliştirilen Çağlar, Aşçı ve Kelecek (2017) tarafından Türkçe geçerlilik ve güvenilirlik çalışması yapılan “Elit Sporcu Benlik Algısı Envanteri (ESBAE)” kullanılmıştır. Ayrıca katılımcıların rekreasyon faaliyetlerine yönelik tatminlerin ölçülmesi amacı ile Beard ve Ragheb (1980) tarafından geliştirilen Karlı, Polat, Yılmaz ve Koçak (2008) tarafından Türkçeye uyarlanıp geçerlilik ve güvenilirlik çalışması yapılan “Serbest Zaman Tatmin Ölçeği (SZTÖ)” kullanılmıştır. Ayrıca elde edilen verilen SPSS 23.0 paket programında çözümlenmiştir. Verilerin analizinde betimsel istatistik, t-testi, Kruskal Wallis, Pearson Korelasyon katsayısı ile analiz yapılmıştır. Araştırmanın bulgularında, t-Testi sonuçlarında “cinsiyet” değişkenine göre ESBAE “algılanan beceri”, “vücut uygunluğu”, “aerobik uygunluk”, “genel performans”, “toplam benlik algısı” ve SZTÖ “psikolojik tatmin” alt boyutlarının anlamlı farklılıklar gösterdiği belirlenmiştir(p&amp;lt;0,05) ve kadın sporcuların lehine daha yüksek düzeyde olduğu saptanmıştır. ESBAE ve SZTÖ alt boyutlarında değişkenlere göre farklılıklar görünse de genel olarak katılımcıların benlik algı düzeyleri ve serbest zaman tatmin düzeylerinin yüksek olduğu belirlenmiştir. Ayrıca sporcularının benlik algıları ile serbest zaman tatminleri arasında pozitif yönde ve orta düzeyde bir ilişki olduğu belirlenmiştir. Sonuç olarak sporcuların benlik algılarının ve tatmin düzeylerinin yüksek olması sporun birey üzerindeki olumlu etkileriyle açıklanabilir.

Acute ACL reconstruction shows superior clinical results and can be performed safely without an increased risk of developing arthrofibrosis

PurposeTo compare acute ACL reconstruction (ACLR) within 8 days of injury with delayed reconstruction after normalized range of motion (ROM), 6–10 weeks after injury. It was hypothesized that acute ACL reconstruction with modern techniques is safe and can be beneficial in terms of patient-reported outcomes and range of motion.MethodsThe effect of acute and delayed ACLR was randomized studied on 70 patients with high recreational activity level, Tegner level 6 or more, between 2006 and 2013. Patient-reported outcomes, objective IKDC, KOOS, and manual stability measurements were documented during the 24-month follow-up period.ResultsThe acute ACLR group did not result in increased stiffness and showed superior outcome regarding strength and how the patient felt their knee functioning at 24 months. In addition, the acute group was not inferior to the delayed group in any assessment. Regarding patient-related outcomes in KOOS, both groups showed significant improvements in all subscales, but no difference was found between the groups. Functional return (FR) rate was almost double compared to the Swedish knee ligament register and treatment failure (TF) rate was reduced by half, no significant difference between the groups. No difference regarding cyclops removal, re-injury of ACL or meniscus was found between the two surgical timing groups.ConclusionAcute ACLR within 8 days of injury does not appear to adversely affect ROM or result in increased stiffness in the knee joint and was not inferior to the delayed group in any assessment when compared to delayed surgery.Level of evidenceI.

Return to Sports and Recreational Activity After Single-Stage Bilateral Short-Stem Total Hip Arthroplasty: 5-Year Results of a Prospective Observational Study.

Background:Single-stage bilateral total hip arthroplasty (THA) is an alternative to staged unilateral THA in patients suffering from bilateral hip arthritis; however, there is still broad concern regarding the safety and reliability of this procedure. Short-stem THA has emerged in recent years. To date, no data are available on sports and recreational activity levels after single-stage bilateral short-stem THA in the general patient population.Hypothesis:Patients who have undergone single-stage bilateral short-stem THA return to a satisfying level of sports and recreational activity at midterm follow-up.Study Design:Case series; Level of evidence, 4.Methods:A total of 54 consecutive patients (108 hips) were prospectively included. Midterm follow-up was performed in 51 patients (94.4%). The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score and the Harris Hip Score (HHS) were assessed clinically after a mean of 5.2 years. After a mean of 4.9 years, activity levels were assessed using the University of California, Los Angeles (UCLA) activity scale via a questionnaire. Additionally, a detailed evaluation of sports behavior was conducted using an additional questionnaire. Pain and satisfaction with sporting ability were assessed using a visual analog scale (VAS). Complications and revisions were documented.Results:Patients had a mean WOMAC score of 98.0 (range, 60.0-100.0) and HHS score of 97.8 (range, 65.0-100.0) at final follow-up. The mean UCLA activity score was 4.7 (range, 2.0-10.0). An increasing number of patients were active in sports at follow-up compared with before surgery (76.5% vs 60.8%, respectively); 2 patients (3.9%) stopped participating in sports on a regular basis, and 10 (19.6%) commenced with sports after surgery. The most popular activities before surgery were cycling (31.4%), hiking (29.4%), swimming (21.6%), and fitness/weight training (15.7%). At follow-up, most patients were engaged in cycling (35.3%) and fitness/weight training (33.3%), followed by swimming (25.5%) and hiking (19.6%). The duration (hours per week) and frequency (times per week) of sporting activities remained stable. The mean VAS pain level during sports was 1.3 (range, 0.0-7.0). No revision surgery had to be performed.Conclusion:After single-stage bilateral short-stem THA, the study patients returned to satisfying levels of activity at midterm follow-up. Postoperatively, few patients were engaged in high-impact sports; however, more patients commenced with lower impact activities. Satisfaction with sporting abilities was high, and the complication rate in total was low.

Prediction models for network-linked data

Prediction algorithms typically assume the training data are independent samples, but in many modern applications samples come from individuals connected by a network. For example, in adolescent health studies of risk-taking behaviors, information on the subjects’ social network is often available and plays an important role through network cohesion, the empirically observed phenomenon of friends behaving similarly. Taking cohesion into account in prediction models should allow us to improve their performance. Here we propose a network-based penalty on individual node effects to encourage similarity between predictions for linked nodes, and show that incorporating it into prediction leads to improvement over traditional models both theoretically and empirically when network cohesion is present. The penalty can be used with many loss-based prediction methods, such as regression, generalized linear models, and Cox’s proportional hazard model. Applications to predicting levels of recreational activity and marijuana usage among teenagers from the AddHealth study based on both demographic covariates and friendship networks are discussed in detail and show that our approach to taking friendships into account can significantly improve predictions of behavior while providing interpretable estimates of covariate effects.

Accessibility drives species exposure to recreation in a fragmented urban reserve network

Outdoor recreation is a valuable ecosystem service permitted in most protected areas globally. Land-use planners and managers are often responsible for providing access to natural areas for recreation while avoiding environmental impacts such as declines of threatened species. Since recreation can have harmful effects on biodiversity, reliable information about protected-area visitation patterns is vital for managers. Our goal was to quantify recreational use in a fragmented urban reserve network and identify factors that influenced visitation. We empirically measured visitation rates at 18 reserves in San Diego County, California. Using random forest models, we identified biophysical and socioeconomic factors that influenced spatial variation in visitation rates and made projections to 27 additional reserves, validating with an expert opinion survey. Visitation rates varied widely across the reserve network. Accessibility variables, such as numbers of housing units and parking lots, were key explanatory variables that had positive relationships with visitation rates. To illustrate the applications of our models, we assessed the exposure of 7 species and subspecies of conservation concern to recreation by comparing predicted occurrence to projected visitation intensities. We found that several species and subspecies, including the orange-throated whiptail (Aspidoscelis hyperythra), western spadefoot (Spea hammondii), and the federally-threatened coastal California gnatcatcher (Polioptila californica californica), are likely exposed to high levels of recreational activity. Our results can be used to identify species for further research, highlight areas with potential conflict between recreation and conservation objectives, and forecast future changes in visitation.

No risk of arthrofibrosis after acute anterior cruciate ligament reconstruction

PurposeTo compare acute ACL reconstruction (ACLR) within 8 days of injury with delayed reconstruction after normalized range of motion (ROM), 6–10 weeks after injury. It was hypothesized that acute ACL reconstruction with modern techniques is safe and can be beneficial in terms of patient-reported outcomes and range of motion.MethodsSample size calculation indicated 64 patients would be required to find a 5° difference in ROM at 3 months. Seventy patients with high recreational activity level, Tegner level 6 or more, were randomized to acute (within 8 days) or delayed (6–10 weeks) ACLR between 2006 and 2013. During the first 3 months following surgery patients were contacted weekly by SMS and asked ‘How is your knee functioning?’, with answers given on a Visual-Analog Scale (0–10). ROM was assessed after 3 months by the rehab physiotherapist. Patient-reported outcomes, objective IKDC and manual stability measurements were collected by an independent physiotherapist not involved in the rehab at the 6-month follow-up.ResultsAt 3-month follow-up, 91% of the patients were assessed with no significant differences in flexion, extension or total ROM demonstrated between groups. At the 6-month follow-up, the acute group had significantly less muscle atrophy of the thigh muscle compared to the contralateral leg. Furthermore, a significantly higher proportion of patients in the acute group passed or were close to passing the one leg hop test (47 versus 21%, p = 0.009). No difference was found between the groups in the other clinical assessments. Additionally, no significant difference between the groups was found in terms of associated injuries.ConclusionAcute ACLR within 8 days of injury does not appear to adversely affect ROM or result in increased stiffness in the knee joint when compared to delayed surgery.Level of evidenceII.

Acute ACL Surgery Decreases First Year Socio Economic Costs Compared to Delayed Reconstruction. A Randomized Controlled Trial

Acute ACLR seems to significantly reduce socio economic costs (compensation for sick leave) compared to delayed reconstruction and can be performed without increased risk of stiffness. Clinical practice has been to avoid acute ACL reconstruction (ACLR) due to the risk of complications, especially arthrofibrosis. Thus, a general rule has been to wait with reconstruction until he knee is “calm”, which usually means 4-8 weeks following injury. Furthermore, there is often also a prolonged waiting time due to operating space and other logistic factors. Since most of the patients undergoing ACLR are of working age, there is a potentially large socio-economic loss due to the fact that many of these patients are unable to work from the time of injury to the time of reconstruction. The aim of this RCT was to assess and compare the total number of sick leave days caused by the knee injury from the day of injury and over the first year between acute and delayed reconstruction. 70 patients with high recreational activity level, Tegner level of 6 or more, who presented with an acute ACL injury were randomized to a acute reconstruction within 8 days from the injury or delayed reconstruction 6-10 weeks post injury. Four surgeons performed the ACLR with quadrupled semitendinosus tendon grafts. Patients were assessed at 6,12 and 24 months and these follow ups included Biodex strength test, Rolimeter, pivot shift, one leg hop, IKDC, KOOS, Lysholm and Tegner activity level. With data from the Swedish Social Insurance Agency information about the number of sick leave days due to the knee injury and over the following twelve months was collected. The data was recalled based on diagnostic numbers related to the specific knee-injury and compared between the two groups. Seventy percent of the patients were males, mean age at the time of inclusion was 27 years (18 -41) and the pre-injury median Tegner level was 9 (5-10), with no differences between the groups. 15/70(21%) patients were students without registered compensation for sick leave. 4 patients in the acute group and 1 in the delayed group were not registered for any compensation for sick leave from work. One patient from the delayed group resigned from the study before surgery. 49/69 (71%) patients received compensation for sick leave, 26 patients in the acute and 23 in the delayed group. The delayed had one continuous or two separate periods depending on the job's physical demand. The mean number of total amount of sick leave days for the acute group was significantly lower (M = 56,9, SD = 36,4) compared to the delayed group (M = 88,5, SD = 58,4), t(47) = -2,30, p < 0,05. The acute group also had mean fewer days for recovery after surgery but not statistically different (M = 52,0 SD = 36,1) compared to the delayed group (M = 65,6, SD = 45,5), t(47) = -1,17, p = 0,25. There were no differences between the groups in ROM and no differences in IKDC, activity level or laxity at 12 months. Acute ACLR seems to significantly reduce socio economic costs (compensation for sick leave) compared to delayed reconstruction and can be performed without increased risk of stiffness.

Results Are Similar Two Years After Acute or Delayed Anterior Cruciate Ligament Reconstruction. A Randomized Controlled Trial

Objectives:Acute ACLR has been avoided since the 1990’s due to reports of postoperative stiffness. But are these risks still valid with modern arthroscopic techniques? The aim of this randomized controlled trial was to assess the impact of the time between injury and reconstruction on the outcome after ACLR. Our hypothesis was that acute ACLR with semitendinosus graft can be performed safely.Methods:The primary endpoint was ROM at three months after surgery. A power calculation revealed the need for 64 patients to detect a ROM difference of 5 degrees between the groups (5% significance level). 70 patients with a high recreational activity level (Tegner ≥6) who presented with an acute ACL injury were randomized to an acute reconstruction within 8 days from the injury or delayed reconstruction (after normalized ROM) 6-10 weeks after the injury. Fixation was with Endobutton in femur and a metallic interference screw in tibia. The rehabilitation was performed at the same physiotherapy center for all patients. Follow up assessment was performed by a physiotherapist not involved with the rehabilitation. The follow up at 24 months included ROM, Lachman, instrumented laxity with Rolimeter, pivot shift, one leg hop index, Biodex, IKDC, KOOS, Lysholm and Tegner Activity level, and a VAS question regarding knee function and the knee function’s effect on activity level.Results:Seventy percent of the patients were males, mean age at the time of surgery was 27 years (18 -41) and the median pre-injury Tegner level was 9 (6-10) with no differences between the groups. 64 (91%) patients were assessed at three months with no difference according to the primary endpoint. Median Tegner level was restored to pre-injury levels in both groups after one year, and did not change between one and two years. 63 (90%) patients were available for the 2-year follow up. There was one graft rupture and one contralateral ACL injury in both groups. There was additional surgery in 15% of the acute patients and in 31% in the delayed (n.s.). The mean instrumented laxity was 1.8 mm in the acute and 2.0 in the delayed group. There were no positive pivot shift in the acute group and 6 patients with grade 1 or not possible to perform in the delayed group (p=0.039). IKDC revealed no significant differences between the groups. Lysholm score was 87 in both groups. KOOS values showed no significant difference between the groups. VAS response to the question “How is your knee working on a scale from 0-100? (100 = best)” was 81 in the acute and 71 in the delayed group (p=0.1) and “How does your knee affect your activity level? (100 = no affection)” the mean score was 75 in the acute and 67 in the delayed group (p=0.3). Functional strength (one leg hop index >90%) was 85% in the acute and 67% in the delayed group (n.s).Conclusion:We found no increased risk of arthrofibrosis after acute ACLR. Good results can be achieved at two years regardless of ROM and swelling in the acute stage.

Sports Activity After Reconstruction of Osteochondral Lesions of the Talus With Autologous Spongiosa Grafts and Autologous Matrix-Induced Chondrogenesis

Background: For the treatment of osteochondral lesions of the talus (OCLTs), autologous matrix-induced chondrogenesis (AMIC) is a safe 1-step procedure with good clinical and radiological results. However, data regarding postoperative sports activity after AMIC are limited. Purpose: To identify significant factors influencing the rate of postoperative sports and recreational activities. Study Design: Case series; Level of evidence, 4. Methods: The sports and recreational activities of 60 patients (mean age, 34.9 ± 11.5 years) undergoing the AMIC procedure were retrospectively analyzed at a mean of 46.9 ± 17.8 months (range, 24.5-87.0 months) postoperatively. The visual analog scale (VAS) for pain score, Tegner activity scale score, activity rating scale (ARS) score, and satisfaction with surgery outcomes were assessed. Results: Corrective calcaneal osteotomy was performed in 38 of 60 (63.3%) patients. Ligament repair was performed in 41 of 60 (68.3%) patients. The mean VAS score improved significantly from 6.9 ± 1.6 points (range, 5-10 points) preoperatively to 2.3 ± 1.9 points (range, 0-6 points) at latest follow-up (P < .001). No significant change in the mean Tegner activity scale score (3.3 ± 2.0 preoperatively to 3.4 ± 2.2 postoperatively; P = .526) and the mean ARS score (2.6 ± 4.3 preoperatively to 2.3 ± 3.4 postoperatively; P = .874) was noted. The percentage of patients involved in sports activity before the onset of symptoms became significantly lower at the time of surgery (from 95.0% to 53.3%; P < .001); no significant difference was noted postoperatively (from 53.3% to 58.3%; P = .663). No significant difference of the weekly sports frequency and the duration of sports activity was found postoperatively. Conclusion: Patients undergoing AMIC repair of an OCLT participate at a similar low postoperative sports and recreational activity level compared with the preoperative level.

Recovery and convalescence after laparoscopic surgery for appendicitis: A longitudinal cohort study

BackgroundInformation about predictors for the duration of convalescence and the overall general wellbeing after laparoscopic surgery for suspected appendicitis is missing in the scientific literature. We aimed to describe and identify predictors for the duration of convalescence and the quality of recovery for patients undergoing laparoscopic surgery for suspected appendicitis. MethodsA prospective cohort of adult patients undergoing laparoscopic surgery for suspected appendicitis was performed between July 2014 and December 2014. Patients completed a QoR-15 questionnaire six times during the 30-d postoperative period. Time until resumption of recreational and occupational activities was recorded. Potential predictors for the duration of convalescence and the quality of recovery measured by the QoR-15 score were identified. ResultsA total of 108 patients were included, and 95 patients were eligible for analysis. The median duration of convalescence was 13 d. Disease, depressive mood, level of recreational activities, age, and pain at rest on the first postoperative day were significant predictors of the duration of convalescence. Gender, postoperative complications, disease, and anxiety were significant predictors of the quality of recovery during the 30-d postoperative period. A 10% increase in the QoR-15 score increased the hazard ratio of 1.24 (95% confidence interval, 1.08-1.43, P = 0.002) for ending the period of convalescence. ConclusionsDuration of convalescence after laparoscopic surgery for appendicitis seems long. Psychological factors, demographical factors, and perioperative outcomes were important predictors for the quality of recovery and the duration of convalescence. Increased quality of recovery is associated with a shorter period of convalescence.

Anterior ankle arthroscopy: state of the art

Increased sports and recreational activity levels have caused a rise in ankle injuries associated with trauma and overuse, requiring orthopaedic management. In athletes, 40% of all injuries consist of ankle and foot injuries. The incidence of residual problems ranges from 20% to 30%. Over the past decade, arthroscopic surgery of the ankle has developed as a minimally invasive alternative to open surgery for a broad range of indications. Whereas open surgery requires a long period of rehabilitation and possible plaster cast immobilisation, arthroscopic surgery enables patients to recover in a shorter period of time and to start functional exercises within a week of surgery. The aim of this article is to discuss anterior ankle arthroscopy with regard to the diagnostics prior to the intervention, the techniques, complications and pitfalls, any regional or geographical differences, and future directions. Open surgery is more frequently replaced by arthroscopic surgery. The number of indications which are treated arthroscopically is rising. The main indications for anterior ankle arthroscopy are ankle impingement, osteochondral and chondral defects, joint instability, synovitis and severe cartilage degeneration. To perform adequate arthroscopic surgery, knowledge of anatomy, diagnostics, ankle pathology and surgical techniques are required. Preoperative planning and correct use of diagnostic tools increase the chance of success. If conservative treatment fails, surgery is often the treatment of choice. Depending on the location of the ankle pathology, an anterior approach can be used. Some surgeons prefer a combined anterior and posterior approach depending on the indication for surgery. Since techniques have improved over time, complication rates have dropped. Geographical variation exists in techniques for anterior ankle arthroscopy. In Europe and Asia, surgeons use the dorsiflexion method, whereas in the USA the non-invasive distraction method is widely used. Arthroscopy as a diagnostic tool has been abandoned for a variety of reasons. A diagnosis must be made before the arthroscopic procedure is performed. Currently, there is need of patient-specific guided implants. In the near future, more dedicated ankle instruments will come on the market. These will be sized and shaped to accommodate the specific contours of the ankle and subtalar joint and take the limited joint space into account.