Preinjury Participation Research Articles

Patient-reported, clinical and radiological factors associated with the result after non-surgical management of acute AC joint dislocation Rockwood type III and V.

The treatment of Rockwood type III and V acromioclavicular (AC) joint dislocations is controversial, and an individualized treatment algorithm is yet to be developed. The objective of this study was to investigate the association of demographical, clinical, patient-reported and radiological variables with the Western Ontario Shoulder Instability Index (WOSI) score and risk of surgery. Inclusion criteria for this prospective cohort study were patients aged 18-60 with an acute AC joint dislocation with >25% increase in the coracoclavicular distance on bilateral Zanca radiographs. Patients were treated non-surgically with 3 months of home-based training and the option of delayed surgical intervention. The outcomes were the WOSI score and surgery yes/no. Demographical, clinical, patient-reported (WOSI and Shoulder Pain and Disability Index [SPADI]) and radiological variables were collected at baseline and 6 weeks after the injury and investigated for association with the outcomes at 3 months, 6 months and 1 year. Ninety-five patients with Rockwood type III/V AC joint dislocation were included. Pre-injury participation in overhead/collision sports was a risk factor for surgery with an odds ratio of 5 (p = 0.03). Reduced range of motion (ROM) at baseline was associated with reduced WOSI scores and increased risk of surgery. At 6 weeks, reduced ROM, increased SPADI and increased pain during cross-over were associated with the outcomes. Radiological measurements were not correlated with the result. At the 6 weeks follow-up, patients eventually requiring surgery could be detected with a sensitivity of 100% and a specificity of 94% based on a SPADI score of >30 and a ROM ≤ 140° in shoulder flexion or abduction. ROM was the only variable consistently associated with both WOSI and risk of surgery. Six weeks after the injury, it was possible to detect patients in need of surgery based on ROM and SPADI with a sensitivity of 100% and a specificity of 94%. Level II.

CRITERION-BASED REHABILITATION PROGRAM WITH RETURN TO SPORT TESTING FOLLOWING ACL RECONSTRUCTION: A CASE SERIES.

Less than 50% of those sustaining an anterior cruciate ligament (ACL) injury return to their preinjury level of sports participation or participate in competitive sport at two to seven years post ACL reconstruction (ACLR). After ACLR, it has been reported that frequency of subsequent ACL tears has reached as high as 31%. The purpose of this case series was to evaluate return to sport and reinjury rates following the use of a criterion-based rehabilitation protocol with a final return to sport test that utilizes minimal equipment following ACL reconstruction. Case series. Following ACL reconstruction, participants were included if they had a goal of returning to their pre-injury sport or level of activity, were between 16 and 50 years of age at the time of evaluation, had at least 25 physical therapy visits covered by insurance, and planned to complete physical therapy until clearance for return to sport. Forty-three participants met the inclusion criteria and enrolled in the study. Twenty-one participants completed the full course of rehabilitation including passing their return to sport test and nineteen participants completed the two-year follow-up. Data obtained at two years indicated that 84% were able to return to their preinjury level of sports competition. A smaller percentage (16%) were able to return to a reduced level of sport and only one participant reported a second ACL injury. Participants that completed the full course of rehabilitation and passed return to sport testing had a larger percentage that were able to return to preinjury participation levels than currently reported in the literature. This case series did not exclude participants based on graft type, single vs double bundle procedure, ACL revision surgeries, nor concomitant procedures or injuries. Level 4.

Return to Play and Patient Satisfaction After ACL Reconstruction: Study with Minimum 2-Year Follow-up.

Return to play and patient satisfaction after anterior cruciate ligament reconstruction (ACLR) have been inconsistently studied. The purposes of this study were to (1) investigate rates and predictors of return to play after ACLR, (2) evaluate patient satisfaction after ACLR, and (3) analyze the relationship between return to play and satisfaction with the result of ACLR. Eligible patients were active athletes included in an institutional ACL registry who had undergone ACLR and had been followed for a minimum of 2 years. A questionnaire was administered to elicit information regarding factors associated with return to play, sports performance, reinjury, and overall patient satisfaction. The Wilcoxon-Mann-Whitney U test was used to compare return to play with patient satisfaction. Multivariable logistic regression was used to identify demographic, sports, and clinical factors associated with return to play. Two hundred and thirty-two patients with a mean age of 26.7 years (standard deviation [SD] = 12.5 years) who had been followed for a mean of 3.7 years were enrolled. Of 231 patients who responded to the return-to-play question, 201 (87.0%) had returned to play, at a mean of 10.1 months; of 175 athletes eligible to return to their prior level of competition, 89.1% had done so. Overall satisfaction was high: 85.4% were very satisfied with the outcome and 98.1% stated that they would have surgery again. Patients were more likely to respond "very satisfied" if they had returned to play (p < 0.001). Use of a patellar tendon autograft (odds ratio [OR] = 5.63, 95% confidence interval [CI] = 1.32 to 25.76) increased the chance of returning to play whereas playing soccer (OR = 0.23, 95% CI = 0.08 to 0.66) or lacrosse (OR = 0.24, 95% CI = 0.06 to 0.99) preoperatively decreased the likelihood of returning to play. The rates of return to play and patient satisfaction are high after ACLR in active athletes. The use of patellar tendon autograft increased the likelihood of returning to play whereas preinjury participation in soccer and lacrosse decreased these odds. Additionally, patients who returned to play were more likely to be very satisfied with the result of the ACLR. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

A Qualitative Assessment of Return to Sport After Hip Arthroscopy for Femoroacetabular Impingement.

Background:Hip arthroscopy for femoroacetabular impingement (FAI) is known to produce excellent outcomes, yet some patients do not return to their preinjury level of sport participation. Much literature on return to sport has revolved around anterior cruciate ligament reconstruction and even shoulder instability, but none to date have used qualitative, semistructured patient interviews on patients with hip labral tears.Purpose:To understand the factors influencing the decision to return to sport after arthroscopic hip surgery for FAI.Study Design:Case series; Level of evidence, 4.Methods:An experienced interviewer conducted qualitative, semistructured interviews of patients aged 18 to 60 years who had arthroscopic hip surgery for FAI. All had preinjury participation in sport and a minimum 2-year follow-up with no revision surgery. Qualitative analysis was then performed to derive codes, categories, and themes. An assessment of preinjury and current sports participation by type, level of competition, and frequency along with patient-reported hip function was also obtained. In addition, current modified Harris Hip Score (mHHS), international Hip Outcome Tool (iHOT-12), Hip Outcome Score–sports-specific subscale (HOS-SSS), and a coping mechanism evaluation (Brief COPE) were also recorded.Results:A total of 23 patients were interviewed to reveal the overarching themes of internal motivation, external encouragement, and resetting expectations as the predominant factors influencing a patient’s decision to return to preinjury sport. Subjective outcome measurements (mHHS, iHOT-12, patient satisfaction) showed significant differences between patients who did and did not return to sport. Interestingly, the adaptive and maladaptive coping mechanisms matched and supported our themes in those patients who described fear and self-motivation as defining features influencing their cessation of or return to play, respectively.Conclusion:Self-motivation, aging, pain, encouragement from others, and adapting to physical limitations can largely affect a patient’s decision to return to sport after arthroscopic hip surgery for FAI. Innate coping mechanisms may also help to predict the course of and subsequently aid in a patient’s postoperative recovery.

The Effectiveness of Nonoperative Rehabilitation Programs for Athletes Diagnosed With Osteitis Pubis.

Clinical Scenario: The differential diagnosis of groin pain can be very challenging due to the many causative pathologies. Osteitis pubis is a pathology that is becoming more recognized in athletes who participate in sports such as soccer, ice hockey, rugby, and football. Conservative nonoperative treatment is often prescribed first before surgical intervention. Of particular interest are the outcomes of nonoperative rehabilitation programs and their effectiveness to return athletes to preinjury levels of participation. The most recent systematic review in 2011 examined the spectrum of treatments for osteitis pubis and found only level 4 (case report or case series) evidence with varying approaches to treatment. Due to the amount of time since the last published review, there is a need to critically appraise the recent literature to see if more high-quality research has been published that measured nonoperative interventions for athletes with osteitis pubis. Focused Clinical Question: Is there evidence to suggest that nonoperative rehabilitation programs for osteitis pubis are effective at returning athletes to their preinjury levels of participation? Summary of Key Findings: Four studies met the inclusion criteria. Only level 4 evidence was found. All studies reported using a structured nonoperative rehabilitation program with a successful return to preinjury participation between 4 and 14 wk, except for 1 study reporting a successful return at 30 wk. Successful long-term follow-up was reported at 6-48 mo for all patients. Clinical Bottom Line: There is weak evidence to support the efficacy of nonoperative rehabilitation programs at returning athletes to their preinjury levels of participation. Strength of Recommendation: There is grade D evidence that a nonoperative program for osteitis pubis is effective at helping athletes return to their preinjury level of participation. The Centre of Evidence Based Medicine recommends a grade D for level 4 evidence with consistent findings.

Assessment of quadriceps/hamstring strength, knee ligament stability, functional and sports activity levels five years after anterior cruciate ligament reconstruction

The purpose of this study was to examine individuals 5 years after ACL reconstruction and analyze changes involving strength, stability, function, and sports activities. Nineteen males and six females, mean age = 31.4 +/- 7.31 years, participated in this study. Fifteen subjects had received extraarticular and ten subjects had received intraarticular ACL reconstructions. Subjects completed a 100 point subjective functional activity questionnaire and a sports participation survey. Knee ligament stability was assessed during an objective knee examination. Isokinetic quadriceps and hamstring muscle strength were tested at 240 and 120 deg/sec using the Cybex II dynamometer. Anterolateral rotatory instability and positive Lachman were elicited on the operated leg for 80% of the subjects. No significant relationship was found between objective instability and the functional activity score. For the intraarticular group, a significant correlation (P less than 0.05) was found between increased quadriceps and hamstring strength on the operated leg and return to functional activities. Subjects' functional activity score was positively correlated (P less than 0.001) with their ability to participate in sports. Subjects participating in sports involving cutting and twisting motions were less successful in returning to their preinjury participation levels and reported more subjective complaints of pain, swelling, and/or instability. These results indicate that long-term progressive rehabilitation emphasizing increased quadriceps and hamstring strength to approximate the nonoperated leg may enhance successful return to functional and sports activities after ACL reconstruction.