Risk Of Reinjury Research Articles

Primary Anterior Cruciate Ligament Reconstruction in Level 1 Athletes: Factors Associated With Return to Play, Reinjury, and Knee Function at 5 Years of Follow-up.

Favorable outcomes after anterior cruciate ligament (ACL) reconstruction (ACLR) are often gauged by successful return to play (RTP), a low incidence of subsequent ACL injury, and positive patient-reported outcomes. Level 1 sports place the highest demands on the knee by requiring frequent pivoting, changes in direction, and jumping. To analyze the outcomes of primary ACLR in level 1 athletes and identify pre- and intraoperative factors associated with RTP, ipsilateral ACL reinjury, contralateral ACL injury, and International Knee Documentation Committee (IKDC) score at 5 years postoperatively. Cohort study; Level of evidence, 2. A consecutive cohort of 1432 patients who underwent primary ACLR by 2 orthopaedic surgeons were prospectively evaluated. The RTP rate, incidence of ipsilateral/contralateral ACL injury, and IKDC score were analyzed at 5 years. Comparative analysis of clinical variables was performed between those who achieved favorable outcomes and those who did not. Outcomes at 5 and 2 years were also compared. The mean age was 24.3 ± 7.3 years (males: 75%, females: 25%). Gaelic football was the predominant sport (40%), followed by soccer (19%). The RTP rate was 87.4%, with 59.8% of athletes still playing at an equivalent or higher level at 5 years. The incidence of ipsilateral reinjury for athletes who resumed level 1 sport was 4.3% for bone-patellar tendon-bone (BPTB) autografts with screw fixation and 19.7% for hamstring tendon (HT) autografts with EndoButton and screw fixation. The incidence of contralateral ACL injury was 13.7%. The mean IKDC score at 5 years (86.6 ± 10.9) was comparable to that at 2 years (86.8 ± 10.1). Patients were more likely to RTP with each year of decreasing age (OR, 1.06; P < .001), with a higher preoperative Marx score (OR, 1.08; P < .001) or a higher 5-year IKDC score (OR, 1.06; P < .001). The risk of ipsilateral ACL reinjury increased each year of decreasing age (OR, 1.11; P < .001) or when an HT autograft was used (OR, 5.56; P < .001). Younger age was also associated with contralateral ACL injury (OR, 1.1; P < .001). Female sex, older age, concomitant meniscal/chondral injuries, and lower preoperative Anterior Cruciate Ligament Return to Sport after Injury scores were associated with lower IKDC scores at 5 years. Most patients could return to level 1 sports, although their performance level was impacted. Those who returned to sport maintained their performance level over the 5 years. The ipsilateral reinjury rate for BPTB autografts with screws was significantly lower than that for HT autografts with EndoButton and screw fixation. Most ACL reinjuries occurred between 2 and 5 years of follow-up. Younger patients had an increased risk of a subsequent ACL injury to either knee, regardless of graft type. IKDC scores were lower in female patients, older patients, and those with concomitant meniscal/cartilage injuries. NCT02771548 (ClinicalTrials.gov identifier).

Quantifying Muscle Volume Deficits Among 38 Lower Extremity Muscles in Collegiate Football Athletes After Anterior Cruciate Ligament Reconstruction.

Quadriceps dysfunction is ubiquitous after anterior cruciate ligament (ACL) reconstruction (ACLR). Addressing quadriceps dysfunction is crucial to improve function, reduce the reinjury risk, and maintain long-term knee health. While deficits specific to the quadriceps are well documented, less is known about the effect of an ACL injury on other lower extremity muscle groups. The purpose of this exploratory analysis was to quantify and rank lower extremity muscle volume deficits using magnetic resonance imaging in collegiate football athletes after ACLR. It was hypothesized that the quadriceps muscles would present with the greatest deficits and that compensatory hypertrophy of muscles at adjacent joints such as the hip and ankle would be observed. Cross-sectional study; Level of evidence, 3. This study is a secondary analysis from an ongoing multicenter prospective cohort study involving Division I collegiate football athletes. Athletes who underwent primary unilateral ACLR (1 [3%] allograft, 2 [7%] quadriceps tendon autograft, 22 [73%] bone-patellar tendon-bone autograft, 5 [17%] hamstring tendon autograft) and magnetic resonance imaging were included. Muscle volumes (mL·kg-1·m-1) were quantified bilaterally from 38 lower extremity muscles using machine learning technology. Paired-samples t tests were performed between limbs for each muscle, which were then ranked and visualized in a forest plot based on standardized mean differences (surgical - nonsurgical limb). A total of 30 athletes (mean time from surgery, 27.9 ± 19.0 months) were included. The largest muscle volume deficits in the surgical limb were seen in the 3 uniarticular quadriceps muscles, followed by the biarticular triceps surae muscles. The rectus femoris and soleus did not show significant differences between limbs. Conversely, the fibularis muscle group had a greater muscle volume in the surgical limb compared with the nonsurgical limb. Most other muscle groups did not present significant differences between limbs. Persistent quadriceps atrophy in a cohort of high-level athletes over 2 years after ACLR was highlighted in this study. Deficits in the gastrocnemius muscles, but not in the soleus, were also identified. This comprehensive approach examining various lower extremity muscles revealed latent muscle volume deficits present after ACLR.

Comparison of rehabilitation approaches for different sports: the example of basketball, boxing, and kickboxing

The article discusses the importance of rehabilitation for athletes after injuries, which is a crucial component of their return to normal sporting activities. Basketball, boxing, and kickboxing are among the most injury-prone sports, where the high intensity of physical exertion and the risk of injury require special rehabilitation methods. The scientific novelty of the research lies in studying, developing, and justifying individualized rehabilitation approaches for athletes in different sports, taking into account the physiological and psychological features of their recovery, with an emphasis on individualization in basketball, boxing, and kickboxing. The aim is to compare the effectiveness of rehabilitation approaches for athletes involved in basketball, boxing, and kickboxing, considering the specific nature of their injuries and recovery requirements. Each of the sports discussed in the work, such as basketball, boxing, and kickboxing, has its own advantages and disadvantages in rehabilitation approaches. However, the general trend in all three sports is the combination of physiotherapeutic procedures, strengthening muscles and joints, and providing psychological support for athletes. The advantage of each approach is that it focuses on the specific needs of athletes, but insufficient attention to any aspect may lead to a slowing down or worsening of the recovery process. Optimal rehabilitation methods for athletes in basketball, boxing, and kickboxing should be individualized and tailored to the specific injuries and characteristics of the sport. Including physiotherapy procedures, exercises for stability and mobility, psychological support, and gradual increases in physical load not only allows athletes to return to training but also reduces the risk of re-injury and improves their physical condition. Comparing rehabilitation approaches in basketball, boxing, and kickboxing shows that although all these sports share common rehabilitation principles (physiotherapy, psychological support, gradual increases in load), each sport has its own specific injury patterns and recovery requirements. Effective rehabilitation is based on an individualized approach to each athlete and takes into account the particularities of the injuries and physical loads present in each of these sports.

Kinetics During the Tuck Jump Assessment and Biomechanical Deficits in Female Athletes 12 Months After ACLR Surgery.

Residual interlimb deficits after anterior cruciate ligament reconstruction (ACLR) can lead to functional maladaptation and increase the risk of reinjury. The tuck jump assessment (TJA) may offer a more effective evaluation of ACLR status as compared with traditional tasks owing to increased risk of altered landing mechanics, asymmetrical landing, and increased knee valgus attributed to the cyclical nature of the task. However, it remains unclear whether altered TJA kinetics resolve over time or persist through return-to-play phases of rehabilitation. To examine longitudinal kinetics, asymmetries, and functional performance deficits during TJA at 9 and 12 months after ACLR in female athletes at high risk of reinjury. Cohort study; Level of evidence, 2. Female athletes (ACLR, n = 24; controls, n = 19; total, N = 43) performed a single trial of TJA on dual-force plates at 2 time points. The ACLR group (mean ± SD age, 16.8 ± 1.9 years) was tested at 9 and 12 months after surgery, and the control group (16.5 ± 3.6 years) was tested at similar time points. All athletes participated in similar sports and had comparable activity levels. Discrete time point analysis and statistical parametric mapping were used to identify deficits within each group. At 9 months after surgery, the ACLR group exhibited significant interlimb differences in all kinetic variables (P < .05), which persisted at 12 months with only small reductions in magnitude. As compared with controls, the ACLR group demonstrated a persistent offloading strategy in the involved limb by exhibiting larger interlimb asymmetries for a range of kinetic variables and a greater vertical ground-reaction force in the uninvolved limb during most of the stance phase at both time points (P < .001). Distinct differences in functional performance of TJA were evident at both time points, characterized by lower peak vertical ground-reaction force, peak center of mass displacement, and relative vertical leg stiffness and longer ground contact times (P < .001). This study revealed that young female athletes after ACLR exhibit persistent interlimb deficits and functional maladaptations up to 12 months after surgery. The TJA identified significant biomechanical impairments to both limbs, resulting in asymmetrical loading and altered movement strategies as compared with healthy controls. Despite some improvements, athletes with ACLR continued to demonstrate offloading to the uninvolved limb, indicating incomplete neuromuscular recovery.

ASSESSMENT OF CORE STRENGTH AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION DURING SINGLE-LEG SQUATS

Background: Core strength plays a pivotal role in dynamic stability and efficient force transmission. Inadequate core and hip muscle strength often contribute to knee valgus, which increases the risk of non-contact anterior cruciate ligament (ACL) injuries. With ACL injuries being prevalent in team sports, there is a growing need for effective rehabilitation strategies. This study addresses a notable gap in understanding the relationship between core strength and single-leg squat (SLS) performance in patients post-ACL reconstruction, providing valuable insights to optimize rehabilitation practices. Objective: To assess the impact of core strength on single-leg squat performance in individuals following ACL reconstruction. Methods: A descriptive cross-sectional study design was employed, including 72 participants selected using non-probability convenient sampling. The study was conducted at Lahore Medical and Dental College over six months. Inclusion criteria included individuals aged 18-40 years with a history of unilateral ACL reconstruction, a stable graft, full knee range of motion, and completion of rehabilitation. Core strength was measured using the Plank Test, while SLS performance was graded using a three-point ordinal scale ("Good," "Fair," and "Poor"). SPSS version 24.0 was used for data analysis, and results were reported as mean, standard deviation, frequency, and percentages. Results: The mean plank hold time was 51.58 seconds (SD = 30.47), with durations ranging from 7 to 130 seconds. SLS grading revealed 45.8% of participants performed in the “Good” category, 29.5% in “Fair,” and 25% in “Poor.” These findings demonstrate a positive association between core strength, as measured by plank hold time, and improved SLS performance. Conclusion: Enhanced core strength significantly improves SLS performance in individuals post-ACL reconstruction. Incorporating core stability training into rehabilitation programs is critical for optimizing lower limb function and reducing the risk of re-injury.

Meniscus Tears: Risk Factors, Physical Examination, and Preventive Approaches

Abstract. Meniscus injuries are among the most frequent knee issues, affecting individuals across a wide age range and often resulting from acute trauma or age-related degeneration. The meniscus, essential for knee stability, shock absorption, and joint lubrication, is particularly vulnerable to injury in sports involving twisting and pivoting motions. This review discusses the anatomy of the meniscus, various types of tearssuch as radial, horizontal, complex, and bucket-handle tearsand the primary risk factors, including sports activities and occupational stress. Diagnostic tools like the McMurray and Apley compression tests, along with MRI, are crucial in assessing the severity of the injury. Effective prevention strategies include strengthening exercises for the quadriceps and hamstrings, flexibility routines, proper movement techniques, and the use of protective gear like knee braces. Early detection and consistent preventive measures are critical in preserving knee function, minimizing the risk of re-injury, and preventing long-term complications such as osteoarthritis.

Neurocognitive and Neuromuscular Rehabilitation Techniques after ACL injury - Part 2: Maximizing Performance in the Advanced Return to Sport Phase.

Anterior cruciate ligament (ACL) injury and reinjury rates are on the rise, despite improved surgical techniques and prevention programs. ACL injuries also lead to a variety of neuroplastic and neuromuscular alterations. Emerging research highlights the importance of addressing neurocognitive deficits that can persist after injury including altered proprioception, impaired motor control, muscle recruitment and heightened reliance on visual feedback. This suggests a shift from subconscious movement, to movements that require increased volitional control, which may contribute to increased risk of re-injury and thus impede return to sport. Given the neurophysiological changes associated with anterior cruciate ligament (ACL) injury that persistent into the late stages of rehabilitation, does the integration of neurocognitive training into mid to late stage rehabilitation protocols improve functional outcomes and reduce the risk of re-injury following ACL reconstruction (ACLR) in athletes? The purpose of Part 2 of this clinical commentary is to offer strategies to implement neurocognitive training elements into the traditional ACLR rehabilitation (in weeks 9+) and review updated testing metrics that may better discern an athletes readiness to return to competition. A comprehensive rehabilitation framework incorporating both physical and neurocognitive components is proposed, aiming to improve both long-term outcomes and return to sport testing, as well as diminishing re-injury risk. Updates to the traditional rehabilitation approach post ACLR, that include increased emphasis on neuroplastic, cognitive, and visual-motor capabilities exist. These help prepare athletes for the unpredictable and chaotic nature of the sporting environment and may facilitate a more effective return to sport for athletes, potentially mitigating the risk of re-injury. 5.

Neural-Targeted Rehabilitation Strategies to Address Neuroplasticity After Joint Injury.

In patients with musculoskeletal injury, changes have been observed within the central nervous system that contribute to altered movement planning. This maladaptive neuroplasticity potentially explains the clinical disconnect where residual neuromuscular dysfunction and high rates of reinjury are often observed even after individuals clear return-to-activity functional testing. An improved understanding of these neural changes could therefore serve as a guide for facilitating a more complete recovery and minimizing risk of reinjury. Therefore, we propose a paradigm of neural-targeted rehabilitation to augment commonly used therapeutic techniques targeting sensorimotor function to better address maladaptive plasticity. Although most treatments have the capability to modify neural function, optimizing these treatments and combining them with integrative therapies (eg, implementation of motor learning strategies, transcranial direct current stimulation) may enhance neural efficiency and facilitate return to activity in patients with musculoskeletal injury. To complete this model, consideration of affective aspects of movement and associated interventions must also be considered to improve the durability of these changes.

Impact of lateral ankle sprains on physical function, range of motion, isometric strength and balance in professional soccer players

ObjectiveLateral ankle sprains (LASs) are prevalent in soccer and can affect long-term performance, injury recurrence and risk for chronic ankle instability. This case–control study examined functional impairments associated with LAS...

3.0-Tesla MRI Observation at Return to Play After Hamstring Injuries.

To describe 3.0-Tesla (T) magnetic resonance imaging (MRI) findings of hamstring muscles in clinically recovered athletes who were cleared for return to play (RTP). Prospective observational study. Hospital. Athletes (amateur and professional) who were cleared for RTP after hamstring injury. Fifty-eight participants were included in the analysis. 3-T MRI at baseline (within 7 days from initial injury) and MRI at RTP (within 10 days of RTP). Injury location, grade of injury (modified Peetrons and British Athletics Muscle Injury Classification/BAMIC), presence and the extent of intramuscular signal abnormality, intramuscular tendon disruption, and thickness. Reinjuries within 1 year of RTP were recorded. Magnetic resonance images at RTP showed that 55 (95%) participants had intramuscular increased signal intensity (edema) and 44 (76%) participants had intramuscular abnormal low-signal intensity (suggesting fibrosis) on MRI. There was an overall reduction of injury grades according to the modified Peetrons and BAMIC classification at initial injury to RTP. Three (5%) participants had no abnormal signal intensities (grade 0 or grade 0A) on MRI at RTP. Intramuscular tendon disruption, waviness, and tendon thickening were present at RTP in, respectively, 22 (38%), 15 (26%), and 36 (62%). We recorded 3 (5%) reinjuries. At RTP, 3.0-T MRI shows high percentages of MRI abnormalities (edema, fibrosis, and intramuscular tendon disruption and thickening). We conclude that complete normalization of 3.0-T MRI is not expected for RTP decision after a hamstring injury. Its possible association with reinjury risk has to be determined in larger cohorts.

Research on the biomechanical characteristics of basketball player injuries and their application in sports rehabilitation

Basketball is a dynamic sport, characterized by fast moves, powerful hops, and constant changes in direction, which contributes to its great intensity and excitement. However, these same features elevate athletes to a risk of various types, which include the most common ones such as ligament tears, knee problems, and ankle sprains. The knowledge of the risk factors associated with particular movement patterns and environmental conditions is made possible by knowledge of the biomechanical qualities of these injuries is crucial if one has to develop effective preventive and rehabilitation strategies. The purpose of the study is to establish the biomechanical characteristics of basketball player injuries and their application in sports rehabilitation. The study proposed a novel Tunicate Swarm Optimized Flexible Extreme Boosting (TSO-FXGBoost) to predict the injuries of basketball players and their sports rehabilitation. Player’s motion data capture sessions utilize cameras and sensors to record their biomechanics during basketball activities. A Gaussian filter was employed to process the data to eliminate the noise present in the biomechanical data. Principal component analysis (PCA) served as a dimensionality reduction approach to extract relevant features from the pre-processed data. The results demonstrate that certain biomechanical features have a strong correlation with the occurrence of injuries, which indicates great potential in the strategies of prevention of injuries. In a comparative analysis, the suggested approach performs various assessment metrics such as accuracy (98%), recall (96.2%), precision (98.49%), and F1 score (97.8%). The suggested approach and rehabilitation strategies can be customized to each player’s unique biomechanical profile, improving rehabilitation times and lowering the risk of re-injury.

Relationships between Patient-Reported Outcomes and Predictors of Second ACL Injuries during Unanticipated Jump Landings.

Reactive and external visual-cognitive demands are prevalent in sport and likely contribute to ACL injury scenarios. However, these demands are absent in common return-to-sport assessments. This disconnect leaves a blind spot for determining when an athlete can return to sport with mitigated re-injury risk. PurposeTo characterize relationships between patient-reported outcome measures (PROMs) and cognitive-task interference (i.e., cognitive demands exacerbating neuromuscular impairments) for biomechanical predictors of second ACL injuries during jump landings that involved rapid unanticipated decision making. MethodsThirty-six persons following primary ACLR (26F/10M, 19.8±1.8 years; 1.71±0.1 m; 69.6±12.8 kg, 1.5±0.6 years post ACLR; Tegner: 6.8±1.8) participated. PROMs of ACL-RSI, and the Forgotten Joint Score-12 Knee (FJS-12) were selected to assess altered psychological state (e.g., confidence, attention toward knee). Jumping tasks under anticipated and unanticipated secondary jump directions were performed. Biomechanical variables were dual-task changes (unanticipated - anticipated) in 1) uninvolved limb hip rotator impulse (DTC_Uni-HRot_Imp), 2) asymmetry of knee extensor moment at initial contact (DTC_KEM_Asym), and 3) range of involved knee abduction angle (DTC_KAbA_Range). Regression models tested for relationships between PROMs and the dual-task change in biomechanical variables. Results: ACL-RSI (DTC_Uni-HRot_Imp (p < 0.001)) and FJS-12 (DTC_KAbA_Range (p = 0.001)) had significant relationships with dual-task change in the opposite direction as expected (worse PROM ➔ less dual-task change). A follow-up analysis indicated that dual-task change was inversely correlated with the baseline estimates for kinetic biomechanical variables (less risky single-task biomechanics ➔ greater dual-task change for Uni-HRot_Imp and KEM_Asym).Conclusions: The collective results are consistent with higher functioning participants (better PROMs) who also demonstrate desirable biomechanics during single-task conditions being prone to demonstrating the greatest risk-associated DTC in unanticipated scenarios.

Hospital-based violence intervention programs: An analysis of costs and key components

BACKGROUND Firearm assaults contribute to nearly 18,000 deaths and at least twice as many injuries annually, with immense human and financial costs. Gun violence survivors especially face unique and long-term physical, mental, economic, and safety-related challenges. Hospital-based violence intervention programs (HVIPs) connect survivors with violence prevention professionals at their hospital bedsides, then provide them with wraparound services in the months to come. Promising research shows that HVIPs reduce risks of reinjury, retaliation, and recidivism. METHODS This report provides a cost analysis of HVIPs, to inform researchers and implementers of the budget and key resources necessary for the first three years of implementation. Researchers employ an ingredients-based costing approach and base-case assumptions for a hospital-linked HVIP situated in a mid-sized city emergency department, serving 100 participants annually. RESULTS Results indicate that this base-case HVIP costs an estimated $1.1 million annually, or just under $10,800 per participant. Staffing accounts for the majority of HVIP budgets, followed by operations, crisis support, and finally transportation. Upfront costs are limited to technical assistance, first-time equipment, and accreditation courses, leaving annual costs relatively stable across the first 3 years of implementation. A customizable workbook is provided, through which users can adjust this study’s assumptions to reflect their own program’s specifications, which may vary. CONCLUSION While a full cost-savings analysis remains needed, HVIP enrollment costs less per person than a single year of medical fees for nonfatal firearm assault-related injuries. This research can inform future cost, benefit, and savings analyses, and empower more communities to implement lifesaving HVIPs. LEVEL OF EVIDENCE Economic and Value-Based Evaluation; Level II.

Neurocognitive and Neuromuscular Rehabilitation Techniques after ACL Injury, Part 1: Optimizing Recovery in the Acute Post-Operative Phase- A Clinical Commentary.

Anterior cruciate ligament (ACL) injury rates are on the rise, despite improved surgical techniques and prevention programs. While traditional rehabilitation emphasizes the restoration of motion, strength, and physical performance, emerging research highlights the importance of addressing neurocognitive deficits that can persist after injury. These deficits, including altered proprioception, impaired motor control and muscle recruitment, as well as heightened reliance on visual feedback, can significantly increase the risk of re-injury and impede return to sport. The purpose of this clinical commentary is to outline a proposed comprehensive approach to rehabilitation that challenges the neurocognitive system to optimize rehabilitation outcomes and reduce reinjury risk. Thus, this clinical commentary discusses the rationale for integrating neurocognitive training into all phases of ACLR rehabilitation, from initial injury to eight weeks post-surgery. It details the neurophysiological changes caused by ACL injury and presents evidence supporting the use of exercises that challenge visual attention, decision-making, and motor planning. A comprehensive rehabilitation framework incorporating both physical and neurocognitive components is proposed, aiming to improve long-term outcomes and reduce re-injury risk. Level of Evidence: 5.

Evaluating the Importance of Return to Sports and Hamstring Strength in a Discrete Choice Experiment for Anterior Cruciate Ligament Injury.

With emerging treatments for anterior cruciate ligament (ACL) injury, analysis of patient preferences is lacking to align clinical care and research with patient priorities. To identify patient priorities for outcomes after surgical intervention if they were to sustain an ACL tear, analyze what outcome measures influenced preferences, and determine whether patient demographics influenced preferences. Cross-sectional study. The authors screened patients aged 18 to 30 years who presented for upper extremity complaints to a single institution in 2023. Patients were excluded for current lower extremity injury or history of a knee injury requiring surgical consultation. The authors designed a discrete choice experiment through literature review of outcome measures for bridge-enhanced ACL restoration (BEAR) and ACL reconstruction (ACLR) with hamstring tendon autograft. Measures included return to sports, risk of arthritis, risk of reinjury, and hamstring strength. Patients chose surgery A (ACLR with hamstring tendon autograft) or surgery B (BEAR) and then rated the importance of each outcome measure on their selection. In total, 100 participants (36 female; mean age, 25.1 ± 4.0 years) completed the discrete choice experiment. Overall, 56.0% participated in sports and 80.0% were employed. Based on surgery choice group, there were no significant differences in sex, age, Marx Activity Scale score, sports participation, or employment status between patients who selected BEAR or ACLR with hamstring tendon autograft (all P > .361). Return to sports and hamstring strength were significant priorities for patients in procedure selection (P ≤ .011). Of the patients who selected ACLR with hamstring tendon autograft, 31.6% would not elect to undergo this procedure. In this discrete choice experiment of adults without prior ACL injury, return to sports and hamstring strength were identified as patient priorities when selecting a procedure for ACL injury. Risk of reinjury, however, was not a significant factor in procedure selection. Importantly, these priorities were maintained regardless of patient characteristics, activity level, or employment status.

Graft Failure in Pediatric Patients After Bone-Patellar Tendon-Bone, Hamstring Tendon, or Quadriceps Tendon Autograft ACLR: A Systematic Review and Meta-analysis.

Anterior cruciate ligament (ACL) reinjury risk is high in young athletes, with graft failure rates as high as 23%. The optimal autograft choice to minimize reinjury risk in this population is unclear. To compare graft failure rates between bone-patellar tendon-bone (BPTB), hamstring tendon (HT), and quadriceps tendon (QT) autografts in patients aged ≤18 years with a minimum follow-up (FU) of 24 months. Systematic review; Level of evidence, 4. A systematic review of the literature between database inception and March 2022 encompassed PubMed/MEDLINE, Cochrane CENTRAL, Embase, and Web of Science Core Collection databases. Studies on autograft ACL reconstruction (ACLR) using HT, QT, or BPTB autograft in patients ≤18 years old with a minimum FU of 2 years were included. Graft failure rates were pooled and estimated using random-effects models via the inverse variance method and logit transformations. Meta-analyses were used to estimate failure rates and pairwise comparisons were conducted by autograft type when appropriate. A total of 24 studies comprising 2299 patients (HT: n = 1237, 44.8% female, 59.1-month mean FU; BPTB: n = 913, 67.3% female, 79.9-month mean FU; QT: n = 149, 36.4% female, 35.3-month mean FU) were included. HT exhibited the highest failure rate at 11.8% (95% CI, 9.0%-15.4%); failure rates for BPTB and QT were 7.9% (95% CI, 6.2%-10.0%) and 2.7% (95% CI, 1.0%-7.5%), respectively. HT had a significantly higher failure rate than both BPTB (Q = 5.01; P = .025) and QT (Q = 7.70; P = .006); BPTB had a significantly higher failure rate than QT (Q = 4.01; P = .045). Male patients were less likely than their female counterparts to experience graft failure after HT ACLR (odds ratio, 0.48; 95% CI, 0.25-0.95). While the HT remains a common choice for ACLR, the current aggregate data indicate that BPTB and QT demonstrated significantly lower failure rates than HT ACLR in adolescent athletes ≤18 years old. The QT demonstrated the lowest failure rate in adolescents but also the lowest proportion of patients represented due to a paucity of published QT data, indicating a need for future studies with larger sample sizes that include QT autografts, reduced risk of bias, and consistent reporting on skeletal maturity and surgical technique to better determine the ideal autograft for active athletic populations ≤18 years old.

The achilles tendon rupture: A deeper dive into its impact on professional and high-performance athletes

Background: The Achilles tendon rupture (ATR) is an injury that has been detrimental to professional athletes over the years, recently rising to unforeseen heights as the intensity of sports has increased. Methods: To obtain relevant statistics for this paper, a review of prior research, including original research and case studies, was conducted. Digital publications and clinical data were reviewed to dissect factors such as injury causes, operations, current initiatives, the role of technology, and future implications. Results: The data revealed a significant increase in documented ATRs in athletes and the National Football League (NFL) over the years; most recently, these injuries increased from 11 in the 2019-2020 season to 24 in the 2021-2022 season.3 Despite advancements in technology and recovery methods, dynamic changes involving training, conditioning, physicality, and intensity in sports have greatly contributed to the increased rates of injuries. With modernized resources such as advanced testing and rehabilitation procedures incorporating artificial intelligence (AI), specialists continue to search for new ways to treat injury and improve functional outcomes more effectively. Conclusion: This paper examines ATRs in athletes, its risk factors, current surgical methods for treatment, and modern rehabilitation methods. Future research should continue to develop comprehensive assessment and treatment methods to decrease the time to return to play, reduce the risk of re-injuries, and ensure cost-effective standards in implementing advanced rehabilitation modalities.

EFFECTIVE REHABILITATION STRATEGIES FOR MUSCLE INJURIES IN FOOTBALL PLAYERS

The rehabilitation of muscle injuries in football players is a pivotal area of sports physiotherapy, addressing the intense physical demands and high injury rates associated with the sport. Muscle injuries often arise from factors such as overload, muscle imbalances, and improper techniques, impacting athletes' performance and career longevity. To optimize recovery, evidence-based methodologies are crucial, allowing physiotherapists to create personalized rehabilitation programs tailored to the specifics of each injury. Central to effective rehabilitation is a thorough functional assessment, which identifies specific deficits in players. Techniques such as electrotherapy and therapeutic ultrasound are effective in accelerating healing and reducing pain, while functional taping provides support without restricting movement. Neuromuscular rehabilitation is equally vital, incorporating proprioceptive exercises to enhance stability and prevent future injuries. The multidisciplinary approach, involving collaboration between physiotherapists, medical professionals, nutritionists, and coaches, ensures comprehensive care for athletes. Psychological support also plays a key role in addressing anxiety and fostering a positive mindset during recovery. Recent studies underscore the importance of accurate diagnosis and individualized treatment plans, utilizing frameworks like the PRICE principle and specific rehabilitation protocols that facilitate faster and safer returns to play. The literature indicates a gap in understanding among team managers regarding the role of sports physiotherapy, highlighting the pressure players face to return prematurely, which increases the risk of re-injury. In summary, successful rehabilitation of muscle injuries in football necessitates a comprehensive, personalized approach that integrates physical, nutritional, and psychological elements. As research continues to evolve, these strategies will enhance the effectiveness of rehabilitation programs, ensuring football players can recover fully and maintain optimal performance levels.

Pediatric Anterior Cruciate Ligament Tears.

Anterior cruciate ligament (ACL) tears have become an increasingly prevalent problem in pediatric patients due to increased youth sports participation and early sports specialization. A high index of suspicion should be utilized for any young patient with an acute knee injury and an associated effusion or difficulty bearing weight. A thorough work-up should be performed that includes a careful assessment of growth remaining and concomitant injuries. While nonoperative management may be a consideration for select cases, most patients will benefit from early surgical management. ACL deficiency or delayed reconstruction can lead to early chondral degeneration and risk for further injury to the cartilage and menisci. The goal of ACL reconstruction is to create a stable knee and prevent secondary chondral or meniscal injury. Physeal-sparing and physeal-respecting transphyseal techniques have been developed that allow for safe and successful ligament reconstruction while minimizing the risk of growth arrest. Younger patients have a higher risk of reinjury and require a longer recovery period for a full return to sports than their older counterparts. Even though there have been advances in the safe and successful treatment of ACL tears in pediatric patients, it remains a devastating physical and psychological injury, and increased efforts should be made at prevention. Injury prevention programs have been shown to reduce the risk of ACL tears, and it is important to increase awareness and utilization of prevention strategies.

Intralimb Coordination Pattern of the Lower Limbs in Male Athletes With Allograft and Autograft Anterior Cruciate Ligament Reconstruction During Landing

Background and Objectives: Two common choices exist for anterior cruciate ligament (ACL) reconstruction, autograft and allograft. Hamstring tendon autografts and soft-tissue allografts are commonly used for ACL reconstruction. The outcomes between these two grafts are controversial. This research aims to quantify and compare lower limb joint coordination between two ACL reconstruction graft options and healthy individuals. Methods: Sixty-one athletes were enrolled after ACL reconstruction surgery (allograft, n=22; autograft, n=18). Furthermore, twenty-one healthy athletes were considered in the control group. The inclusion criteria included unilateral anterior cruciate ligament reconstruction surgery with allograft and autograft methods, male athletes with a minimum of 9 months and a maximum of two years since their surgery, successfully passing a series of quadriceps and hamstring strength tests and distance jumping before entering sports-specific activities under the supervision of a sports physiotherapist, and returning to pre-injury sports activities. Results: Autograft was not statistically different from matched healthy limbs in terms of joint coordination variability and magnitude (P&gt;0.05). However, the magnitude of joint coordination was superior to the allograft group compared to the autograft reconstructed ACL (P&lt;0.05). Conclusion: Although our result reported no significant difference between groups in joint coordination variability, having an insight into coordinative function after ACL reconstruction will help develop postoperative rehabilitation programs as well as minimize the re-injury risk among patients. We also suggest that scholars should conduct more robust trials with valid research designs to control the results of ACL reconstruction comparison with autograft and allograft.