Risk Of Reinjury Research Articles

Players' and parents' perceptions of injury in elite Northern Irish schools’ rugby – A qualitative study

ObjectivesTo explore schools' rugby players' and their parents’ perceptions of injury. DesignA qualitative study using focus groups. SettingSchools who compete in the Ulster Schools’ Cup competition. Participants13 players and 9 parents. Outcome measuresA thematic analysis approach was used to examine players' and parents’ beliefs and attitudes towards injury, return to play and injury risk. ResultsFindings suggest schools' rugby players and their parents are aware of injury risk in the schoolboy game. They are aware of concussion injury but are less aware of musculoskeletal injury. Parents' perceptions of injury are based on their experience of their sons’ injuries. Parents are unaware of return to play strategies for musculoskeletal injury. ConclusionsSchools' rugby players and their parents are aware of injury to some extent, however players' and parents’ knowledge and understanding of injury is based on and informed by personal experience, not the evidence base. Whist they are aware of injury, many players will seek to push their fears to the back of their mind. However, for those players who have suffered severe injury, they are concerned about the risk of reinjury.

THE CONTRALATERAL LIMB IS NOT AN ADEQUATE REHABILITATION GOAL FOR ASSESSING MUSCLE FUNCTION IN AN ANTERIOR CRUCIATE LIGAMENT-INJURED PAEDIATRIC POPULATION

To investigate changes in quadriceps and hamstrings muscle groups during sustained isokinetic knee flexion and extension.125 paediatric participants (45 males and 80 females, mean age 14.2 years) were divided into two groups: participants with a confirmed ACL tear (ACLi, n = 64), and puberty- and activity-level matched control participants with no prior history of knee injuries (CON, n = 61). Participants completed a series of 44 repetitions of isokinetic knee flexion and extension at 90 deg/ sec using a Biodex dynamometer (Biodex Medical Systems Inc, Shirley, New York). Surface EMG sensors (Delsys Incorporated, Natick, MA) simultaneously recorded the quadriceps and hamstring activations. Muscle function was assessed as the change in quadriceps activation and extension torque were calculated using the percent difference between the mean of the first five trials, and the mean of the last five trials.ACLi participants had significantly higher percent change in quadriceps activation for both healthy and injured legs, in comparison to CON dominant leg. As such, the healthy leg of the ACLi participants is activating significantly more than their health matched controls, while also demonstrating reduced muscular endurance (less torque in later repetitions). Therefore, we conclude that the non-injured limb of the ACLi participant is not performing as a healthy limb. Since return to activity clearance following ACLi implies return to sport against age- and activity matched opponents, clearing young athletes based on the non-injured contralateral limb may put them at greater risk of reinjury.

Why paediatric knee surgery is not just knee surgery on small knees

Paediatric knee surgery is a developing subspecialty in the UK. The rise in early participation of children in organized competitive sports has led to an increase in knee injury presentations, and brings unique challenges. Children's knee surgery encompasses varied and complex pathologies, and combines expertise in soft tissue and arthroscopic techniques with an understanding of the unique characteristics of children, their skeleton and growth potential. Children are inherently high-risk surgical candidates due to ligamentous laxity, growth potential, difficulties in rehabilitating post-surgery and risks of re-injury. Goals of treatment include management of instability and pain, restoration of function and rehabilitation, in order to preserve the knee for the child's future. This review will focus on the commonly presenting problems of cruciate, meniscal and patellofemoral pathology.

Good rates of return-to-sport in athletes after revision anterior cruciate ligament reconstruction using autologous patellar tendon and lateral extra-articular tenodesis: a 2-year follow-up prospective study

BackgroundMost athletes who undergo revision of the anterior cruciate ligament reconstruction (ACLR) aim to return to their preinjury sport at a similar level of performance while minimizing the risk for reinjury. Additional lateral extra-articular tenodesis (LET) has recently been correlated with improved outcomes and low complication rate. Yet, there are few series evaluating return-to-sport (RTS) and clinical outcomes after revision ACLR using bone-patellar tendon-bone (BPTB) and LET in athletes.MethodsThe study cohort consisted of 19 eligible athletes who had undergone their first revision ACLR using BPTB and LET (modified Lemaire) between January 2019 and 2020. Patients were prospectively followed and interviewed in a sports activity survey during a 2-year follow-up.ResultsDespite all patients returning to sports after revision ACLR surgery, 52.6% resumed playing at their preinjury level. Furthermore, patient-reported functional outcomes improved significantly following revision surgery, as evidenced by improvements in IKDC [64.4 (± 12) to 87.8 (± 6)], Lysholm [71.27 (± 12) to 84.2 (± 9.7)], and SF-12 scales [Physical: 53.3 (± 3) 57 (± 1.2); Mental: 50.2 (± 3.3) to 52.7 (± 2.4)]. One case (5.3%) experienced persistent pain and underwent reoperation for a partial meniscectomy.ConclusionAfter revision ACLR using autologous BPTB and LET, all active individuals are expected to RTS, similar to primary ACLR. The difference comes down to returning to the preinjury level, where the levels are lower depending on the sport and initial level of play. Good mid-term functional outcomes with a low complication rate can be expected in most cases.Study designCase series; Level of evidence IV.Ethical Committee Approval NumberPR(ATR)79/2021 and HCB/2023/0173.

Mesenchymal Stem Cells for Enhanced Healing of the Medial Collateral Ligament of the Knee Joint.

Background and Objectives: The medial collateral ligament (MCL) is one of the major supporting ligaments of the knee joint, and MCL injuries are common where excessive valgus loading is applied to the knee joint. Although most MCL injuries can be treated conservatively, healing of the MCL can take several weeks to months. Furthermore, once injured, the biomechanical properties of the healed MCL differ from those of the native MCL, resulting in an increased risk of re-injury and chronic remnant symptoms. Mesenchymal stem cells (MSCs), owing to their therapeutic potential, have been investigated in various musculoskeletal injuries, and some preclinical studies regarding MSC-based approaches in MCL injuries have shown promising results. Despite satisfactory results in preclinical studies, there is still a lack of clinical studies in the orthopedic literature. This article describes the basic knowledge of the MCL, standard treatments for MCL injuries, and recent studies regarding the application of MSCs for enhanced healing of the MCL. MSC-based approaches are expected to be a potential therapeutic option for enhanced healing of the MCL in the future.

The Implementation of a Return-to-Play Protocol with Standardized Physical Therapy Referrals in a Collegiate Football Program: PT's Role in Return-to-Play, A Clinical Commentary.

Level V.

Effect of Quadriceps and Hamstring Strength Relative to Body Weight on Risk of a Second ACL Injury: A Cohort Study of 835 Patients Who Returned to Sport After ACL Reconstruction.

Anterior cruciate ligament (ACL) injuries are common sports-related injuries with a high risk of reinjury after return to sport (RTS). Rehabilitation aims to regain symmetrical knee strength and function to minimize the risk of a second ACL injury after RTS. To determine the effect of absolute quadriceps and hamstring strength, normalized by body weight, on the risk of a second ACL injury during the first 2 years after RTS in patients who have undergone ACL reconstruction (ACLR). Cohort study; Level of evidence, 3. Data from patients after index ACLR at the time of RTS were extracted from a rehabilitation registry-Project ACL. Patients who had performed isokinetic tests for quadriceps and hamstring strength and hop tests before RTS were included. The endpoint was a second ACL injury or a follow-up of 2 years after RTS after ACLR. A total of 835 patients (46% women), with a mean age of 23.9 ± 7.7 years, were included. During the study period, 69 (8.3%) second ACL injuries (ipsilateral and contralateral) occurred. Greater relative quadriceps strength in the injured leg increased the risk of a second ACL injury (relative risk [RR], 1.69 [95% CI, 1.05-2.74]; P = .032). In patients who had recovered symmetrical quadriceps strength (limb symmetry index ≥90%), there was no effect of quadriceps strength on the risk of second ACL injury (RR, 1.33 [95% CI, 0.69-2.56]; P = .39). Quadriceps strength on the healthy side or hamstring strength, regardless of side, had no effect on the risk of a second ACL injury. Greater relative quadriceps strength in the injured leg at the time of RTS after ACLR was associated with an increased risk of a second ACL injury. There was no effect of relative quadriceps strength on the risk of a second ACL injury in patients who had recovered symmetrical quadriceps strength.

Ankle sprain and podoscopic footprint pattern in female volleyball players.

Ankle sprain (AS) is the most common sports injury that can be complicated by chronic joint instability. The aim of this study was to examine the relationship between foot types and the ankle sprain events suffered during the sport career in female volleyball players. In this retrospective study, we randomly selected 98 female volleyball players competing in several divisions. Data were obtained from self-administered questionnaires in which the athlete noted data about volleyball practice, whether they had had ankle sprains and the number of these events. Plantar footprint was photographed by a plantoscope classifying each foot as normal, flat or cavus (196 feet). Of the 196 feet, 145 (74.0%) were normal, 8 (4.1%) were flat 43 and (21.9%) were cavus. Thirthy-five athletes reported at least one AS during volleyball practice. In total 65 sprain injuries were reported (35 to the right side and 30 to the left side). In 22 ankles (14 right, 8 left) sprain reinjure (AS >1) have been reported. A higher AS reinjury rate is correlated to the cavus footprint pattern (p = 0,005). Cavus foot associates to a higher risk of reinjury for ankle sprains in female volleyball players. Knowing the athletes which are more likely to sustain a reinjure may be helpful for the orthopedic surgeon to plan preventive strategies.

Effects of mental fatigue on biomechanical characteristics of lower extremities in patients with functional ankle instability during unanticipated side-step cutting.

Background: Functional ankle instability (FAI) is the primary classification of ankle injuries. Competitive activities have complicated movements that can result in ankle re-injury among patients with FAI. Unanticipated movement state (MS) and mental fatigue (MF) could also happen in these activities, which may further increase their joint injury risk. Objective: This study aimed to clarify the biomechanical characteristics difference of the lower extremity (LE) between the injured side and the uninjured side among patients with FAI when they perform unanticipated side-step cutting after MF. Methods: Fifteen males with unilateral FAI participated in this study (age: 20.7 ± 1.3years, height: 173.6 ± 4.4cm, weight: 70.1 ± 5.0kg). They used the injured side and the uninjured side of LE to complete anticipated and unanticipated side-step cutting before and after MF. The kinematic and kinetics data were evaluated using three-way ANOVA with repeated measures. Results: During patients with FAI performed anticipated side-step cutting, the ankle stiffness of both sides showed no significant change after MF; During they performed unanticipated side-step cutting, their injured side presented significantly lower ankle stiffness after MF, while the uninjured side did not have such change. In addition, after MF, the injured side exhibited increased ankle inversion, knee valgus and LR, but the uninjured side did without these changes. Conclusion: Influenced by MF, when patients with FAI use their injured side of LE to perform side-step cutting, this side LE has a higher risk of musculoskeletal injuries such as lateral ankle sprains and anterior cruciate ligament injury. The ankle stiffness of the injured side will be further reduced when patients with FAI perform unanticipated side-step cutting, which increases ankle instability and the risk of re-injury.

Using trunk kinematics to predict kinetic asymmetries during double-leg jump-landings in collegiate athletes following anterior cruciate ligament reconstruction

BackgroundBilateral vertical ground reaction force (VGRF) and knee extension moment asymmetries are commonly observed during jumping and landing tasks following anterior cruciate ligament (ACL) reconstructions (ACLR) in collegiate athletes. Kinetic asymmetries during landings are associated with increased ACL re-injury risk. Efforts have been made to predict bilateral kinetic asymmetries using trunk kinematics during squats but not during jump-landings. Research questionTo determine the correlations between trunk kinematics (medial-lateral shoulder positions, medial-lateral hip positions, and lateral trunk bending angles) and bilateral kinetic asymmetries (VGRF and knee extension moments) during double-leg jump-landings in collegiate athletes following ACLR. MethodsFifteen National Collegiate Athletic Association Division I athletes who had ACLR in the past 24 months participated. Eleven of them performed two assessments over the study period for a total of 26 assessments for data analyses. Athletes performed three double-leg countermovement jumps. Kinematics and kinetics data were collected. Medial-lateral shoulder and hip positions relative to ankle positions, lateral trunk bending angles, and kinetic asymmetries were calculated during the jumping (the lowest hip position until takeoff) and landing (the first 100 ms after initial contact) phases. ResultsMedial-lateral shoulder positions correlated with VGRF (r = 0.63, p < 0.001) and knee moment asymmetries (r = 0.53, p = 0.006) in the jumping phase. Medial-lateral hip positions correlated with VGRF (r = 0.61, p < 0.001; r = 0.52, p = 0.006) and knee moment asymmetries (r = 0.55, p = 0.004; r = 0.61, p < 0.001) in both jumping and landing phases. SignificanceMedial-lateral hip positions correlated with kinetic asymmetries during double-leg jump-landings in collegiate athletes following ACLR. A 2D assessment using a standard video camera might be used as a low-cost and clinically applicable tool to assess bilateral kinetic asymmetries by quantifying medial-lateral hip positions during jump-landings following ACLR.

Secondary Anterior Cruciate Ligament Injury Prevention Training in Athletes: What Is the Missing Link?

After reconstruction, the return to full competition rate of athletes is low, while the re-injury rate remains high despite the completion of a rehabilitation programme. Primary ACL prevention programmes are well developed, yet few research papers focus on secondary ACL injury prevention. The aim of current review is to determine if current ACL secondary prevention training has a positive influence on the re-injury rate, the clinical or functional outcomes, or the risk of re-injury in athletes. Studies investigating secondary prevention of ACL were searched in PubMed and EBSCOhost, followed by a review of the references in the identified articles. The existing evidence suggests that neuromuscular training, eccentric strengthening, and plyometric exercises may have a potential impact on improving biomechanical, functional, and psychological outcomes in athletes; however, the studies on the prevention of second ACL injury in athletes is scarce and inconclusive. Future research is needed to investigate the effectiveness of secondary ACL prevention in reducing the re-injury rates. (PROSPERO Registration number: CRD42021291308).

Patent Landscape Review on Ankle Sprain Prevention Method: Technology Updates

Ankle sprains are among the most prevalent musculoskeletal system injuries. Prevention of ankle sprains is important, given the frequency of occurrence of an ankle sprain, the risk of reinjury, and its long-term effects. A systematic patent review using the World Intellectual Property Organization (WIPO)’s PATENTSCOPE database has been performed to study the current development of ankle sprain prevention methods. Using the PRISMA statement as a basis, a total of 426 patent documents have been selected for review, consisting of 150 granted patents and 276 patent applications. In the past decade, China and the United States of America (43% and 29% of the patent applications, respectively) have shown great interest in developing ankle sprain prevention methods. Approximately 49% (or 74) of the patents from the 150 granted are associated with braces, 46% (or 68) are related to orthosis, 3% (or 5) are related to tape, and the remaining 2% (or 3) are associated with other types of ankle sprain prevention methods. This patent review shows that inventors are leaning towards braces and orthosis as the main prevention methods for ankle sprains, with greater interest in orthosis in recent years. Additionally, patents on smart wearable devices suggest initial commercial interest in the development of smart wearable devices as an ankle sprain prevention method.

Comparison of Dynamic Balance and Unilateral Hop Performance Between Women and Men Handball Players After Anterior Cruciate Ligament Reconstruction: A Pilot Study.

After anterior cruciate ligament reconstruction (ACLR), long-term functional deficiencies can occur, with controversial results reported when comparing women and men. Dynamic balance and unilateral hop test performance are considered important indicators for the risk of reinjury of the lower extremity. Although both sexes seem to have a similar risk to experience a second anterior cruciate ligament injury, sex-specific differences of dynamic balance and unilateral hop performance in handball players following ACLR are unknown. To compare dynamic balance and unilateral hop performance between women and men handball players at least 6months after ACLR. Cross-sectional pilot study. Ten women (27.6 [4.5]y) and 10 men (26.5 [3.1]y) handball players 6 to 16months after ACLR. Dynamic balance and unilateral hop performance were assessed using the Y-Balance Test and the Single-Leg Hop for Distance Test. Women players demonstrated significantly better results in the anterior direction of the Y-Balance Test for both legs compared with men players. Hop performance was not significantly different between sexes. Dynamic balance and single-leg hop performance seem not to differ between women and men handball players 6 to 16months after ACLR. The difference between sexes in the anterior reach direction of the Y-Balance Test should be considered small, rather than representing a true difference.

Strengthening Doctor-Patient Relationships Through Hospital-Based Violence Interventions.

Violence in Chicago has been persistently high in low-income communities of color. Recent attention has focused on how structural inequities weaken protective factors that help keep communities healthy and safe. Spikes in community violence seen in Chicago since the COVID-19 pandemic further expose the lack of social service, health care, economic, and political safety nets in low-income communities and the apparent dearth of faith in those systems. The authors contend that a comprehensive, collaborative approach to violence prevention that prioritizes treatment and community partnerships is needed to address social determinants of health and structural characteristics that often provide the context for interpersonal violence. One strategy to address decreasing faith in systems like hospitals is foregrounding frontline paraprofessional prevention workers who possess cultural capital based on their experiences navigating interpersonal and structural violence. Hospital-based violence intervention programs help professionalize these prevention workers by providing a framework for patient-centered crisis intervention and assertive case management. The authors describe how the Violence Recovery Program (VRP), a multidisciplinary hospital-based violence intervention model, leverages the cultural capital of credible messengers to use teachable moments to promote trauma-informed care to violently injured patients, assess their immediate risk for reinjury and retaliation, and connect them to wrap-around services to help aid comprehensive recovery. Violence recovery specialists have engaged over 6,000 victims of violence since the program's launch in 2018. Three-quarters of patients expressed social determinants of health needs. Over the past year, specialists have connected over one-third of engaged patients to mental health referrals and community-based social services. High violence rates in Chicago limited case management opportunities in the emergency room. In fall 2022, the VRP began to establish collaborative agreements with community-based street outreach programs and medical-legal partnerships to address structural determinants of health.

Anterior Cruciate Ligament Reconstruction Return-to-Sport Decision-Making: A Scoping Review.

Clinical guidelines support the use of testing batteries to assess athlete readiness for return to sport (RTS) and risk of reinjury after anterior cruciate ligament (ACL) reconstruction (ACL-R). There is no consensus on the composition of the testing batteries. Test selection is based mainly on commonality in research, personal preference, and equipment availability. Including athletic performance assessments (APA) used in the athlete's sport may assist RTS decision-making for stakeholders. To determine whether APA for speed, agility, strength, or cardiovascular endurance are (1) used in ACL-R RTS literature and (2) indicative of RTS or reinjury rates. A systematic search was performed in MEDLINE, EMBASE, CINAHL, SPORTDiscus, Scopus, Web of Science, and ProQuest Dissertations and Theses Global. Eligibility criteria were as follows: (1) athletes between 6 months and 2 years post-ACL-R, (2) commonly used APA, (3) peer-reviewed primary study with original published data. Scoping Review. Level 4. A total of 17 studies included 24 instances of APA with a high degree of heterogeneity for both tests and protocols. Agility makes up 75% of the APA. Only 17.6% of studies reported RTS or reinjury rates, none of which reported a significant relationship between these rates and APA outcomes. Speed, strength, and cardiovascular endurance tests are underrepresented in ACL-R RTS literature. Compared with healthy controls, deficits in APA results for ACL-R athletes were common; however, many studies reported significant improvements in results for ACL-R athletes over time. There is some evidence that well-trained ACL-R athletes can match the performance of uninjured athletes in high-level sports.

Quantitative MRI Biomarkers to Predict Risk of Reinjury Within 2 Years After Bridge-Enhanced ACL Restoration

Background: Quantitative magnetic resonance imaging (qMRI) methods were developed to establish the integrity of healing anterior cruciate ligaments (ACLs) and grafts. Whether qMRI variables predict risk of reinjury is unknown. Purpose: To determine if qMRI measures at 6 to 9 months after bridge-enhanced ACL restoration (BEAR) can predict the risk of revision surgery within 2 years of the index procedure. Study Design: Cohort study; Level of evidence, 2. Methods: Originally, 124 patients underwent ACL restoration as part of the BEAR I, BEAR II, and BEAR III prospective trials and had consented to undergo an MRI of the surgical knee 6 to 9 months after surgery. Only 1 participant was lost to follow-up, and 4 did not undergo MRI, leaving a total of 119 patients for this study. qMRI techniques were used to determine the mean cross-sectional area; normalized signal intensity; and a qMRI-based predicted failure load, which was calculated using a prespecified equation based on cross-sectional area and normalized signal intensity. Patient-reported outcomes (International Knee Documentation Committee subjective score), clinical measures (hamstring strength, quadriceps strength, and side-to-side knee laxity), and functional outcomes (single-leg hop) were also measured at 6 to 9 months after surgery. Univariate and multivariable analyses were performed to determine the odds ratios (ORs) for revision surgery based on the qMRI and non-imaging variables. Patient age and medial posterior tibial slope values were included as covariates. Results: In total, 119 patients (97%), with a median age of 17.6 years, underwent MRI between 6 and 9 months postoperatively. Sixteen of 119 patients (13%) required revision ACL surgery. In univariate analyses, higher International Knee Documentation Committee subjective score at 6 to 9 months postoperatively (OR = 1.66 per 10-point increase; P = .035) and lower qMRI-based predicted failure load (OR = 0.66 per 100-N increase; P = .014) were associated with increased risk of revision surgery. In the multivariable model, when adjusted for age and posterior tibial slope, the qMRI-based predicted failure load was the only significant predictor of revision surgery (OR = 0.71 per 100 N; P = .044). Conclusion: Quantitative MRI-based predicted failure load of the healing ACL was a significant predictor of the risk of revision within 2 years after BEAR surgery. The current findings highlight the potential utility of early qMRI in the postoperative management of patients undergoing the BEAR procedure.

Optimizing repair of tendon ruptures and chronic tendinopathies: Integrating the use of biomarkers with biological interventions to improve patient outcomes and clinical trial design.

Tendons are dense connective tissues of the musculoskeletal system that link bones with muscles to foster mobility. They have complex structures and exist in varying biomechanical, metabolic and biological environments. In addition, tendon composition and mechanical properties can change over the lifespan as an individual ages. Many tendons function in high stress conditions with a low vascular and neuronal supply, conditions often leading to development of chronic tendinopathies, and in some cases, overt rupture of the tissues. Given their essential nature for human mobility and navigation through the environment, the effective repair and regeneration of different tendons after injury or damage is critical for quality of life, and for elite athletes, the return to sport participation at a high level. However, for mainly unknown reasons, the outcomes following injury are not always successful and lead to functional compromise and risk for re-injury. Thus, there is a need to identify those patients who are at risk for developing tendon problems, as well those at risk for poor outcomes after injury and to design interventions to improve outcomes after injury or rupture to specific tendons. This review will discuss recent advances in the identification of biomarkers prognostic for successful and less successful outcomes after tendon injury, and the mechanistic implications of such biomarkers, as well as the potential for specific biologic interventions to enhance outcomes to improve both quality of life and a return to participation in sports. In addition, the implication of these biomarkers for clinical trial design is discussed, as is the issue of whether such biomarkers for successful healing of one tendon can be extended to all tendons or are valid only for tendons in specific biomechanical and biological environments. As maintaining an active lifestyle is critical for health, the successful implementation of these advances will benefit the large number of individuals at risk.

Utilizing mesenchymal stem cells to improve the healing process of the medial collateral ligament in the knee

The healing process of the medial collateral ligament (MCL) in the knee is often slow, resulting in adverse outcomes such as scar tissue formation, joint instability, limited range of motion, and an increased risk of re-injury. Consequently, novel therapeutic strategies are imperative to enhance MCL healing. Mesenchymal stem cells (MSCs) have emerged as a promising treatment modality due to their robust proliferative ability, reparative potential, and ability to differentiate into various cell types. Although preclinical studies have shown encouraging results for MSC-based approaches in MCL injuries, clinical studies in the orthopedic literature remain scarce. This review provides an overview of the MCL, conventional treatments for MCL injuries, and recent advances in MSC research for augmenting MCL healing. MSC-based approaches hold promise as a future therapeutic option to improve MCL healing. Nonetheless, further research is warranted to establish the effective ness and safety of this emerging treatment modality.

Association Between Knee Extension Strength at 3 and 6Months After Anterior Cruciate Ligament Reconstruction.

Deficits in knee extension strength after anterior cruciate ligament reconstruction have been a major problem. The inadequate recovery of the knee extension strength of surgical limb reportedly delays return to sports and increases reinjury risk. Accordingly, the early detection of knee extension strength deficits after reconstruction may help plan early interventions to manage impairment. This study aimed to clarify the association between knee extension strength at 3 and 6months after anterior cruciate ligament reconstruction. Retrospective study. Fifty patients who underwent primary anterior cruciate ligament reconstruction using hamstring grafts were included. At 3months postoperatively, the limb symmetry index (LSI) of isokinetic knee extension strength (IKE) at 60°/s, degree of swelling, passive range of motion of knee flexion and extension, and anterior leg reach distance were measured. At 6 months postoperatively, the LSI of IKE was measured at 60°/s, which was used as the main outcome. A correlation analysis was performed with the LSI of IKE at 6months postoperatively as the dependent variable and the LSI of IKE at 3months postoperatively as the independent variable. Subsequently, a multiple regression analysis was performed, with LSI of IKE at 6months postoperatively as the dependent variable; LSI of IKE at 3months postoperatively as the independent variable; and other variables, demographic information, and surgical data as covariates. The correlation analysis revealed that the LSIs of IKE at 3 and 6months postoperatively were correlated (r = .535, P < .001). In the multiple regression analysis, the LSI of IKE at 3months postoperatively was significantly associated with that at 6months postoperatively, even when other variables were included as covariates (R2 = .349, P = .004). Asymmetry of knee extension strength at 3months postoperatively could be more useful than other variables related to knee strength in predicting the asymmetry of knee extension strength at 6months postoperatively.

MRI findings prior to return to play as predictors of reinjury in professional athletes: a novel decision-making tool

BackgroundBecause MRI has shown great accuracy in assessing acute muscle injuries, identification of risk factors for reinjury before return to play (RTP) in professional athletes during the healing process could be very relevant. We assessed the value of MRI findings prior to RTP as predictors of reinjury.MethodsRetrospective observational study of 59 professional athletes, mean age 26 years, with first-time acute muscle injury and successful rehabilitation ready to RTP. They underwent MRI within 6 days of the injury and within 7 days prior to RTP. The primary outcome was reinjury. Risk of reinjury was assessed using radiological signs in control MRI scans before RTP. The risk was classified as low, medium or high when none, one or two radiological signs were observed, respectively.ResultsReinjury occurred in 9 participants, with a rate of 15.2%. None of the baseline MRI-related variables was significantly associated with reinjury. In the control MRI scan performed within 7 days prior to RTP, three independent findings were significantly associated with reinjury. These included transversal and/or mixed connective tissue gap (p = 0.002), intermuscular oedema (p = 0.015) and callus gap (p = 0.046). In the predictive model of the risk of reinjury, the presence of two of these radiological signs, together with interstitial feathery oedema, was associated with a high risk of recurrence (OR 29.58, 95% CI 3.86–226.64; p = 0.001).ConclusionsIn professional athletes with acute muscle injuries of the lower limbs successfully rehabilitated, some radiological signs on MRI performed shortly before RTP were associated with a high risk of reinjury.