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Return to play after ACL

Richard Connell, Bruce Paton, Ross Milne
Background: The risk of reinjury and other sequelae following anterior cruciate ligament reconstruction (ACLR) remains high. Lack of knowledge regarding factors contributing to these risks limits our ability to develop sensitive return to play (RTP) tests. Using a running task, we evaluate whether fatigue induces alterations in foot progression angle (FPA), a proposed biomechanical risk factor and could be used to enhance RTP test sensitivity. Method: Transverse plane foot kinematics (FPA) were assessed for 18 post-ACLR subjects during a treadmill running task, before and after a generalised lower limb fatigue protocol...
2019: BMJ Open Sport & Exercise Medicine
Matthew Bauer, Brian T Feeley, Robert A Gallo
BACKGROUND: After anterior cruciate ligament (ACL) reconstruction, 63% to 87% of high school athletes return to competition. Although physical and psychological factors are known contributors for failure to return to play, little attention has been paid to effect of academic grade level. Our purpose was to determine the influence of effect of academic grade level on return to competitive play. The primary hypothesis is that high school seniors who undergo ACL reconstruction or knee arthroscopy will be less likely to return to competitive play at 1 year than those in grades 9 to 11...
April 2019: Journal of Pediatric Orthopedics
Kristoffer W Barfod, Randi Rasmussen, Birgitte Blaabjerg, Per Hölmich, Martin Lind
After anterior cruciate ligament (ACL) reconstruction, 30% of the patients aged 20 years and younger experience a second injury. Studies imply, that with the right rehabilitation and testing many of these injuries can be prevented. Return to play should not be allowed until nine months after surgery at the earliest and should be based on relevant testing of strength, function and mental readiness.
February 18, 2019: Ugeskrift for Laeger
April L McPherson, Julian A Feller, Timothy E Hewett, Kate E Webster
BACKGROUND: Lower psychological readiness to return to sport has been reported for younger patients (≤20 years) who go on to a second anterior cruciate ligament (ACL) injury. However, changes in psychological readiness and specific psychological responses associated with second injury have not been identified. PURPOSE/HYPOTHESIS: To identify changes in psychological readiness over time associated with a second ACL injury. It was hypothesized that younger patients who suffered a second injury would have smaller changes in psychological readiness to return to sport when compared with those who did not have a second injury...
February 20, 2019: American Journal of Sports Medicine
Tsuneari Takahashi, Tomohiro Matsumura, Kazuaki Ishihara, Shuhei Hiyama, Katsushi Takeshita
Knee dislocation with concomitant multiligament injury is a rare and devastating injury. We report the successful repair of a rare case of open knee dislocation with concomitant multiligament injury and patellar tendon rupture of an 18-year-old male due to a motorcycle accident. The patient presented with an open wound running parallel to the knee joint line and patellar tendon rupture with full exposure of the cartilage of the distal femur. Staged surgical management including the application of a ring-type external fixator with a hinged joint, lateral collateral ligament repair, medial collateral ligament reconstruction using autogenous hamstring tendon, and joint release was performed...
2019: SAGE Open Medical Case Reports
Kate E Webster, Julian A Feller
Most athletes who undergo anterior cruciate ligament (ACL) reconstruction surgery plan to return to some level of sporting activity. However, rates of return to pre-injury sport are often less than might be expected and many factors influence whether individuals return to sport after this surgery. They include surgical and rehabilitation factors as well as social, psychological and demographic characteristics. The fate of the younger athlete who sustains an ACL injury is a topic that has received recent attention due to accumulating evidence that younger athletes are at considerable risk for not only one, but multiple ACL injuries...
January 28, 2019: Journal of Orthopaedics and Traumatology: Official Journal of the Italian Society of Orthopaedics and Traumatology
Todd Furman, Holly Silvers-Granelli
Soccer players recovering from anterior cruciate ligament (ACL) injuries have better options for treatment today than they did 25 years ago. Surgical techniques have improved, and rehabilitation protocols have evolved considerably. Although the rehabilitation community is doing a better job of treating this patient population, the evidence does demonstrate that both re-injury and return- to-play (RTP) rates are still suboptimal. Most protocols focus on normalizing strength and range of motion (ROM) and achieving limb symmetry with soccer-specific movements...
December 2018: American Journal of Orthopedics
Peter DeLuca
Retear after an anterior cruciate ligament reconstruction is unavoidable. Many variables contribute to graft failure after anterior cruciate ligament reconstruction. Time from surgery to return to play is not the sole determinant. Graft maturation and symmetrical return of function need to be more carefully evaluated to reduce the risk of reinjury.
January 2019: Arthroscopy: the Journal of Arthroscopic & related Surgery
Kelechi R Okoroha, Mohsin S Fidai, Joseph S Tramer, Jaafar Elmenini, Eric C Makhni, Nikhil N Verma, Bernard R Bach, Vasilios Moutzouros
PURPOSE: To determine whether the length of time between primary anterior cruciate ligament reconstruction (ACLR) and return to sport (RTS) predicted the need for revision ACLR in National Football League (NFL) athletes. METHODS: All NFL players who underwent ACLR from 2009 to 2015 were identified. The date of index ACLR and date of return to NFL regular-season game play after surgery were recorded. The length of time between ACLR and RTS was compared between players who required revision ACLR and those who did not...
January 2019: Arthroscopy: the Journal of Arthroscopic & related Surgery
Dean Wang, Theresa Chiaia, John T Cavanaugh, Scott A Rodeo
No abstract text is available yet for this article.
January 2019: JBJS Reviews
Mansour Sadeqi, Shahnaz Klouche, Yoann Bohu, Serge Herman, Nicolas Lefevre, Antoine Gerometta
Background: Successful return to sport after anterior cruciate ligament (ACL) reconstruction requires optimal physical and psychological recovery. The main validated tool to quantify a patient's psychological readiness to return to sport after this surgery is the Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) scale. Purpose: The primary aim was to analyze the progression of the ACL-RSI score from preoperatively to 2-year follow-up. A secondary goal was to identify the factors associated with returning to the same preinjury sport...
December 2018: Orthopaedic Journal of Sports Medicine
Anne Fältström, Joanna Kvist, Håkan Gauffin, Martin Hägglund
BACKGROUND: Many patients with anterior cruciate ligament (ACL) reconstruction who return to sport suffer new ACL injuries or quit sports soon after returning. PURPOSE: To prospectively follow a cohort of female soccer players with primary unilateral ACL reconstruction and matched knee-healthy controls from the same soccer teams to compare (1) the rate of new traumatic and nontraumatic knee injuries and other injuries, (2) the proportion of players who quit soccer, and (3) player-reported activity level and satisfaction with activity level and knee function...
November 27, 2018: American Journal of Sports Medicine
Kathryn A Barth, Cort D Lawton, Daniel C Touhey, Ryan S Selley, Daniel D Li, Earvin S Balderama, Gordon W Nuber, Wellington K Hsu
BACKGROUND: Soccer is one of the most common international sports in which ACL injuries occur, with previous studies reporting high return-to-play rates following ACL reconstruction (ACLR). Return-to-play analysis fails to take into consideration how effective a player remains once returning to competition. The aims of this study are to provide a large-scale international analysis of return-to-play and player performance statistics among professional soccer athletes following ACLR. METHODS: Using publicly available sources, professional soccer athletes who have undergone ACLR between the 1996 and 2015 seasons were identified...
November 15, 2018: Knee
Courtney C H Lai, Julian A Feller, Kate E Webster
BACKGROUND: Anterior cruciate ligament (ACL) injury has been a major cause of missed game time among Australian Football League (AFL) players. Return to play after ACL reconstruction is not always achieved, even among elite athletes. The rate of subsequent ACL injury in the AFL from 1990 to 2000 was high as compared with that of other elite sports. PURPOSE: To determine the rates of return to play and subsequent ACL injury after ACL reconstruction among AFL players from 1999 to 2013 and to explore factors associated with differing rates of return to play and subsequent ACL injury...
December 2018: American Journal of Sports Medicine
N E Marshall, R A Keller, J Dines, C Bush-Joseph, O Limpisvasti
PURPOSE: Advances in anterior cruciate ligament (ACL) reconstruction have allowed for many progressions in postoperative management. However, there is no standardized protocol for immediate postoperative management or return to play. Our objective was to evaluate current trends in immediate postoperative and return to sport practices after ACL reconstruction. LEVEL OF EVIDENCE: Cross sectional study, Level IV. METHODS: Surveys were obtained from four large sports fellowship alumni networks...
October 25, 2018: Musculoskeletal Surgery
N van Melick, L van Rijn, M W G Nijhuis-van der Sanden, T J Hoogeboom, R E H van Cingel
PURPOSE: Athletes who meet return to play (RTP) criteria after anterior cruciate ligament reconstruction (ACLR) rehabilitation still have a substantially increased risk of second ACL injury. One of the contributing factors to this increased risk could be that the RTP criteria are often not tested in an ecologically valid environment and in a fatigued state. The purpose of this cross-sectional case-control study was to investigate the influence of neuromuscular fatigue on both movement quantity and quality in fully-rehabilitated soccer players after ACLR and to compare them with healthy soccer players...
September 27, 2018: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Mattia Alessio-Mazzola, Matteo Formica, Antonio Russo, Francesca Sanguineti, Andrea Giorgio Capello, Stefano Lovisolo, Lamberto Felli
We report the functional outcome after combined anterior cruciate ligament (ACL) reconstruction and lateral extra-articular tenodesis (LET) for ACL re-rupture and high-grade pivot shift in professional soccer players. For this retrospective review, the medical records of 24 professional soccer players were analyzed. The mean age at surgery was 23.8 ± 4.2 years and the mean follow-up was 42.2 ± 16.9 months. Pre- and postoperative assessment included the KT-1000 Lachman test, pivot shift test, International Knee Documentation Committee (IKDC) subjective knee evaluation, Tegner activity scale (TAS), and Lysholm score...
September 18, 2018: Journal of Knee Surgery
Christiane Wilke, Lars Grimm, Björn Hoffmann, Ingo Froböse
A rupture of the anterior cruciate ligament (ACL) represents a severe injury in game sports, which is time and cost-intensive for athletes and clubs alike. As the lower extremities are subjected to multiple forms of strain and high demands are placed on them, athletes in games like soccer are affected more often than others. The point of return-to-play after such severe injuries is often preceded by long periods of rehabilitation. However, these periods often vary strongly. Multiple approaches are being discussed to estimate the point of return-to-play using functional test procedures...
August 2018: Sportverletzung Sportschaden: Organ der Gesellschaft Für Orthopädisch-Traumatologische Sportmedizin
Lee Herrington, Hussain Ghulam, Paul Comfort
Herrington, L, Ghulam, H, and Comfort, P. Quadriceps strength and functional performance after anterior cruciate ligament reconstruction in professional soccer players, at time of return to sport. J Strength Cond Res XX(X): 000-000, 2018-Poor quadriceps strength has been associated with poor outcome after anterior cruciate ligament (ACL) reconstruction (ACLR). This study aims to assess quadriceps strength, muscle inhibition, and hop test performance in professional soccer players after ACLR. Fifteen professional soccer players (age 22...
August 17, 2018: Journal of Strength and Conditioning Research
Matthew J Matava
Making a National Football League (NFL) team is tough; making one after undergoing an anterior cruciate ligament (ACL) reconstruction is tougher. NFL Combine participants who are post-ACL reconstruction, particularly with certain graft types such as allografts and to a lesser extent hamstring grafts, are frequently 'down-graded' despite the presence of a stable, well-placed graft without any associated meniscal or chondral damage. Whether NFL general managers are truly prescient in accurately predicting decreased performance by choosing a player later in the draft, or whether NFL coaching staffs knowingly or unknowingly restrict an athlete's playing time based on draft position or surgical history is unknown...
August 2018: Arthroscopy: the Journal of Arthroscopic & related Surgery
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