scholarly journals Patellofemoral Joint Loads During Running at the Time of Return to Sport in Elite Athletes With ACL Reconstruction

2017 ◽  
Vol 45 (12) ◽  
pp. 2812-2816 ◽  
Author(s):  
Lee Herrington ◽  
Saud Alarifi ◽  
Richard Jones
Keyword(s):  
Joint Pain ◽  
Patellofemoral Joint ◽  
Sport Participation ◽  
Inverse Dynamics ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Knee Extensor ◽  
Joint Stress ◽  
Patellofemoral Contact Pressure ◽  
And Control

Background: Patellofemoral joint pain and degeneration are common in patients who undergo anterior cruciate ligament reconstruction (ACLR). The presence of patellofemoral joint pain significantly affects the patient’s ability to continue sport participation and may even affect participation in activities of daily living. The mechanisms behind patellofemoral joint pain and degeneration are unclear, but previous research has identified altered patellofemoral joint loading in individuals with patellofemoral joint pain when running. It is unclear whether this process occurs after ACLR. Purpose: To assess the patellofemoral joint stresses during running in ACLR knees and compare the findings to the noninjured knee and matched control knees. Study Design: Controlled laboratory study. Methods: Thirty-four elite sports practitioners who had undergone ACLR and 34 age- and sex-matched controls participated in the study. The participants’ running gait was assessed via 3D motion capture, and knee loads and forces were calculated by use of inverse dynamics. Results: A significance difference was found in knee extensor moment, knee flexion angles, patellofemoral contact force (about 23% greater), and patellofemoral contact pressure (about 27% greater) between the ACLR and the noninjured limb ( P ≤ .04) and between the ACLR and the control limb ( P ≤ .04); no significant differences were found between the noninjured and control limbs ( P ≥ .44). Conclusion: Significantly greater levels of patellofemoral joint stress and load were found in the ACLR knee compared with the noninjured and control knees. Clinical Relevance: Altered levels of patellofemoral stress in the ACLR knee during running may predispose individuals to patellofemoral joint pain.

scholarly journals Novel classification for multi-ligament knee injury including both tibiofemoral joint factor and patellofemoral joint factor (193)

2021 ◽  
Vol 9 (10_suppl5) ◽  
pp. 2325967121S0030
Author(s):  
Takuya Tajima ◽  
Nami Yamaguchi ◽  
Yudai Morita ◽  
Takuji Yokoe ◽  
Etsuo Chosa
Keyword(s):  
Patellofemoral Joint ◽  
Cruciate Ligament ◽  
Knee Extensor ◽  
Quadriceps Tendon ◽  
Collateral Ligament ◽  
Patella Tendon ◽  
Joint Factor ◽  
Type D ◽  
Neurovascular Injury ◽  
Type C

Objectives: Multi-ligament knee injury (MLKI) shows very varied symptoms which was depended on the combination of injured ligaments. Schenck`s knee dislocation classification which was one of useful classifications for surgeon in decision making. However, Schenck`s classification is only referred to the factors of cruciate ligament and collateral ligament. It is well known that knee joint consists of two important structure; tibiofemoral joint and patellofemoral joint. Knee extensor structure is one of important factors of knee function. Dislocation of patella, quadriceps or patella tendon rupture are sometimes occurred in the knee trauma and provided severe instability or disability of knee function. Of course, these injuries were also target for consideration of treatment. Moreover, knee extensor structure disruption was sometimes combined with other knee ligaments such as cruciate or collateral ligament. Unfortunately, the case of combined cruciate or collateral ligament with knee extensor structure disruption could not classified in the previous classifications. Therefore, we proposed new classification for MLKI which contains both femorotibial factor and patellofemoral factor. We established and defined several categories in accordance with number of injured ligaments, combination of injured ligaments, and additional combined injury such as fracture, nerve injury, vascular injury. It was hypothesized that all cases at least two ligaments involved situation not only combination of tibiofemoral factor, but also including patellofemoral factor, could classify and divide into the new established classification. Methods: The present study was conducted in 2019, involving patient who was diagnosed MLKI at our institute. The study followed both retrospective and prospective observational design including data collected from Apr 2007 to Aug 2020. The experimental design was reviewed and approved (Accession No. 0-0602) by the Ethics Committee of our institute. The procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Inclusion criteria were the cases of two or more injured ligaments diagnosed clinically and by MRI testing and dynamic X-ray testing. Detail of ligament around knee joint were defined as follows; ‘cruciate ligaments` which contains ACL and PCL; ‘collateral ligaments` which contains MCL and posterolateral corner (PLC) certainly include lateral collateral ligament, and; ‘patellofemoral joint factor` which contains medial patellofemoral ligament (MPFL), quadriceps tendon and patellar tendon. Exclusion criteria was any prior knee surgery cases. Total 65 MLKI cases were met the inclusion criteria and were enrolled in this study. We focused on the number of injured ligaments, combination of the injured ligaments, and complication such as fracture, neurovascular injury. Based on the number of injured ligaments, 2 injured ligaments case was categorized as Type A, 3 injured ligaments case was as Type B, 4 ligaments case was as Type C, and 5 ligaments case was as Type D, respectively. We defined that injured ligament counting was follows; cruciate ligament group; ACL and/or PCL, collateral ligament group; MCL and/or PLC, and PF joint group; one of the MPFL or patellar tendon or quadriceps tendon. Depended on the combination of injured ligaments, each case was subdivided into 1 to 5 in Type A and B, into 1 to 3 in Type C. Additional injuries with MLKI were also subdivided as follows; MLKI with fracture case was defined as X, with neurovascular injury case was as Y, and both fracture and neurovascular injury case was as Z. (Table 1, 2, 3, and 4). For each case, final decision of injured ligament was recorded under clinical examination and image evaluation. MLKI cases were divided into both Schenk’s KD classification and the present new established classification. Results: Fifty-seven of 65 cases were divided into Schenck’s KD classification as follows; 19 cases of ACL+MCL and 13 cases of ACL+PLC and 9 cases of PCL+PLC and 2 cases of PCL+MCL as KD-?, 4cases of ACL+PCL as KD-? and one case of ACL+PCL with fracture as KD-?2, 6 cases of ACL+MCL, 2 cases of ACL+PCL+PLC as KD-?, and 1 case of ACL+PCL+MCL+MCL with fracture as KD-?5, respectively. Eight cases (12.3%) could not be divided into Schenk’s KD classification. Combination of these 8 cases were follows; 2 cases of PLC+MPFL, and single case of ACL+MCL+PLC, ACL+PCL+MCL+PLC+MPFL, ACL+MPFL, PCL+PLC+MPFL+ fracture, ACL+MCL+MPFL, and PCL+ patella tendon, respectively. Seven of 8cases contained PF joint factor injury. At the established new classification for MLKI, all 65 cases were divided into each category, successfully. PLC+MPFL was divided into Type-A5, ACL+MCL+PLC was Type-B2, ACL+PCL+MCL+PLC+MPFL was Type-D, ACL+MPFL was Type-A4, PCL+PLC+MPFL was Type-B3-X, ACL+MCL+MPFL was Type-B3, and PCL+ patella tendon was Type-A4. Conclusions: Several classification systems have been reported for diagnosis of MLKI cases. Kennedy `s classification and the French Society of Orthopedic Surgery and Traumatology 2008 classification were focused on the mechanism and direction of dislocation. These classifications were available for understanding comprehension mechanism of injured knee. However, previous classifications including Schenck’s classification were lack of PF joint factor. It is very important for knee surgeon that understanding injured mechanism as well as number of injured ligaments and combination of injured ligaments for decision making for surgery. The present classification was useful for MLKI case which contains both tibiofemoral factor and patellofemoral factor.

scholarly journals The Effect of Patient Sex and Graft Type on Postoperative Functional Outcomes After Primary ACL Reconstruction

2020 ◽  
Vol 8 (6) ◽  
pp. 232596712092605
Author(s):  
Milos Lesevic ◽  
Michelle E. Kew ◽  
Stephan G. Bodkin ◽  
David R. Diduch ◽  
Stephen F. Brockmeier ◽  
...  
Keyword(s):  
Patellar Tendon ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Knee Extensor ◽  
Postoperative Rehabilitation ◽  
Knee Flexor ◽  
Female Patients ◽  
Bptb Graft ◽  
Knee Extensor Strength ◽  
Male Patients

Background: Graft choice in anterior cruciate ligament reconstruction (ACLR) and postoperative rehabilitation may affect strength recovery differently in men than women and therefore affect a timely and successful return to sport. Purpose: To compare knee extensor and flexor strength between men and women who underwent isolated ACLR with either patellar tendon or hamstring tendon (HST) autografts. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 166 patients (87 women, 79 men) with primary unilateral and uncomplicated ACLRs were recruited for participation. A total of 100 patients had bone–patellar tendon–bone (BPTB) autografts and 66 had HST autografts. At 6 months postoperatively, all patients completed the Tegner activity scale and International Knee Documentation Committee Subjective Knee Evaluation as well as underwent bilateral isokinetic (90 deg/s) tests of the knee extensor and flexor groups. Outcomes were recorded in a single session as part of a return-to-sport test battery. Surgical notes were obtained to determine the type of autograft and nerve block used at the time of ACLR. Results: There was a significant sex × graft type interaction for mass-normalized knee flexor torque ( P = .017). Female patients with an HST graft had a significantly lower knee flexor torque compared with female patients with a BPTB graft (0.592 ± 0.49 N·m/kg vs 0.910 ± 0.24 N·m/kg; Cohen d [95% CI] = 0.91 [0.45, 1.36]). They also had a significantly lower knee flexor torque when compared with male patients with an HST graft (0.592 ± 0.49 N·m/kg vs 0.937 ± 0.35 N·m/kg; Cohen d [95% CI]= 0.88 [0.45, 1.31]). There were significant main effects for graft type with knee flexion ( P = .001) and extension ( P = .008) symmetry. Patients with a BPTB graft demonstrated lower knee extensor symmetry (65.7% ± 17.0%) and greater knee flexor symmetry (98.7% ± 18.0%) compared with patients with an HST graft (extension: 77.1% ± 32%, Cohen d [95% CI] = 0.47 [0.16, 0.79]; flexion: 82.9% ± 33.3%, Cohen d [95% CI] = 0.63 [0.31, 0.95]). We also observed a significant main effect for sex ( P = .028) and graft type ( P = .048) for mass-normalized knee extensor strength. Female participants and patients of either sex with BPTB grafts had lower knee extensor strength compared with male participants and patients with HST grafts, respectively. Conclusion: At approximately 6 months after ACLR, female patients reconstructed with HST autografts demonstrated weaker HST strength compared with female patients with a BPTB autograft. There were no differences in HST strength between graft types in male patients. Female patients appear to be recovering HST strength differently than male patients when using an HST autograft. These findings may have implications in surgical planning, postoperative rehabilitation, and return-to-sport decision making.

scholarly journals Single leg hop for distance symmetry masks lower limb biomechanics: time to discuss hop distance as decision criterion for return to sport after ACL reconstruction?

2021 ◽  
pp. bjsports-2020-103677
Author(s):  
Argyro Kotsifaki ◽  
Rod Whiteley ◽  
Sam Van Rossom ◽  
Vasileios Korakakis ◽  
Roald Bahr ◽  
...  
Keyword(s):  
Lower Limb ◽  
Inverse Dynamics ◽  
Cruciate Ligament ◽  
Three Dimensional ◽  
Return To Sport ◽  
Decision Criterion ◽  
Control Group ◽  
Trunk Flexion ◽  
Joint Work ◽  
Hip Flexion

BackgroundWe evaluated the lower limb status of athletes after anterior cruciate ligament reconstruction (ACLR) during the propulsion and landing phases of a single leg hop for distance (SLHD) task after they had been cleared to return to sport. We wanted to evaluate the biomechanical components of the involved (operated) and uninvolved legs of athletes with ACLR and compare these legs with those of uninjured athletes (controls).MethodsWe captured standard video-based three-dimensional motion and electromyography (EMG) in 26 athletes after ACLR and 23 healthy controls during SLHD and calculated lower limb and trunk kinematics. We calculated lower limb joint moments and work using inverse dynamics and computed lower limb muscle forces using an EMG-constrained musculoskeletal modelling approach. Between-limb (within ACLR athletes) and between-group differences (between ACLR athletes and controls) were evaluated using paired and independent sample t-tests, respectively.ResultsSignificant differences in kinematics (effect sizes ranging from 0.42 to 1.56), moments (0.39 to 1.08), and joint work contribution (0.55 to 1.04) were seen between the involved and uninvolved legs, as well as between groups. Athletes after ACLR achieved a 97%±4% limb symmetry index in hop distance but the symmetry in work done by the knee during propulsion was only 69%. During landing, the involved knee absorbed less work than the uninvolved, while the uninvolved knee absorbed more work than the control group. Athletes after ACLR compensated for lower knee work with greater hip work contribution and by landing with more hip flexion, anterior pelvis tilt, and trunk flexion.ConclusionSymmetry in performance on a SLHD test does not ensure symmetry in lower limb biomechanics. The distance hopped is a poor measure of knee function, and largely reflects hip and ankle function. Male athletes after ACLR selectively unload the involved limb but outperform controls on the uninvolved knee.

scholarly journals Injury-Related Fears During the Return-to-Sport Phase of ACL Reconstruction Rehabilitation

2020 ◽  
Vol 8 (3) ◽  
pp. 232596712090938
Author(s):  
Adam Meierbachtol ◽  
Michael Obermeier ◽  
William Yungtum ◽  
John Bottoms ◽  
Eric Paur ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Training Program ◽  
Sport Participation ◽  
Cruciate Ligament ◽  
Case Series ◽  
Return To Sport ◽  
Level Of Evidence ◽  
Sport Training ◽  
Anterior Cruciate ◽  
The Individual

Background: Fear of reinjury is common after anterior cruciate ligament reconstruction (ACLR) and often deters a return to preinjury sport participation. A better understanding of injury-related fear is needed to inform rehabilitation strategies. Purpose/Hypothesis: The purpose of this study was to (1) identify individual fear-evoking tasks or situations, (2) compare the intensity and amount of change relative to other injury-related fears (reinjury, knee giving way, and knee pain) after completion of a return-to-sport training program, and (3) determine whether standardized questionnaires can identify the intensity of fear for the individual fear-evoking task or situation and for fear of reinjury. The hypothesis was that the task or situation that evokes fear would vary across patients and the intensity of that fear would be higher and show less change after return-to-sport training compared with other injury-related fears. Study Design: Case series; Level of evidence, 4. Methods: Participants included 33 patients (15 males; mean age, 18 years) with ACLR who enrolled in a group-format return-to-sport training program. Questionnaires completed before and after return-to-sport training included items to specify fear-evoking tasks or situations, items to rate the intensity of various injury-related fears, the Anterior Cruciate Ligament Return to Sport after Injury scale (ACL-RSI), and the Tampa Scale for Kinesiophobia (TSK-11). Results: The most common fear-evoking task or situation was cutting, followed by contact, jumping, and other. Intensity of fear-evoking task or situation was higher than other injury-related fears, but all fears decreased in intensity after training. The ACL-RSI score better identified the intensity of fear for the individual fear-evoking task or situation and for fear of reinjury than did the TSK-11 score. Conclusion: Activities that evoke fear vary across patients, but fear of cutting is common. The intensity of common fears after ACLR decreased after advanced group training, and large effect sizes were seen for nearly all examined fears. Fear of reinjury and intensity of individually feared tasks may be better reflected in the ACL-RSI score than the TSK-11 score.

Expectations for Return to Preinjury Sport Before and After Anterior Cruciate Ligament Reconstruction

2019 ◽  
Vol 47 (3) ◽  
pp. 578-583 ◽  
Author(s):  
Kate E. Webster ◽  
Julian A. Feller
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Ligament Reconstruction ◽  
Sport Participation ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Cruciate Ligament Reconstruction ◽  
Factors Associated ◽  
Before And After ◽  
Anterior Cruciate

Background: There is limited information about patient expectations regarding return to sport after anterior cruciate ligament reconstruction (ACLR). While it has generally been assumed that patients expect to return, it has also been acknowledged that expectations may change after surgery. Purpose: To investigate return-to-sport expectations before and after ACLR and determine factors associated with changed expectations. Study Design: Cohort study; Level of evidence, 2. Methods: The study sample consisted of 675 eligible patients (437 male, 238 female). Return-to-sport expectations were recorded preoperatively. Primary ACLR was performed in 595 patients (of whom 81 had a prior contralateral ACLR) and revision ACLR in 80 patients. At 12 months after surgery, the return to preinjury sport status was assessed along with patients’ current sport expectations. The proportion of patients who expected to return to their preinjury level of sport was determined along with actual return rates. Logistic regression was performed to determine the factors associated with the decision to cease sport participation in patients who had expected to be able to return to their preinjury level of sport. Results: Overall, 84% of patients expected to be able to return to their preinjury level of sport. Expectations were higher for patients about to undergo their first ACLR, with 88% expecting to return, than for those about to undergo revision surgery or second primary ACLR (63% and 80% expected to return, respectively; P < .001 and P = .08, respectively). At 12 months after surgery, 24% of patients who expected to return to their preinjury level of sport had actually returned, and 15% of all patients had already decided to give up sport. In the regression models, being female ( P = .02) and having undergone previous ACLR ( P < .0001) were factors significantly associated with the decision to give up sport participation. Conclusion: Patients had high expectations for returning to their preinjury level of sport at the time of undergoing initial ACLR. Expectations were lower for those who had undergone previous ACLR. Female patients and patients who had undergone previous ACLR were more likely to change their expectations and cease sport participation. These data can be used to provide patients with realistic return-to-sport expectations in the first postoperative year and highlight the challenge for patients who aim to return from multiple ACL injuries.

Knee-ankle-foot orthosis with powered knee for support in the elderly

2017 ◽  
Vol 231 (8) ◽  
pp. 715-727 ◽  
Author(s):  
Peter Paul Pott ◽  
Sebastian Immanuel Wolf ◽  
Julia Block ◽  
Stefan van Drongelen ◽  
Markus Grün ◽  
...  
Keyword(s):  
Inverse Dynamics ◽  
Knee Extensor ◽  
The Elderly ◽  
Sensor Data ◽  
Ground Reaction Forces ◽  
Similar Reduction ◽  
Skin Preparation ◽  
User Intention ◽  
Reaction Forces ◽  
And Control

A prototype of a powered knee orthotic device was developed to determine whether fractional external torque and power support to the knee relieves the biomechanical loads and reduces the muscular demand for a subject performing sit-to-stand movements. With this demonstrator, consisting of the subsystems actuation, kinematics, sensors, and control, all relevant sensor data can be acquired and full control is maintained over actuator parameters. A series-elastic actuator based on a direct current motor provides up to 30 Nm torque to the knee via a hinge joint with an additional sliding degree of freedom. For reasons of feasibility under everyday conditions, user intention is monitored by employing a noninvasive, nonsticking muscle activity sensor to replace electromyographic sensors, which require skin preparation. Furthermore, foot plates with force sensors have been developed and included to derive ground reaction forces. The actual knee torque needed to provide the desired support is based on an inverse dynamics model using ground reaction forces signals and leg kinematics. A control algorithm including disturbance feed forward has been implemented. A demonstration experiment with two subjects showed that 23 % of moment support in fact leads to a similar reduction in activation of the main knee extensor muscle.

Effect of Posttrial Visual Feedback and Fatigue During Drop Landings on Patellofemoral Joint Stress in Healthy Female Adults

2018 ◽  
Vol 34 (1) ◽  
pp. 82-87 ◽  
Author(s):  
Christina Olbrantz ◽  
Jamie Bergelin ◽  
Jill Asmus ◽  
Thomas Kernozek ◽  
Drew Rutherford ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Visual Feedback ◽  
Patellofemoral Joint ◽  
Inverse Dynamics ◽  
Reaction Force ◽  
Optimization Approach ◽  
Joint Stress ◽  
Landing Mechanics ◽  
Quadriceps Force ◽  
Drop Landings

Patellofemoral pain (PFP) is common in females. Patellofemoral joint stress (PFJS) may be important in the development of PFP. Ground reaction force (GRF) during landing activities may impact PFJS. Our purpose was to determine how healthy females alter their landing mechanics using visual posttrial feedback on their GRF and assess how PFJS changes. Seventeen participants performed a series of drop landings during 3 conditions: baseline, feedback, and postfatigue feedback. The fatigue protocol used repetitive jump squats. Quadriceps force was estimated through inverse-dynamics-based static optimization approach. Then, PFJS was calculated using a musculoskeletal model. Multivariate differences were shown across conditions (P = .01). Univariate tests revealed differences in PFJS (P = .014), knee range of motion (P = .001), and GRF (P = .005). There were no differences in quadriceps force (P = .125). PFJS and GRF decreased from baseline to feedback (P = .002, P = .007, respectively), while PFJS increased from feedback to postfatigue feedback (P = .03). Knee range of motion increased from baseline to feedback (P = .043), then decreased from feedback to postfatigue feedback (P < .001). Visual feedback of GRF may reduce PFJS, but may not effectively transfer to a fatigued state.

scholarly journals Decision to Return to Sport Participation After Anterior Cruciate Ligament Reconstruction, Part II: Self-Reported and Functional Performance Outcomes

2018 ◽  
Vol 53 (5) ◽  
pp. 464-474 ◽  
Author(s):  
Jennifer L. Werner ◽  
Julie P. Burland ◽  
Carl G. Mattacola ◽  
Jenny Toonstra ◽  
Robert A. English ◽  
...  
Keyword(s):  
Performance Measures ◽  
Knee Injury ◽  
Sport Participation ◽  
Outcome Measure ◽  
Functional Performance ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
International Knee Documentation Committee ◽  
Activity Scale ◽  
Anterior Cruciate

Context: Anterior cruciate ligament (ACL) reconstruction (ACLR) is the most commonly used method for helping athletes regain function and return to preinjury activity levels after ACL injury. Outcomes after ACLR have suggested that athletes return to a level of function that would support a return to sport participation; however, in a recent meta-analysis, pooled return rates were only 55%. It is unclear whether this discrepancy is a result of functional impairments.Objective: To compare patient-reported outcomes (PROs), dynamic balance, dynamic functional performance, strength, and muscular endurance in athletes who returned to sport (RTS) and athletes who did not return to sport (NRTS) after ACLR.Design: Case-control study.Setting: University research laboratory.Patients or Other Participants: Two groups of participants with primary unilateral ACLR: 18 RTS individuals (7 males, 11 females; age = 23 ± 11 years, height = 163.58 ± 40.41 cm, mass = 70.00 ± 21.75 kg, time since surgery = 4.02 ± 3.20 years) and 12 NRTS individuals (5 males, 7 females; age = 26 ± 13 years, height = 171.33 ± 48.24 cm, mass = 72.00 ± 21.81 kg, time since surgery = 3.68 ± 2.71 years).Intervention(s): The PROs consisted of the International Knee Documentation Committee Subjective Knee Evaluation Form, Knee Injury and Osteoarthritis Outcome Score, Tegner Activity Scale, and Marx Activity Scale. Functional performance outcome measures were the anterior and posteromedial reach on the Star Excursion Balance Test, a battery of single-legged–hop tests, isokinetic quadriceps and hamstrings strength at 60°/s and 180°/s, and a novel step-down-to-fatigue test. All measures were taken during a single laboratory session.Main Outcome Measure(s): The Limb Symmetry Index was calculated for all functional performance measures. Mann-Whitney U tests were used to compare measures between groups (P &lt; .10).Results: Compared with the RTS group, the NRTS group had lower scores on the International Knee Documentation Committee Subjective Knee Evaluation Form (RTS median = 92.52, range = 66.67–97.70; NRTS median = 82.76, range = 63.22–96.55; P = .03) and Knee Injury and Osteoarthritis Outcome Score Symptoms subscale (RTS median = 88, range = 54–100; NRTS median = 71, range = 54–100; P = .08). No differences were observed for any functional performance measures.Conclusions: The NRTS athletes displayed lower PROs despite demonstrating similar function on a variety of physical performance measures. These results further support existing evidence that physical performance alone may not be the ideal postoperative outcome measure. Measures of patients' symptoms and self-perceived physical function may also greatly influence postoperative activity choices.

scholarly journals Factors Associated With Psychological Readiness to Return to Sport After Anterior Cruciate Ligament Reconstruction Surgery

2018 ◽  
Vol 46 (7) ◽  
pp. 1545-1550 ◽  
Author(s):  
Kate E. Webster ◽  
Christopher V. Nagelli ◽  
Timothy E. Hewett ◽  
Julian A. Feller
Keyword(s):  
Anterior Cruciate Ligament ◽  
Sport Participation ◽  
Cruciate Ligament ◽  
Univariate Analysis ◽  
Return To Sport ◽  
Sports Participation ◽  
Acl Injury ◽  
Psychological State ◽  
Anterior Cruciate ◽  
And Function

Background: Anterior cruciate ligament (ACL) injury has a significant psychological effect, and a negative psychological state is a commonly cited reason for a reduction or cessation of sports participation after ACL reconstruction (ACLR) surgery. Purpose: To identify factors that contribute to an athlete’s psychological readiness to return to sport (RTS) after ACLR. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A cohort of 635 athletes (389 male, 246 female) who underwent ACLR and had been cleared to RTS completed the Anterior Cruciate Ligament–Return to Sport After Injury (ACL-RSI) scale at an average 12 months (range, 11-24 months) after surgery. Demographics (age, sex), sporting outcomes (preinjury frequency), surgical timing (injury to surgery interval), clinical factors (laxity), functional measures (single-limb hop symmetry), and symptoms of pain and function (International Knee Documentation Committee subjective) were also taken, and univariate and multiple regression models were used to determine the association between these and the psychological readiness of the athlete to RTS (ACL-RSI scores). Data for the entire cohort were initially analyzed; then, patients were grouped according to whether they had returned to competitive sport, and the analysis repeated for each group (return/nonreturn). Results: Univariate analysis for the entire group showed that all of the following had a positive effect on psychological readiness: male sex (β = 5.8; 95% CI, 2-10), younger age (β = −0.2; 95% CI, –0.4 to 0.01), a shorter interval between injury and surgery (β = −0.1; 95% CI, −0.1 to −0.02), a higher frequency of preinjury sport participation (β = 5.4; 95% CI, 2-9), greater limb symmetry (β = 0.5; 95% CI, 0.3-0.6), and higher subjective knee scores (β = 1.3; 95% CI, 1.1-1.4). In the multivariate model, subjective knee scores and age significantly accounted for 37% of the variance in psychological readiness ( r2 = 0.37, P < .0001). The only difference between the groups who had and had not returned to sport was that female sex was a significant contributor for the nonreturn group. Conclusion: Self-reported symptoms and function were most associated with psychological readiness to RTS after ACLR surgery. Male patients who participated frequently in sport before ACL injury had higher psychological readiness. Conversely, female patients had a more negative outlook and may therefore benefit more from interventions designed to facilitate a smooth transition back to sport.

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