The influence of distribution, severity and volume of posttraumatic bone bruise on functional outcome after ACL reconstruction for isolated ACL injuries.

INTRODUCTION: Posttraumatic MRI of ACL tears show a high prevalence of bone bruise (BB) without macroscopic proof of chondral damage. Controversial results are described concerning the association between BB and outcome after ACL tear. Aim of this study is to evaluate the influence of distribution, severity and volume of BB in isolated ACL injuries on function, quality of life and muscle strength following ACL reconstruction (ACLR). MATERIALS AND METHODS: MRI of n = 122 patients treated by ACLR without concomitant pathologies were evaluated. BB was differentiated by four localizations: medial/lateral femoral condyle (MFC/LFC) and medial/lateral tibial plateau (MTP/LTP). Severity was graded according to Costa-Paz. BB volumes of n = 46 patients were quantified (software-assisted volumetry). Outcome was measured by Lysholm Score (LS), Tegner Activity Scale (TAS), IKDC, isokinetics and SF-36. Measurements were conducted preoperatively (t0), 6 weeks (t1), 26 weeks (t2) and 52 weeks (t3) after ACLR. RESULTS: The prevalence of BB was 91.8%. LTP was present in 91.8%, LFC 64.8%, MTP 49.2% and MFC 28.7%. 18.9% were classified Costa-Paz I, 58.2% II and 14.8% III. Total BB volume was 21.84 ± 15.27 cm3, the highest value for LTP (14.31 ± 9.93 cm3). LS/TAS/IKDC/SF-36/isokinetics improved significantly between t0-t3 (p < 0.001). Distribution, severity and volume had no influence on LS/TAS/IKDC/SF-36/isokinetics (n.s.). CONCLUSIONS: No impact of BB after ACLR on function, quality of life and objective muscle strength was shown, unaffected by concomitant pathologies. Previous data regarding prevalence and distribution is confirmed. These results help surgeons counselling patients regarding the interpretation of extensive BB findings. Long-time follow-up studies are mandatory to evaluate an impact of BB on knee function due to secondary arthritis.

Metabolic, cognitive and neuromuscular responses to different multidirectional agility-like sprint protocols in elite female soccer players - a randomised crossover study.

PURPOSE: Resistance to fatigue is a key factor in injury prevention that needs to be considered in return-to-sport (RTS) scenarios, especially after severe knee ligament injuries. Fatigue should be induced under game-like conditions. The SpeedCourt (SC) is a movement platform for assessing multidirectional sprint performance, typical of game-sports, due to change-of-direction movements in response to a visual stimulus. Designing adequate fatigue protocols requires the suitable arrangement of several loading variables such as number of intervals, sprint distance or work/relief ratio (W:R). Therefore, this study analysed the acute fatigue effects of different SC protocols on metabolic load, cognitive function and neuromuscular performance. METHODS: Eighteen female soccer players (mean ± SD; age: 23.1 ± 4.6 years) of the 1st German Division participated in this randomised, crossover study. Using a random allocation sequence, players completed four volume-equated protocols differing in W:R and sprint distance per interval (P1:12 × 30 m, W:R = 1:2 s; P2:12 × 30 m, W:R = 1:3 s; P3:18 × 20 m, W:R = 1:2 s; P4:18 × 20 m, W:R = 1:3 s). Pre- and post-exercise, metabolic load was measured per blood lactate concentration (BLaC), cognitive function per reaction time (RT), and neuromuscular performance including multiple rebound jumps (MRJ height, primary outcome variable; Reactive Strength Index, RSI) and 5 m sprint times (SP5). RESULTS: Repeated-measures ANOVA revealed significant main time effects (p < .05) with improved performance post-exercise in RT (504 vs. 482 ms, d = 1.95), MRJ height (24.0 vs. 24.8 cm, d = 0.77), RSI (1.39 vs. 1.43, d = 0.52), and SP5 (1.19 vs. 1.17 s, d = 0.56). There was significant main time (p < .001) and time x protocol interaction effects in BLaC (p < .001). P1 induced higher BLaC values (4.52 ± 1.83 mmol/L) compared to P2 (3.79 ± 1.83 mmol/L; d = 0.74) and P4 (3.12 ± 1.83 mmol/L; d = 1.06), whereas P3 (4.23 ± 1.69 mmol/L) elicited higher BLaC values compared to P4 (d = 0.74). CONCLUSION: All protocols caused an improved cognitive function and neuromuscular performance. The former may be related to enhanced noradrenergic activation or exercise specificity which induced an improved stimulus processing. The latter may be explained by a possible post-activation performance enhancement effect on jump and sprint performance. A shorter relief duration in W:R as opposed to sprint distance per interval produced higher BLaC values. The protocols may serve as reference data for improved RTS decision-making in elite female soccer players. TRIAL REGISTRATION: Deutsches Register Klinischer Studien (DRKS), No.: DRKS00033496 , Registered 19. Februar 2024, Retrospectively Registered.

Effectiveness of the SMART training intervention on ankle joint function in patients with first-time acute lateral ankle sprain: study protocol for a randomized controlled trial.

BACKGROUND: The lateral ankle sprain (LAS) is the most common injury in the field of everyday and sports-related activities. There is a high rate of patients with LAS who will develop chronic ankle instability (CAI). A possible explanation for this high rate is an insufficient rehabilitation and/or a premature return to intense exercise and workloads. Currently, there are general rehabilitation guidelines for LAS but there is a lack of standardized evidenced-based rehabilitation concepts for LAS, which effectively reduce the high CAI rate. The primary aim of the study is to investigate the effectiveness of a 6-week sensorimotor training intervention (SMART-Treatment, SMART) in contrast to standard therapy (Normal Treatment, NORMT) after an acute LAS on perceived ankle joint function. METHODS: This study will be a prospective, single-center, interventional randomized controlled trial with an active control group. Patients (14-41 years) with an acute LAS and a MRI confirmed lesion or rupture of at least one ankle ligament will be included. Exclusion criteria are acute concomitant injuries of the ankle, pre-injuries of the ankle, serious lower-extremity injuries of the last 6 months, lower-extremity surgery, and neurological diseases. The primary outcome measure will be the Cumberland Ankle Instability Tool (CAIT). Secondary outcomes include the Foot and Ankle Ability Measurement (FAAM), isokinetic and isometric strength diagnostics, joint repositioning sense, range of motion, measurements of postural control, gait and run analysis, and jump analysis. This protocol will follow the SPIRIT guidance. DISCUSSION: Current management of LAS rehabilitation lacks since there is a high rate of patients developing a CAI. It has been shown that exercise therapy improves ankle function in acute LAS as well as in patients with CAI. It is further recommended to address specific impairment domains in ankle rehabilitation. However, empirical data for such a holistic treatment algorithm is missing. Therefore, this study has the potential to improve the healthcare for LAS patients and might be used for a future standardized evidence-based rehabilitation concept. TRIAL REGISTRATION: "Prospectively registered" ISRCTN - ISRCTN13640422 17/11/2021; DRKS (German Clinical Trials Register) - DRKS00026049.

Assessment of return to play after an acute shoulder injury: protocol for an explorative prospective observational German multicentre study.

INTRODUCTION: To date, there is no valid single test or battery of tests for informing return-to-play (RTP) decisions following an acute shoulder injury. The purpose of this exploratory study is to evaluate a diagnostic test battery based on a Delphi consensus at the time of unrestricted return to team training after acute shoulder injury. METHODS AND ANALYSIS: Data for this prospective multicentre cohort study are collected at two measurement time points: when the respective physician clears the patient for RTP (t1) and 12 months after RTP (t2). The study participants are 18-35 years old athletes participating at a professional level in the following team sports: handball, basketball, ice hockey, soccer, volleyball and American football. Maximum comparability will be ensured via uninjured matched pair teammates. To assess the subjective assessment of shoulder functioning and the athlete's readiness to RTP, patient-reported outcome measures (Western Ontario Shoulder Instability Index, Quick-Disabilities of the Arm, Shoulder and Hand, Psychological Readiness of Injured Athlete to Return to Sport and Shoulder Instability-Return to Sport after Injury) will be completed. After a medical check-up with a range of motion and anthropometric measurements as well as clinical tests, the participants will perform a structured warm-up protocol. The functional tests comprise handgrip strength, upper quarter Y-balance test, isometric strength, closed kinetic chain upper extremity stability test, wall hop test, functional throwing performance index and the unilateral seated shot put test and isokinetic tests. ETHICS AND DISSEMINATION: The results of this study will be disseminated through peer-reviewed publications and scientific presentations at national and international conferences. Ethical approval was obtained through the Institutional Review Board of Martin-Luther-University Halle-Wittenberg (reference number: 2022-016). TRIAL REGISTRATION NUMBER: DRKS00028265.

Brace-Free Rehabilitation after Isolated Anterior Cruciate Ligament Reconstruction with Hamstring Tendon Autograft Is Not Inferior to Brace-Based Rehabilitation-A Randomised Controlled Trial.

PURPOSE: The postoperative use of a rehabilitative knee brace after isolated primary anterior cruciate ligament (ACL) reconstruction (ACLR) using a hamstring tendon (HT) autograft is controversial. A knee brace may provide subjective safety but can cause damage if applied incorrectly. The aim of this study is to evaluate the effect of a knee brace on clinical outcomes following isolated ACLR using HT autograft. METHODS: In this prospective randomised trial, 114 adults (32.4 ± 11.5 years, 35.1% women) underwent isolated ACLR using HT autograft after primary ACL rupture. Patients were randomly assigned to wear either a knee brace (n = 58) or no brace (n = 56) for 6 weeks postoperatively. An initial examination was performed preoperatively, and at 6 weeks and 4, 6, and 12 months. The primary endpoint was the subjective International Knee Documentation Committee (IKDC) score to measure participants' subjective perceptions. Secondary endpoints included objective knee function assessed by IKDC, instrumented knee laxity measurements, isokinetic strength tests of the knee extensors and flexors, Lysholm Knee Score, Tegner Activity Score, Anterior Cruciate Ligament-Return to Sport after Injury Score, and quality of life determined by Short Form-36 (SF36). RESULTS: There were no statistically significant or clinically meaningful differences in IKDC scores between the two study groups (3.29, 95% confidence interval (CI) -1.39 to 7.97, p = 0.03 for evidence of non-inferiority of brace-free compared with brace-based rehabilitation). The difference in Lysholm score was 3.20 (95% CI -2.47 to 8.87); the difference in SF36 physical component score 0.09 (95% CI -1.93 to 3.03). In addition, isokinetic testing did not reveal any clinically relevant differences between the groups (n.s.). CONCLUSIONS: Brace-free rehabilitation is non-inferior to a brace-based protocol regarding physical recovery 1 year after isolated ACLR using HT autograft. Consequently, the use of a knee brace might be avoided after such a procedure. LEVEL OF EVIDENCE: Level I, therapeutic study.

go4cognition: Combined Physiological and Cognitive Intervention in Mild Cognitive Impairment.

BACKGROUND: While cognitive interventions in mild cognitive impairment (MCI) show positive effects on cognitive performance, physical activity appear to slow down cognitive decline, suggesting a relationship between both factors. However, previous combined programs that have shown significant improvement in cognitive function in MCI have typically trained cognition and physical functioning separately. OBJECTIVE: This project aimed at evaluating two group interventions combining the stimulation of physical and cognitive domains in individuals with MCI: Simultaneous stimulation of physical and cognitive skills in comparison to a standardized training, which stimulates cognitive and physical functions separately. METHODS: The study was designed as a randomized controlled trial. The first group was trained on the SpeedCourt® system while the second group completed the standardized Fitfor100 program. Training was completed by a total of 39 subjects with diagnosed MCI as determined by the CERAD (SpeedCourt®: 24 subjects, Fitfor100:15 individuals). RESULTS: There were significant improvements of physical factors (e.g., hand strength and balance) in both groups. Improvement in the CERAD total score allowed for a post interventional classification of all participants into non-MCI and MCI. This effect persisted over a period of three months. Both forms of intervention were found to be effective in improving various cognitive functions which persisted for a period of three months. CONCLUSION: Both evaluated non-pharmacological, multicomponent interventions, which combined physical and cognitive training in a social setting showed improvement of cognitive functions leading to a persistent classification of former MCI patients in non-MCI patients.

Delayed functional therapy after acute lateral ankle sprain increases subjective ankle instability - the later, the worse: a retrospective analysis.

BACKGROUND: The lateral ankle sprain (LAS) is one of the most common injuries in everyday and sports activities. Approximately 20-40 % of patients with LAS develop a chronic ankle instability (CAI). The underlying mechanisms for CAI have not yet been clearly clarified. An inadequate rehabilitation after LAS can be speculated, since the LAS is often handled as a minor injury demanding less treatment. Therefore, the aims of this retrospective study were to determine the CAI rate depending on age and sex and to identify possible determinants for developing CAI. METHODS: Between 2015 and 2018 we applied the diagnostic code "sprain of ankle" (ICD S93.4) to identify relevant cases from the database of the BG Klinikum Duisburg, Germany. Patients received a questionnaire containing the Tegner-Score, the Cumberland Ankle Instability Tool (CAIT) and the Foot and Ankle Disability Index. Additionally, there were questions about the modality and beginning of therapy following LAS and the number of recurrent sprains. There was a total of 647 completed datasets. These were divided into a CAI and non-CAI group according to a CAIT cut-off-score with CAI ≤ 24 and non-CAI > 24 points, representing one out of three criteria for having CAI based on international consensus. RESULTS: The overall CAI rate was 17.3 %. We identified a higher CAI rate in females and within the age segment of 41 to 55 years. A later start of therapy (> 4 weeks) after acute LAS significantly increases ankle instability in CAIT (p < .05). There was a significantly higher CAIT score in patients having no recurrent sprain compared to patients having 1-3 recurrent sprains or 4-5 recurrent sprains (p < .001). CONCLUSIONS: Females over 41 years show a higher CAI rate which implies to perform specific prevention programs improving ankle function following acute LAS. A delayed start of therapy seems to be an important determinant associated with the development of CAI. Another contributing factor may be a frequent number of recurrent sprains that are also linked to greater levels of subjective ankle instability. Therefore, we would recommend an early start of functional therapy after acute LAS in the future to minimize the development of CAI.