Reduced performance after return to competition in ACL injuries: an analysis on return to competition in the 'ACL registry in German Football'.

PURPOSE: ACL injuries are one of the most severe injuries in football, but medical consequences and performance outcomes after return to competition are only rarely investigated. Aim of this study was to analyse the time of return to competition (RTC) in German professional, semi-professional and amateur football. Also, this investigation highlights the rate of career ending and performance outcome after RTC in different playing levels by the measurement of playing level, performed matches and played minutes. METHODS: Database of this investigation is the 'ACL registry in German Football' with prospectively collected injury data. Between 2014 and 2018, four seasons in professional (1st-3rd league), semi-professional (4th-6th league) and amateur leagues (7th league) were analysed regarding the return to competition period and performance parameters. Data were collected for three subsequent seasons after injury and compared with the pre-injury and injury season. Data collection was performed using standardized methods. RESULTS: A total of 607 ACL injuries were registered during the 4-year period with a mean RTC time of 337.1 day (SD: 183). After primary ACL ruptures, the fastest RTC was found in professional football (247.3 days), while in semi-professional (333.5 d; p < 0.0001) and amateur football (376.2 d; p < 0.0001) a prolonged absence was detected. Re-ruptures occurred in 17.8% (n = 108) and showed similar trend with fastest RTC in professionals (289.9 days; p = 0.002). Within the first three seasons after injury, 92 players (36.7%) in semi-professional and 24 (20%) in professionals had to end their career. Keeping the level of play was only possible for 48 (47.5%) of professionals, while only 47 (29.6%) of semi-professionals and 43 (28.1%) of amateurs were able to. Only in professional football, no significant difference could be seen in the played minutes and games after 2 years compared to the pre-injury season. CONCLUSION: Lower playing levels and re-ruptures are the main factors for a prolonged return to competition after ACL rupture in German football. Significant reduction in playing level and a high rate of career endings were found for all levels of play. However, only professional players were able to regain their playing minutes and games 2 years after injury, while lower classed athletes did not reach the same amount within 3 years. LEVEL OF EVIDENCE: Level III.

Timing return-to-competition: a prospective registration of 45 different types of severe injuries in Germany's highest football league.

INTRODUCTION: Many professional football players sustain at least one severe injury over the course of their career. Because detailed epidemiological data on different severe injuries in professional football have been missing so far, this study describes the frequency and return-to-competition (RTC) periods of different types of severe football injuries. MATERIAL AND METHODS: This epidemiological investigation is a prospective standardised injury analysis based on national media longitudinal registration. Injuries were classified according to the consensus statement by Fuller et al. (2006). The analysis includes injuries sustained by players of the first German football league during the seasons 2014-2015 to 2017-2018. LEVEL OF EVIDENCE: II. RESULTS: Overall, 660 severe injuries were registered during the four seasons (mean 165 per season; 9.2 per season per team; incidence in 1000 h: 0.77). The body region most frequently affected by severe injury was the knee (30.0%; 49.5 injuries per season/SD 13.2) followed by the thigh (26.4%; 43.5 injuries/SD 4.2) and the ankle (16.7%; 27.5 injuries/SD 5.0). The distribution of injuries over the course of a season showed a trend for ACL ruptures to mainly occur at the beginning of a season (45.8%), overuse syndromes such as achillodynia (40.9%) and irritation of the knee (44.4%) during the winter months and severe muscle and ankle injuries at the end of a season. ACL ruptures showed the longest RTC durations (median 222 days). CONCLUSION: This study presents detailed epidemiological data on severe injuries in professional football. The body region most frequently affected by severe injuries was the knee. Several types of severe injuries showed a seasonal injury pattern. The appropriate timing of RTC after an injury is one of the most important and complex decisions to be made. This study provides information on the typical time loss due to specific severe football injuries, which may serve as a guideline.

Standardized Rehabilitation or Individual Approach?-A Retrospective Analysis of Early Rehabilitation Protocols after Isolated Posterior Cruciate Ligament Reconstruction.

(1) Background: Isolated posterior cruciate ligament (PCL) tears represent a severe type of injury. In hospitals, PCL reconstruction (PCL-R) is less frequently performed than other types of knee surgery. It is unclear whether there is consensus among surgeons on how to perform rehabilitation after PCL-R or if there are different, more individual approaches in daily routines. (2) Methods: Rehabilitation protocols and their main criteria (the progression of weight bearing and range of motion, the use of knee braces, rehabilitation training, and sports-specific training) were retrospectively analyzed after PCL-R. (3) Results: Only 33 of 120 (27.5%) analyzed institutes use rehabilitation protocols after PCL-R. The applied protocols showed vast differences between the individual rehabilitation criteria, especially with regard to the progression of weight bearing and the range of motion. The only standardized recommendations were the obligatory use of knee braces and the general restriction of weight bearing and range of motion immediately post-surgery. Therefore, because of the lack of a consensus about a standardized rehabilitation protocol after PCL-R, no recommendation can be made on one particular protocol. (4) Conclusion: There is no acknowledged standardized rehabilitation protocol after PCL-R. In clinical practice, recommendations are influenced by, i.a., surgeons' opinions and experience. The lack of scientific evidence on a particular standardized rehabilitation protocol after PCL-R suggests that rehabilitation protocols need to be tailored to the individual patient.

Current Standards of Early Rehabilitation after Anterior Cruciate Ligament Reconstruction in German Speaking Countries-Differentiation Based on Tendon Graft and Concomitant Injuries.

Background: Although anterior cruciate ligament reconstruction (ACLR) is a well-established procedure and is standardly performed by orthopedic surgeons all over the world, there does not seem to be a standard protocol for early rehabilitation. The purpose of this study was to give answers to the following questions: (i) Does (a) the use of a specific tendon graft, and (b) potentially additional therapy of concomitant pathologies influence surgeons' choice of a distinct postoperative rehabilitation protocol after ACLR? (ii) To what extent do these rehabilitation recommendations differ? Methods: Retrospective analysis of currently used early rehabilitation protocols after ACLR in German-speaking countries (GER, AUT and SUI) was conducted. Rehabilitation criteria included weight bearing, range of motion (ROM), the utilization of braces, continuous passive/active motion therapy (CPM/CAM), rehabilitation training and sport-specific training. Tendon grafts were differentiated as hamstring (HAM) and bone−patellar tendon−bone grafts (BTB). Concomitant pathologies included meniscus injuries (+M) and unhappy triad injuries (+UTI). Results: Most of the surveyed protocols were differentiated according to the used tendon graft or additional therapy of concomitant injuries (ACLR-differentiated, n = 147 vs. ACLR without graft differentiation, n = 58). When comparing ACLR-HAM and ACLR-BTB, significant differences were found regarding weight bearing (p = 0.01), ROM (p = 0.05) and the utilization of braces (p = 0.03). Regarding ACLR+M, an overall significant decelerated rehabilitation could be detected. After ACLR+UTI-therapy, a significant delayed start to full weight bearing (p = 0.002) and ROM (p < 0.001) was found. Conclusions: Most orthopedic surgeons from German-speaking countries differentiate early rehabilitation after ACLR according to the tendon graft used and therapy of concomitant pathologies. No consensus about early rehabilitation after ACLR is available. However, tendencies for an accelerated rehabilitation after ACLR-BTB and a more restrained rehabilitation of multiple injured knees were detected.

Does Phototherapy Promote Wound Healing? Limitations of Blue Light Irradiation.

INTRODUCTION: Phototherapy is gaining increased attention in the research and treatment of various diseases. In particular, the use of blue light seems to bear promise, owing to its antimicrobial and immune-modulating properties; however, research focused on the effects of blue light on keratinocytes and reepithelization is rare. In addition, few studies to date have evaluated devices that are used in daily hospital routine. OBJECTIVE: This study investigated the effects of phototherapy on keratinocytes with 2 established devices in vitro. MATERIALS AND METHODS: Human adult low calcium high temperature keratinocytes were irradiated with 2 different devices, and the effects on scratch wound closure, proliferation, cell viability, and cytokine expression were evaluated. RESULTS: Blue light irradiation reduced reepithelization at high doses in a scratch wound healing model (wound closure on day 1: control group, 25.57 percentage points [PP] ± 2.36 standard deviation vs Device A for 10 minutes, 1.33 PP ± 1.01) and mitochondrial activity measured with resazurin conversion (Device A for 10 minutes, 33.28% ± 12.34). Irradiated cells demonstrated a lower ratio of proliferating cell nuclear antigen-positive cells and, as a result, lower proliferation. CONCLUSIONS: Blue light reduces keratinocyte proliferation and migration at high doses and therefore could negatively affect wound healing. Available irradiation devices for possible use in wound therapy should be critically scrutinized and evaluated with in vitro methods prior to clinical use.

Early Functional Rehabilitation after Meniscus Surgery: Are Currently Used Orthopedic Rehabilitation Standards Up to Date?

Meniscus therapy is a challenging process. Besides the respective surgical procedure such as partial meniscectomy, meniscus repair, or meniscus replacement, early postoperative rehabilitation is important for meniscus regeneration and return to sport and work as well as long-term outcome. Various recommendations are available. However, the current literature lacks information concerning the actual early rehabilitation in daily routine recommended by orthopedic surgeons. Thus, the purpose of this study was to investigate currently used standard early rehabilitation protocols in the daily routine of orthopedic surgeons. This study investigated the recommendations and concepts for early rehabilitation after meniscus therapy given by German, Austrian, and Swiss orthopedic institutions. Standardized criteria such as weight bearing, range of motion, use of an orthosis, and rehabilitation training were analyzed according to the conducted surgical procedure: partial meniscectomy, meniscus repair, or meniscus replacement. The analysis of standard rehabilitation concepts for partial meniscectomy (n = 15), meniscus repair (n = 54), and meniscus replacement (n = 7) showed significantly earlier functional rehabilitation in all criteria after partial meniscectomy in contrast to meniscus repair techniques (p < 0.001). In addition, significant restrictions were found in full weight bearing, full range of motion, and the use of braces. In summary, a wide range of recommendations for weight bearing, ROM, brace therapy, and mobilization is available, particularly after meniscus repair and meniscus replacement. Most concepts are in accordance with those described in the current literature. Further research is necessary to enhance the scientific evidence on currently used early rehabilitation concepts after meniscus therapy.

High return to competition rate following ACL injury - A 10-year media-based epidemiological injury study in men's professional football.

Ruptures of the anterior cruciate ligament (ACL) typically occur in professional football and epidemiological data about longitudinal injury development is needed. This practice-driven investigation of media-derived ACL data provides information about professional football over 10 years. Injury registration was based on "kicker" sports magazine information that have been recorded over one decade in a standardized manner. Only ACL ruptures in the first German football league were included when they could be verified by a second reliable source. Level of evidence: III. Fifty-seven primary ACL ruptures were verified in the first German football league during the seasons 2007/2008 to 2016/2017. Among them, six re-injuries were found. Mean age at the time of injury was 24.8 years (SD 3.8). 31% (n = 20) of ACL ruptures occurred at the beginning of the season in August or September (p = 0.02). Mean time of RTC after primary ACL ruptures was 226.7 days (SD: 93.5) and 245.6 days (SD: 45.4) after re-injury. Although 62 (98%) players returned to football after injury and only one player immediately finished his career, 54.9% of the affected individuals played 3 years after the ACL rupture in the same league. ACL ruptures lead to longer absence than 7 months from football but does not give reason for immediate career-ending. The decrease in playing level after 3 years illustrate the serious consequences of ACL ruptures in football. Media-based injury reports may provide interesting information.

Early functional rehabilitation after patellar dislocation-What procedures are daily routine in orthopedic surgery?

INTRODUCTION: Patellar dislocation and rupture of the medial patellofemoral ligament (MPFL) are frequently seen in daily orthopedic practice. Besides initial non-surgical treatment, surgery and subsequent rehabilitation are crucial for restoring stability in the femoropatellar joint. This study investigated current rehabilitation strategies after patellar dislocation because knowledge on this topic has been severely limited so far. MATERIALS AND METHODS: The current rehabilitation protocols of 42 orthopedic and trauma surgical institutions were analyzed regarding their recommendations on weight bearing, range of motion (ROM), and use of movement devices and orthosis. All protocols for conservative treatment and postoperative rehabilitation after MPFL reconstruction were compared. Descriptive and statistical analyses were carried out when appropriate. RESULTS: The different rehabilitation strategies for conservative and surgical treatment after patellar dislocation showed a tendency towards earlier functional rehabilitation after surgical MPFL reconstruction than after conservative treatment. Both surgical and conservative treatment involved initial restrictions in weight bearing, ROM, and use of movement devices and orthosis at the beginning of rehabilitation. The rehab protocols showed a significant earlier full weight bearing after surgical MPFL reconstruction (p > 0.001). Due to the presence of other parameters for early functional treatment, the absence of an indication for using orthosis (surgical: 44%, conservative: 33%; p = 0.515) or start of unlimited ROM of the knee (surgical: 4.9 weeks, conservative: 5.7 weeks; p = 0.076) showed by trend an earlier functional strategy after MPFL reconstruction than after conservative therapy. CONCLUSIONS: Both conservative and surgical treatment after patellar dislocation showed restrictions in the early phase of the rehabilitation. Earlier functional therapy was more common after MPFL reconstruction than after conservative treatment. Further clinical and biomechanical studies on rehabilitation strategies after patellar dislocation are needed to improve patient care und individualized therapy.