Analysis of the diet, weight-loss behavior, and nutritional knowledge of athletes and coaches in weightclass sports: influence of a coach's nutritional knowledge on athletes.

BACKGROUND: This study was conducted to investigate the nutritional knowledge of elite athletes undergoing weight loss and to identify differences in weight-loss strategies according to nutritional knowledge. METHODS: The participants included 22 coaches and 88 elite athletes registered under the same affiliation. The survey involved translating the General Nutrition Knowledge Questionnaire (GNKQ), and interviews were used to confirm the diet and weight loss patterns of the athletes. The coaches and athletes were divided into high-rank (12 coaches and 57 athletes) and low-rank (10 coaches and 31 athletes) groups based on GNKQ scores. Paired t-tests, correlation analysis, and logistic regression analysis were performed. RESULTS: GNKQ results showed significant differences between high-ranking and low-ranking coaches (p < 0.001). Furthermore, a significant difference in nutrition knowledge scores was also noticed between athletes with high-ranking and low-ranking coaches (p < 0.001). A strong correlation was observed between the GNKQ scores of coaches and athletes (r = 0.369; p < 0.001). The nutritional knowledge of coaches was also correlated with weight-loss strategies (weight loss attempt frequency; r = -0.235; p = 0.027; weight loss duration; r = -0.268; p = 0.012). Additionally, differences were observed in the intake of all nutrients (carbohydrates, proteins, and fat) in the diets of athletes (p < 0.001). CONCLUSION: Our study suggests that the nutritional knowledge of coaches indirectly affects athletes. Coaches have significant influence over athletes and possess experience with diet and weight-loss patterns. This insight should be effectively utilized to enhance the training and performance of athletes and coaches.

Mental processes in professional football players.

Objective: Clear connections have been found between mental processes and performance in elite level football. Yet, few studies have investigated how professional football players' experience the influence of mental processes on performance. Method: This study used a qualitative research design and in-depth interview of six Norwegian professional football players at elite level with a mean age of 28, 3 years and represented five professional clubs. The aim of the study was to investigate how they perceived the importance of arousal regulation, mental toughness, and self-confidence, and that of the sport psychologist in developing these skills. Results: The results revealed a complex and multifaceted link between mental processes and performance. All players, demonstrate a conscious awareness of how mental processes influence their performance. The use of a sport psychologist in working with mental processes emerges as a crucial factor for developing their mental skills. Another important aspect is the need for increased knowledge about mental training's effect in elite football. Mental toughness emerges as the most significant mental process for players' performance because it makes them capable of coping with challenging situations and periods. Conclusion: This study shows that mental processes are important for performing, both related to arousal regulation, and self-confidence, and especially mental toughness. However, mental toughness was also considered a product of age and experience, where older players tend to have experience of more situations that enable them to handle adversity better than younger players. Interestingly, the youngest players seem to be most aware of the use of a sports psychologist.

Effects of dry needling on vertical jump performance in female volleyball players. A randomized controlled trial.

Introduction: Injury prevention and performance enhancement are paramount goals in sports. Myofascial Pain Syndrome, primarily caused by myofascial trigger points, can result in referred pain, stiffness, muscle shortening, and weakness. This study aimed to assess the impact of dry needling (DN) on latent myofascial trigger points on vertical jump performance in female volleyball players. Methods: A single-blind, randomized controlled clinical trial was conducted with twenty-six healthy female volleyball players who had no lower limb injuries in the last six months, exhibited latent trigger points in the triceps surae muscles, and were familiar with the countermovement jump test. Participants were randomly assigned to either a control group or an experimental group (which received a single DN session). Vertical jump performance variables, including jump height as the primary outcome, were assessed using a force platform at five time points: before the intervention, immediately post-treatment, 24 h post-treatment, 72 h post-treatment, and one-week post-intervention. Results: The experimental group showed significantly lower values for vertical jump height, flight time, velocity, strength, and power immediately after the needling intervention (p < 0.05). However, these values were significantly higher one-week post-intervention across all variables (p < 0.01). These findings indicate that DN initially decreases jumping performance, but improvements are observed one week after the intervention. In the comparison between groups, the experimental group exhibited higher values at the one-week follow-up for vertical jump height, flight time, speed, and power compared to the control group (p < 0.05). Conclusions: DN appears to be an effective technique for improving vertical jump performance in female volleyball players one week after its application. Clinical Trial Registration: ClinicalTrials.gov, identifier (NCT06184672).

Exploring the relationship between trunk muscles and lower limb injuries in Australian badminton players.

Due to its dynamic nature, lower limb injuries are common in badminton. Overuse injuries of the knee, including tendon related conditions, are the most common. During jumping and landing, force transference and dissipation through the trunk is required, with the trunk muscles playing a vital role. However, the relationship between knee pain and the ability to voluntarily contract the trunk muscles has not yet been explored in badminton players. A cross-sectional study of Australian badminton players was therefore conducted. Players performed a single leg decline squat to identify those with knee pain. Ultrasound imaging was used to image and measure the size of the multifidus and quadratus lumborum, and the ability to contract the abdominal and multifidus muscles. Voluntary contraction of the trunk muscles was conducted with the subjects lying down. Independent samples T-Tests were performed to test for between group differences. Badminton players with knee pain had larger quadratus lumborum muscles and demonstrated a greater change in muscle thickness from the rested to contracted state. While we cannot comment on causation or direction, over co-contraction of trunk muscles has been shown in other studies to be associated with increased ground reaction forces on landing. Motor control training has been successfully used in other conditions to modify trunk muscle recruitment patterns and may therefore potentially represent a useful approach for badminton players.

Enhancing Recovery and Performance Through Plyometric Training for a Badminton Athlete After Anterior Cruciate Ligament (ACL) Reconstruction: A Case Report.

Anterior cruciate ligament (ACL) injuries are widespread, particularly in sports that involve rapid changes in direction, such as badminton, and it incapacitates an athlete severely and for a long time. ACL reconstruction followed by a structured rehabilitation program is essential for returning to peak performance. Plyometric training, known for enhancing explosive power and agility, is increasingly incorporated in post-ACL reconstruction rehabilitation for athletes. This case report presents the rehabilitation of a 19-year-old female badminton player operated for ACL reconstruction through the inculcation of plyometric training in the later phase to optimize better performance outcomes. The athlete demonstrated significant improvements in knee stability, strength, and functional performance. Plyometric exercises played a crucial role in restoring explosive power and agility, essential for competitive badminton, thereby facilitating a successful return to sport.

Quality and Reliability of YouTube Video Contents About Sports Mouthguards: A Cross-Sectional Study.

BACKGROUND: Sports dentistry aims to prevent and manage orofacial injuries, tooth fractures, tooth loss, and soft tissue trauma during sport activities. Mouthguards are appliances that protect athletes from dental trauma during contact sports. The video-sharing platform YouTube has a large number of informative videos about mouthguards. This study aimed to analyze the quality, accuracy, and reliability of YouTube videos about mouthguards, investigate the relationship between the features and the quality of mouthguard videos on YouTube, and provide suggestions for future informative content about mouthguards and sports dentistry. MATERIALS AND METHODS: The first 100 videos for each keyword from YouTube were collected using the keywords "mouthguard," "sports mouthguard," and "mouthguard and dental trauma." Videos meeting the inclusion criteria were categorized based on publisher (dental professionals and nonprofessionals) and type (animation/slideshow, interview, and product introduction). Video features were recorded. Video content quality, reliability, and accuracy were measured by the Video Information and Quality Index (VIQI), the Journal of the American Medical Association (JAMA) benchmarks, the DISCERN Instrument, the Global Quality Scale (GQS), and the usefulness score. Data were analyzed using SPSS (IBM 29.0) at a 95% statistical significance level (p = 0.05). RESULTS: Out of 300 videos, 80 videos were included. Most of the videos were uploaded by dental professionals (n = 49). The average values of the VIQI, JAMA, DISCERN, and GQS scores were 15.33 out of 20.0, 1.38 out of 4.00, 49.24 out of 80.0, and 2.99 out of 5.00, respectively. Videos uploaded by dental professionals had significantly higher scores in VIQI, JAMA, DISCERN, GQS, and usefulness scores but exhibited a lower number of likes, comments, and views (p < 0.05). Of all included videos, 51% (n = 41) were categorized as "moderately useful" and 10% (n = 8) as "very useful." CONCLUSIONS: Mouthguard videos uploaded by dental professionals are more useful, accurate, and of higher quality. Therefore, patients should consider the information shared by dental professionals. Greater participation from dentists in sharing high-quality content would be beneficial.

Correlation properties of heart rate variability for exercise prescription during prolonged running at constant speeds: A randomized cross-over trial.

The study explores the validity of the nonlinear index alpha 1 of detrended fluctuation analysis (DFAa1) of heart rate (HR) variability for exercise prescription in prolonged constant load running bouts of different intensities. 21 trained endurance athletes (9 w and 12 m) performed a ramp test for ventilatory threshold (vVT1 and vVT2) and DFAa1-based (vDFAa1-1 at 0.75 and vDFAa1-2 at 0.5) running speed detection as well as two 20-min running bouts at vDFAa1-1 and vDFAa1-2 (20-vDFAa1-1 and 20-vDFAa1-2), in which HR, oxygen consumption (VO2), respiratory frequency (RF), DFAa1, and blood lactate concentration [La-] were assessed. 20-vDFAa1-2 could not be finished by all participants (finisher group (FG), n = 15 versus exhaustion group (EG), n = 6). Despite similar mean external loads of vDFAa1-1 (10.6 ± 1.9 km/h) and vDFAa1-2 (13.1 ± 2.4 km/h) for all participants compared to vVT1 (10.8 ± 1.7 km/h) and vVT2 (13.2 ± 1.9 km/h), considerable differences were present for 20-vDFAa1-2 in EG (15.2 ± 2.4 km/h). 20-vDFAa1-1 and 20-DFAa1-2 yielded significant differences in FG for HR (76.2 ± 5.7 vs. 86.4 ± 5.9 %HRPEAK), VO2 (62.1 ± 5.0 vs. 77.5 ± 8.6 %VO2PEAK), RF (40.6 ± 11.3 vs. 46.1 ± 9.8 bpm), DFA-a1 (0.86 ± 0.23 vs. 0.60 ± 0.15), and [La-] (1.41 ± 0.45 vs. 3.34 ± 2.24 mmol/L). Regarding alterations during 20-vDFAa1-1, all parameters showed small changes for all participants, while during 20-vDFAa1-2 RF and DFAa1 showed substantial alterations in FG (RF: 15.6% and DFAa1: -12.8%) and more pronounced in EG (RF: 20.1% and DFAa1: -35.9%). DFAa1-based exercise prescription from incremental testing could be useful for most participants in prolonged running bouts, at least in the moderate to heavy intensity domain. In addition, an individually different increased risk of overloading may occur in the heavy to severe exercise domains and should be further elucidated in the light of durability and decoupling assessment.

Smoking at football clubs with and without smoke-free policies in the Netherlands: an observational study.

OBJECTIVES: Research shows that smoking persists in sports clubs with smoke-free policies (SFPs). It is unknown to what extent smoking occurs at such clubs and how much that may differ from clubs without SFPs. This study aimed to determine whether and to what extent smoking differs at Dutch football clubs with and without SFPs. STUDY DESIGN: This cross-sectional study used a purposive sampling method to compare smoking indicators at 117 Dutch football clubs, with 49 clubs (41.8%) having an SFP. METHODS: Using a standardised checklist, three smoking indicators were observed (number of people smoking, smoking facilities, and cigarette butts) and combined in a total smoking score (scale 0-9). Multi-level linear regression analysis was used to analyse the association between club SFP, local tobacco control policies (TCPs), and smoking indicators. RESULTS: Significantly fewer smoking facilities were present at clubs with an SFP (-2.35, 95% confidence interval [CI]: -3.61; -1.09), but no significant associations were found between SFP and the number of people smoking and cigarette butts. The total smoking score was 1.74 points lower for clubs with an SFP (95% CI: -2.53; -0.96) and 1.85 points lower for clubs in municipalities with strong local TCPs (95% CI: -2.98; -0.72). Strong local TCPs were associated with significantly fewer people smoking at clubs (-1.79, 95% CI: -3.41; -0.17). CONCLUSIONS: SFPs at sports clubs succeed in limiting the number of smoking facilities but do not show differences in terms of smoking rates or smoking-related litter when compared to clubs without SFPs. Our results highlight the need for enhancing implementation of comprehensive SFPs, including clear guidelines for compliance and enforcement.

Post-exercise hypotension and recreational futsal: Effects of a 3-month intervention and association with resting blood pressure adaptations.

To investigate i) if a recreational futsal (RF) training session elicits post-exercise hypotension (PEH), ii) the impact of a 3-month RF intervention on PEH, and iii) the association between PEH in the early phase of the intervention with resting blood pressure (BP) chronic adaptions in men with treated hypertension. BP was measured before and after a RF training session every 5-min (total of 30-min) in the early (weeks 1-2) and the final phases (weeks 11-12) of a 3-month RF intervention, comprising 3 weekly one-hour sessions. Thirty-three men (48 ± 7 years; mean arterial pressure [MAP]: 96 ± 8 mmHg; BMI: 32.2 ± 4.9 kg/m2) participated. In the intervention early phase, systolic BP ([SBP]; -15.4 mmHg; 95% CI: -10.9, -16.8), diastolic BP ([DBP]; -5.4 mmHg; 95% CI: -7.8, -3.0), and MAP (-8.8 mmHg; 95% CI: -11.2, -6.4) significantly decreased 30-min post- compared to pre-training session (n = 33). In the intervention final phase (n = 24), SBP (-8.1 mmHg; 95% CI: -12.0, -3.9) and MAP (-3.0 mmHg; 95% CI: -5.4, -0.7) significantly decreased 30-min post- compared to pre-training session, but not DBP (-0.5 mmHg; 95% CI: -3.7, 2.7). PEH in the final phase was significantly inferior compared to the early phase. PEH in the early phase of the intervention was not consistently associated with chronic BP changes.

Effects of Swimming Exercise on Early Adolescents' Physical Conditioning and Physical Health: A Systematic Review.

BACKGROUND/OBJECTIVES: Swimming is a popular and cost-effective way to prevent sedentary behavior and improve physical conditioning and health during early adolescence. However, information on its impact and benefits on daily life activities is lacking. This systematic review aims to summarize the chronic effects of swimming on physical conditioning and physical health outcomes in early adolescents. METHODS: The PRISMA 2020 guidelines were followed and PubMed, Scopus, Web of Science, and International Symposium of Biomechanics and Medicine in Swimming proceedings databases were searched. Eligibility criteria were defined on the PICOS framework (healthy adolescents in early puberty, swimming programmes or training, passive or active control groups, general effects on physical conditioning or health, longitudinal) and risk of bias was assessed using RoBANS 2. RESULTS: From 2365 records, 20 non-randomized studies met the defined criteria. High heterogeneity in sample size and intervention was observed. While studies related to physical conditioning (n = 5) focused on physiological variables and muscular function, the evidence regarding physical health outcomes (n = 15) explored bone accrual, haemodynamics, body composition, musculoskeletal system, and lung growth. High overall risk of bias (70%) was observed due to strict criteria. CONCLUSIONS: Swimming exercise seems to improve cardiorespiratory fitness, cardiac output, haemodynamics, heart growth, motor performance, and body composition of early adolescents. Despite clear evidence that exists on these chronic effects, research on bone health, postural deficit, motor skills, and sleep quality is still missing.

The Effect of the Mamanet Cachibol League on Psychosomatic Symptoms, Healthy Eating, and Social Support Among Arab Women: A Mixed-Methods Study.

BACKGROUND: The Mamanet Cachibol League (MCL), a community-based model developed in Israel, promotes physical activity and amateur team sports among women. Women in the Arab society have traditionally played few sports, especially team sports. AIMS: The study aimed to assess the differences in health indicators and well-being, including psychosomatic symptoms, self-reported health, healthy eating habits, and social support, by comparing Arab women MCL participants and nonparticipants and examines benefits and motivations of community-based team sports for participants. METHODS: An explanatory sequential mixed-methods approach included a cross-sectional study with intervention and control groups of Israeli Arab women aged 25-59 years. Two-way analyses of covariance and multiple regression models evaluated demographics, well-being, healthy eating, and social support. Quality in-depth interviews with 30 MCL participants further explained the quantitative findings. RESULTS: MCL participants reported higher self-assessed health (P < .001) and decreased psychosomatic symptoms (P < .001) than nonparticipants. Healthier eating and well-being were also linked to MCL participation. The women sense of belonging improved social interactions, personal and professional happiness, and group dedication. MCL attendees felt empowered because the group advocated equality and valued women. Women said their involvement helped their families. CONCLUSIONS: Findings on the MCL community-based model suggest that team sports may serve as an effective tool for promoting health and well-being of Arab women and foster positive community relationships. The sense of belonging and personal empowerment derived from being part of a sports team may also contribute to positive mental health outcomes.

How does prolonged tennis playing affect lower limb muscles' activity during first and second tennis serves?

We examined the effect of prolonged tennis playing on lower limb muscles' activity during the execution of first and second tennis serves. Ten male competitive tennis players executed five first and second serves before (pretest) and after (posttest) a 3-h tennis match. Surface electromyographic (EMG) activity of four lower limb muscles (vastus lateralis, rectus femoris, gastrocnemius lateralis, and soleus muscles) on each leg was recorded along with maximum ball velocity measured by a radar gun and peak vertical forces recorded by a force platform. For the vastus lateralis, gastrocnemius lateralis, and soleus muscles of the left leg as well as the vastus lateralis muscle of the right leg, EMG amplitude decreased from pre- to posttests (p ≤ 0.033). These reductions in the EMG signal were generally more pronounced in the first serve (i.e., ranging from -10% to -40%) compared to the second serve (0% to -25%). Maximum ball velocity for both first (159 ± 12 vs. 154 ± 12 km/h) and second (126 ± 20 vs. 125 ± 15 km/h) serves remained unchanged from pre- to posttests (p = 0.638) Similarly, peak vertical forces did not differ between pretest and posttest for both first (1.78 ± 0.30 vs. 1.72 ± 0.29 body weight) and second (1.62 ± 0.25 vs. 1.75 ± 0.23 body weight) serves (p = 0.730). In conclusion, a 3-h tennis match led to decreased activation levels in various leg muscles during serves, particularly in first serves compared to second serves. Despite consistent maximum ball velocity and peak vertical forces, these reductions in EMG signals suggest that skilled tennis players may adopt compensatory strategies after prolonged play.

Health outcomes of former division I college athletes.

BACKGROUND: Former professional collision sport (CS) athletes, particularly American football players, are at risk of developing chronic health conditions; however, little is known about the health outcomes of amateur athletes. METHODS: A 60-item health survey examined self-reported symptoms and diagnoses among former Division 1 Collegiate CS athletes and non- or limited-contact sport (non-CS) athletes. Binary logistic regressions tested the association between playing CS and health outcomes. RESULTS: Five hundred and two (6.2%) participants completed the survey: 160 CS athletes (mean age: 59.2, SD = 16.0) and 303 non-CS athletes (mean age: 54.0, SD = 16.9). CS athletes had increased odds of reported cognitive complaints and neuropsychiatric symptoms including memory (Padj < 0.01), attention/concentration (Padj = 0.01), problem solving/multi-tasking (Padj = 0.05), language (Padj = 0.02), anxiety (Padj = 0.04), impulsivity (Padj = 0.02), short-fuse/rage/explosivity (Padj < 0.001), and violence/aggression (Padj = 0.02). CS athletes also reported higher rates of sleep apnea (Padj = 0.02). There were no group differences in cardiovascular and physical health outcomes. CONCLUSIONS: Former CS athletes reported more cognitive and neuropsychiatric complaints. The low response rate is a limitation of this study; however, over 500,000 athletes play college sports each year, thus research on long-term health outcomes in this population is critical.

Discovery of Biomarkers of a Recombinant Human Erythropoietin Administration to Thoroughbred Geldings by Label-Free Proteomics.

Erythropoiesis-stimulating agents (ESAs) continue to be a significant threat to the integrity of human and equine sports. Besides conventional direct testing, monitoring the biomarkers associated with the effects of ESAs may provide a complementary approach via indirect detection to enhance doping control. In this study, we applied label-free proteomics to discover plasma protein biomarkers in Thoroughbred geldings after administration with a long-acting form of recombinant human erythropoietin (rhEPO), methoxy polyethylene glycol epoetin beta, Mircera. Increased haematocrit, haemoglobin and red blood cell (RBC) levels were evidenced as early as 4 days post-administration in all three horses to varying extents. Tryptic peptides were obtained from plasma samples and analysed by nanoflow ultra-high-performance liquid chromatography-high-resolution tandem mass spectrometry (nano-UHPLC-HRMSMS) using data-independent acquisition. Differential protein abundance analysis has shortlisted seven protein biomarker candidates that showed significant changes specifically after Mircera administration in the treated but not in the control geldings, which comprised downregulation of two proteins, haptoglobin (HP) and haemopexin (HPX), and upregulation of five proteins, transferrin receptor 1 (TFR1), phospholipid transfer protein (PLTP), tenascin C (TNC), vascular cell adhesion molecule 1 (VCAM1) and galectin 3 binding protein (LGALS3BP). Multivariate analysis of plasma proteome has allowed the classification of control and treated samples. This is the first report on the discovery of plasma protein biomarkers of rhEPO administration to geldings. The results lay a foundation for applications of protein biomarkers for controlling the misuse of ESAs.

Does wet-cupping therapy improve repeated sprint ability, perceived wellness, and rating of perceived exertion in young active males?

Wet-cupping therapy (WCT) is one of the oldest known medical techniques, used as a traditional and complementary therapy with a wide application all around the world for general health. Research on the effects of WCT on sports performance are sparse and inconsistent. Thus, we aimed to explore the effects of WCT on repeated sprint ability, wellness, and exertion in young active males. Forty-nine active adult males (age: [28 â€‹± â€‹5] years; body height [177 â€‹± â€‹8] cm; body mass: [79 â€‹± â€‹7] kg; body mass index: [25.4 â€‹± â€‹1.8] kg/m2) were selected for the study. The participants performed a running-based sprint test on two separate occasions (Control and Post-WCT). WCT was performed 24 â€‹h before the testing session. They completed the Hooper questionnaire to assess their well-being ( i.e. , sleep, stress, fatigue, and soreness) before each session. The rating of perceived exertion (RPE) was collected after each testing session. A higher maximum power (p â€‹< â€‹0.05, effect size [ES] â€‹= â€‹0.6), mean power (p â€‹< â€‹0.01, ES â€‹= â€‹0.5) and minimum power (p â€‹< â€‹0.01, ES â€‹= â€‹0.6) were recorded post-WCT as compared to Control session along with a better perceived sleep (p â€‹< â€‹0.01, ES â€‹= â€‹0.85). Perceived stress (p â€‹< â€‹0.01, ES â€‹= â€‹0.6) and RPE (p â€‹< â€‹0.001; ES â€‹= â€‹1.1) were lower during the post-WCT compared to the Control session. The present findings demonstrated that WCT moderately enhanced repeated sprint ability and had positive effects on perceived sleep, stress, and exertion. WCT may be an effective ergogenic aid to improve repeated sprint ability and general well-being in young adult males. Future large-scale multicentric clinical studies are paramount to confirm the results of our study.

Darts fast-learning reduces theta power but is not affected by Hf-tRNS: A behavioral and electrophysiological investigation.

Sports trainers have recently shown increasing interest in innovative methods, including transcranial electric stimulation, to enhance motor performance and boost the acquisition of new skills during training. However, studies on the effectiveness of these tools on fast visuomotor learning and brain activity are still limited. In this randomized single-blind, sham-controlled, between-subjects study, we investigated whether a single training session, either coupled or not with 2 mA online high-frequency transcranial random noise stimulation (hf-tRNS) over the bilateral primary motor cortex (M1), would affect dart-throwing performance (i.e., radial error, arm range of motion, and movement variability) in 37 healthy volunteers. In addition, potential neurophysiological correlates were monitored before and after the training through a 32-electrode portable electroencephalogram (EEG). Results revealed that a single training session reduced radial error and arm range of motion during the dart-throwing task, but not movement variability. Furthermore, after the training, resting state-EEG data showed a decrease in theta power. Radial error, arm movement, and EEG were not further modulated by hf-tRNS. This indicates that a single training session, regardless of hf-tRNS administration, improves dart-throwing precision and movement accuracy. However, it does not improve movement variability, which might require multiple training sessions (expertise resulting in slow learning). Theta power decrease could describe a more efficient use of cognitive resources (i.e., attention and visuomotor skills) due to the fast dart-throwing learning. Further research could explore different sports by applying longer stimulation protocols and evaluating other EEG variables to enhance our understanding of the lasting impacts of multi-session hf-tRNS on the sensorimotor cortex within the framework of slow learning and training assistance.

In non-elite athletes, women are more likely to return to sports after anterior cruciate ligament reconstruction: a retrospective cohort study.

BACKGROUND: The desire to return to sports (RTS) and return to performance at preinjury level (RTSP) is a common motivator for athletes undergoing anterior cruciate ligament (ACL) reconstructive surgery. However, for non-elite athletes little is known about the patient and surgical variables influencing RTS/RTSP. Purpose was to determine which patient or surgical variables had an effect on RTS/RTSP in non-elite athletes. We also analyzed whether patients that RTS and RTSP have more confidence in the knee and less difficulty pivoting. METHODS: A single-centre retrospective cohort study. All patients who had undergone primary hamstring ACL reconstruction within a 5-year period were included. Patients were asked about their pre- and postoperative sports participation using the Tegner Activity Score (TAS) as well as about their RTS/RTSP. Confidence in the knee and difficulty with pivoting were asked about. To determine the potential adverse effect of patient variables at the time of surgery (sex, age, height, weight, TAS preop) and surgical variables (graft diameter, surgical technique, concomitant injury) influencing RTS/RTSP, univariate and multivariate logistic regression analysis were used. RESULTS: 370 ACL reconstructions were included. Average follow-up was 4.6 years (SD 1.4). RTS rate was 65% and RTSP 43%. Median preinjury TAS was 7 (Q1:6, Q3:8)), postoperative 6 (Q1:4, Q3:7). Multivariate analysis showed that women were more likely to RTS (OR 2.40, 1.16-4.97). A lower preinjury TAS (OR 0.80, 0.67-0.95) resulted in higher RTSP levels. None of the surgical variables had a significant influence on RTS or RTSP. Patients who returned to sports or to preinjury-level performance displayed significantly more confidence in the operated knee and less difficulty pivoting than non-returning patients. CONCLUSION: Our study shows that 65% of non-elite athletes with an ACL reconstruction returned to sports, 43% at preinjury level. Women were over twice more likely to RTS than men. Preinjury TAS significantly influences RTSP, with a lower preinjury TAS leading to a higher percentage of RTSP. Patients returning to both scored better in their self-reported confidence in the knee and difficulty pivoting than non-returning patients. LEVEL OF EVIDENCE: Retrospective cohort III.

'Going through the motions'; a rich account of the complexity of the anterior cruciate ligament reconstruction pathway, a UK qualitative study.

OBJECTIVES: This study aimed to understand the lived experiences of patients on the anterior cruciate ligament reconstruction (ACLR) pathway up to 3 months before, 3 months after and 1 year after surgery. Study objectives were to explore (1) patient experiences of preoperative and postoperative treatment, (2) views of/involvement in prehabilitation and (3) sources and consistency of healthcare advice. DESIGN: Semi-structured interviews analysed using reflexive thematic analysis. SETTING: Midlands, England. PARTICIPANTS: Purposive sample of 18 participants aged 18-45. Three identified as female and 15 as male. Participants' ethnic origin was white (n=14), Indian (n=2), British Asian (n=1) and Pakistani (n=1). 10 participants were awaiting ACLR, six were 3months postsurgery and two were 1 year postsurgery. RESULTS: Participants gave a rich account of ACLR pathway experiences discussing negative impacts of the injury, difficulties with navigating the pathway and making decisions about surgery. Interacting with healthcare professionals and managing the variety of resources, advice and opinions were also highlighted as challenges. Participants reflected on their preoperative journey accounting a wide spectrum of expectations and realities of returning to work and physical activity postoperatively. Prehabilitation was perceived to offer an advantage to recovery, mental well-being, injury knowledge, postoperative rehabilitation and supports a faster return to physical activity. Five themes were identified:Injury experience, impact and support.Navigating the treatment pathway.Sense making in the preoperative period.Uncertainty, expectations and reality of the postsurgical period.Balancing resources, advice and opinions. CONCLUSION: This study has illuminated patient experiences of the National Health Service (NHS) ACLR pathway, novel to the evidence base.The results highlight the perceived shortcomings in patient support. They also demonstrate the difficulty patients face when navigating the NHS system, communicating with clinicians, making decisions about treatment and managing conflicting sources of healthcare advice. These problems are more prominent than previously recognised in the literature. REGISTRATION: ClinicalTrials.gov Identifier: NCT05529511.