Cervical musculoskeletal and sensorimotor impairments 4 weeks to 6 months following mild traumatic brain injury: An observational cohort study.

BACKGROUND: Clinically relevant scores of neck disability have been observed in adults post mild traumatic brain injury (mTBI), even in those who initially report to be recovered. Potentially cervical musculoskeletal and/or cervical sensorimotor impairments may underlie these persistent symptoms post mTBI. OBJECTIVE: To determine whether cervical impairments exist beyond expected recovery times following concussion compared to healthy controls (HC). STUDY DESIGN: Observational cohort study. METHODS: Participants aged 18-60 years consisting of 39 HC, and 72 individuals, 4 weeks to 6 months post mTBI of which 35 considered themselves asymptomatic (Asymp), and 37 symptomatic (Symp). Cervical outcome measures included range and velocity of motion, flexor muscle endurance, presence of at least one dysfunctional cervical joint, joint position error -neutral and torsion, movement accuracy, smooth pursuit neck torsion test (SPNT) and balance. RESULTS: Individuals in the Symp mTBI group demonstrated significantly reduced: flexion and rotation range, rotation velocity, flexor endurance and movement accuracy as well as increased postural sway and a higher percentage had positive cervical joint dysfunction (p < 0.01]. The mTBI group who considered themselves recovered (Asymp)demonstrated significantly lower rotation range, flexor endurance, and a higher percentage had positive cervical joint dysfunction and positive SPNT (p < 0.05) compared to HCs. CONCLUSION: Individuals reporting symptoms post mTBI demonstrated cervical spine musculoskeletal and sensorimotor impairments beyond expected recovery times. Those not reporting symptoms had fewer but some cervical impairments. The need for a comprehensive neck assessment should be considered, perhaps even in those not reporting symptoms.

Modifiable factors and their association with self-reported knee function and activity after anterior cruciate ligament reconstruction: a systematic review and meta-analysis.

OBJECTIVE: To determine if body mass index (BMI), smoking status, prehabilitation or time to reconstruction are associated with recovery of self-reported knee function and activity after ACL reconstruction (ACLR). DATA SOURCES: Four electronic databases were systematically searched. STUDY SELECTION: English language articles were included if: (1) participants aged 16-70 years had primary or first revision ACLR with autograft, following complete rupture; and (2) the association between one of four modifiable factors: (1) BMI; (2) smoking; (3) prehabilitation; or (4) time to reconstruction with self-reported knee function and activity, ACL graft rupture or return to sport was evaluated. RESULTS: Twelve articles (representing 11 studies) were included. Meta-analyses found low-quality evidence of no difference in self-reported knee function (d = -0.07, 95% CI -0.37 to 0.23, I2 = 0%) or activity levels (d = 0.11, 95% CI -0.2 to 0.41, I2 = 0%) between acute and subacute ACLR. There was no difference in the relative risk of ACL graft rupture with the timing of ACLR (one study). Meta-analysis demonstrated very low-quality evidence that smokers had worse self-reported functional outcomes after ACLR compared to non-smokers (d = -0.58, 95% CI -0.788 to -0.28, I2 = 59%). One study suggested an inverse relationship between BMI and knee-related quality of life after ACLR. One RCT suggested prehabilitation may reduce time to return to sport. CONCLUSION: Low-quality evidence suggests there is no difference in delaying ACLR and very low-quality evidence suggests smokers have worse self-reported functional outcome after ACLR compared to non-smokers. High-quality RCTs are needed to confirm the relationship between the four modifiable factors studied and ACLR outcome.