Secondary Anterior Cruciate Ligament Injury Prevention Training in Athletes: What Is the Missing Link?

After reconstruction, the return to full competition rate of athletes is low, while the re-injury rate remains high despite the completion of a rehabilitation programme. Primary ACL prevention programmes are well developed, yet few research papers focus on secondary ACL injury prevention. The aim of current review is to determine if current ACL secondary prevention training has a positive influence on the re-injury rate, the clinical or functional outcomes, or the risk of re-injury in athletes. Studies investigating secondary prevention of ACL were searched in PubMed and EBSCOhost, followed by a review of the references in the identified articles. The existing evidence suggests that neuromuscular training, eccentric strengthening, and plyometric exercises may have a potential impact on improving biomechanical, functional, and psychological outcomes in athletes; however, the studies on the prevention of second ACL injury in athletes is scarce and inconclusive. Future research is needed to investigate the effectiveness of secondary ACL prevention in reducing the re-injury rates. (PROSPERO Registration number: CRD42021291308).

Integrating Transwomen and Female Athletes with Differences of Sex Development (DSD) into Elite Competition: The FIMS 2021 Consensus Statement.

Sport is historically designated by the binary categorization of male and female that conflicts with modern society. Sport's governing bodies should consider reviewing rules determining the eligibility of athletes in the female category as there may be lasting advantages of previously high testosterone concentrations for transwomen athletes and currently high testosterone concentrations in differences in sex development (DSD) athletes. The use of serum testosterone concentrations to regulate the inclusion of such athletes into the elite female category is currently the objective biomarker that is supported by most available scientific literature, but it has limitations due to the lack of sports performance data before, during or after testosterone suppression. Innovative research studies are needed to identify other biomarkers of testosterone sensitivity/responsiveness, including molecular tools to determine the functional status of androgen receptors. The scientific community also needs to conduct longitudinal studies with specific control groups to generate the biological and sports performance data for individual sports to inform the fair inclusion or exclusion of these athletes. Eligibility of each athlete to a sport-specific policy needs to be based on peer-reviewed scientific evidence made available to policymakers from all scientific communities. However, even the most evidence-based regulations are unlikely to eliminate all differences in performance between cisgender women with and without DSD and transwomen athletes. Any remaining advantage held by transwomen or DSD women could be considered as part of the athlete's unique makeup.

Impact of Platelet-Rich Plasma Use on Pain in Orthopaedic Surgery: A Systematic Review and Meta-analysis.

CONTEXT: Amid extensive debate, evidence surrounding the use of platelet-rich plasma (PRP) for musculoskeletal injuries has rapidly proliferated, and an overall assessment of efficacy of PRP across orthopaedic indications is required. OBJECTIVES: (1) Does PRP improve patient-reported pain in musculoskeletal conditions? and (2) Do PRP characteristics influence its treatment effect? DATA SOURCES: MEDLINE, EMBASE, Cochrane, CINAHL, SPORTDiscus, and Web of Science libraries were searched through February 8, 2017. Additional studies were identified from reviews, trial registries, and recent conferences. STUDY SELECTION: All English-language randomized trials comparing platelet-rich therapy with a control in patients 18 years or older with musculoskeletal bone, cartilage, or soft tissue injuries treated either conservatively or surgically were included. Substudies of previously reported trials or abstracts and conference proceedings that lacked sufficient information to generate estimates of effect for the primary outcome were excluded. STUDY DESIGN: Systematic review and meta-analysis. LEVEL OF EVIDENCE: Level 1. DATA EXTRACTION: All data were reviewed and extracted independently by 3 reviewers. Agreement was high between reviewers with regard to included studies. RESULTS: A total of 78 randomized controlled trials (5308 patients) were included. A standardized mean difference (SMD) of 0.5 was established as the minimum for a clinically significant reduction in pain. A reduction in pain was associated with PRP at 3 months (SMD, -0.34; 95% CI, -0.48 to -0.20) and sustained until 1 year (SMD, -0.60; 95% CI, -0.81 to -0.39). Low- to moderate-quality evidence supports a reduction in pain for lateral epicondylitis (SMD, -0.69; 95% CI, -1.15 to -0.23) and knee osteoarthritis (SMD, -0.91; 95% CI, -1.41 to -0.41) at 1 year. PRP characteristics did not influence results. CONCLUSION: PRP leads to a reduction in pain; however, evidence for clinically significant efficacy is limited. Available evidence supports the use of PRP in the management of lateral epicondylitis as well as knee osteoarthritis.

The effect of early whole-body vibration therapy on neuromuscular control after anterior cruciate ligament reconstruction: a randomized controlled trial.

BACKGROUND: Despite rehabilitation training, deficiency in knee joint position sense, muscular performance, postural control, and functional ability is common after anterior cruciate ligament reconstruction (ACLR). Whole-body vibration therapy (WBVT), which is initiated from 3 months postoperatively, has proven benefits. However, the effect of earlier WBVT is unknown. PURPOSE: To investigate the effect of early WBVT on neuromuscular control after ACLR. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: A total of 48 patients with unilateral complete isolated ACL tears were recruited. Single-bundle hamstring ACLR was performed in all patients. After surgery, they were randomly assigned to either the reference or treatment group. Reference group patients received conventional ACL rehabilitation, while treatment group patients received 8 weeks of WBVT in addition to conventional rehabilitation, starting from 1 month postoperatively. Joint position sense, postural control, and knee isokinetic performance were assessed before surgery and at 1, 3, and 6 months postoperatively using the Biodex dynamometer, Biodex Stability System, and Cybex NORM, respectively. Knee range of motion (ROM), stability (manual testing and KT-1000 arthrometer), and functional ability (single-legged hop test, triple hop test, shuttle run test, and carioca test) were also examined. Two-way repeated-measures analysis of variance and the Mann-Whitney U test were used for statistical analysis. RESULTS: There was no complication throughout the rehabilitation. All patients achieved full knee ROM and stable knee joints at 6 months after surgery. The WBVT group demonstrated significantly better postural control, muscle performance, single-legged hop, and shuttle run (P < .05) than the reference group, but there was no significant difference in knee joint position sense, triple hop, carioca, ROM, and stability (P > .05). CONCLUSION: Early WBVT started from 1 month postoperatively was an effective training method without compromising knee ROM and stability. It improved postural control, isokinetic performance, single-legged hop, and shuttle run but not knee joint position sense, triple hop, and carioca.

A rare mode of extensor mechanism failure in total knee arthroplasty.

We reported a rare mode of extensor mechanism failure in total knee arthroplasty. The patellar tendon was elongated and thin instead of disruption at the bone-tendon junction. We also described the surgical technique for reconstruction of patellar tendon. Patellar tendon was shortened by a precalculated amount. It was then augmented by autologous semitendinosus tendon graft and protected by tension band wire. Active full knee extension could be achieved at postoperative 10 months after the removal of wire loop.