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1.
Clin Orthop Relat Res ; 479(11): 2375-2384, 2021 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-34166305

RESUMO

BACKGROUND: Lower extremity fractures represent a high percentage of reported injuries in the United States military and can devastate a service member's career. A passive dynamic ankle-foot orthosis (PD-AFO) with a specialized rehabilitation program was initially designed to treat military service members after complex battlefield lower extremity injuries, returning a select group of motivated individuals back to running. For high-demand users of the PD-AFO, the spatiotemporal gait parameters, agility, and quality of life is not fully understood with respect to uninjured runners. QUESTIONS/PURPOSES: Do patients who sustained a lower extremity fracture using a PD-AFO with a specialized rehabilitation program differ from uninjured service members acting as controls, as measured by (1) time-distance and biomechanical parameters associated with running, (2) agility testing (using the Comprehensive High-level Activity Mobility Predictor performance test and Four Square Step Test), and (3) the Short Musculoskeletal Function Assessment score. METHODS: We conducted a retrospective data analysis of a longitudinally collected data registry of patients using a PD-AFO from 2015 to 2017 at a single institution. The specific study cohort were patients with a unilateral lower extremity fracture who used the PD-AFO for running. Patients had to be fit with a PD-AFO, have completed rehabilitation, and have undergone a three-dimensional (3-D) running analysis at a self-selected speed at the completion of the program. Of the 90 patients who used the PD-AFO for various reasons, 10 male service members with lower extremity fractures who used a PD-AFO for running (median [range] age 29 years [22 to 41], height 1.8 meters [1.7 to 1.9], weight 91.6 kg [70 to 112]) were compared with 15 uninjured male runners in the military (median age 33 years [21 to 42], height 1.8 meters [1.7 to 1.9], weight 81.6 kg [71.2 to 98.9]). The uninjured runners were active-duty service members who voluntarily participated in a gait analysis at their own self-selected running speeds; to meet eligibility for inclusion as an uninjured control, the members had to be fit for full duty without any medical restrictions, and they had to be able to run 5 miles. The controls were then matched to the study group by age, weight, and height. The primary study outcome variables were the running time-distance parameters and frontal and sagittal plane kinematics of the trunk and pelvis during running. The Four Square Step Test, Comprehensive High-level Activity Mobility Predictor scores, and Short Musculoskeletal Function Assessment scores were analyzed for all groups as secondary outcomes. Nonparametric analyses were performed to determine differences between the two groups at p < 0.05. RESULTS: For the primary outcome, patients with a PD-AFO exhibited no differences compared with uninjured runners in median (range) running velocity (3.9 meters/second [3.4 to 4.2] versus 4.1 meters/second [3.1 to 4.8], median difference 0.2; p = 0.69), cadence (179 steps/minute [169 to 186] versus 173 steps/minute [159 to 191], median difference 5.8; p = 0.43), stride length (2.6 meters [2.4 to 2.9] versus 2.8 meters [2.3 to 3.3], median difference 0.2; p = 0.23), or sagittal plane parameters such as peak pelvic tilt (24° [15° to 33°] versus 22° [14° to 28°], median difference 1.6°; p = 0.43) and trunk forward flexion (16.2° [7.3° to 23°) versus 15.4° [4.2° to 21°), median difference 0.8°; p > 0.99) with the numbers available. For the secondary outcomes, runners with a PD-AFO performed worse in Comprehensive High-level Activity Mobility Predictor performance testing than uninjured runners did, with their four scores demonstrating a median (range) single-limb stance of 35 seconds (32 to 58) versus 60 seconds (60 to 60) (median difference 25 seconds; p < 0.001), t-test result of 15 seconds (13 to 20) versus 13 seconds (10 to 14) (median difference 2 seconds; p < 0.001), and Illinois Agility Test result of 22 seconds (20 to 25) versus 18 seconds (16 to 20) (median difference 4; p < 0.001). Edgren side step test result of 20 meters (16 to 26) versus 24 meters (16 to 29) (median difference 4 meters; p = 0.11) and the Four Square Step Test of 5.5 seconds (4.1 to 7.2) versus 4.2 seconds (3.1 to 7.3) (median difference 1.3 seconds; p = 0.39) were not different between the groups with an effect size of 0.83 and 0.75, respectively. CONCLUSION: The results of our study demonstrate that service members run with discernible differences in high-level mobility and demonstrate inferior self-reported patient functioning while having no differences in speed and biomechanics compared with their noninjured counterparts with the sample size available. This study is an early report on functional gains of highly motivated service members with major lower extremity injuries who use a PD-AFO and formalized therapy program to run. LEVEL OF EVIDENCE: Level III, therapeutic study.


Assuntos
Órtoses do Pé , Fraturas Ósseas/reabilitação , Traumatismos da Perna/reabilitação , Volta ao Esporte/fisiologia , Corrida/lesões , Adulto , Tornozelo/fisiopatologia , Fenômenos Biomecânicos , Estudos de Casos e Controles , Avaliação da Deficiência , Pé/fisiopatologia , Fraturas Ósseas/fisiopatologia , Marcha/fisiologia , Análise da Marcha , Humanos , Traumatismos da Perna/fisiopatologia , Estudos Longitudinais , Masculino , Militares , Estudos Retrospectivos , Corrida/fisiologia , Resultado do Tratamento
2.
Sci Rep ; 11(1): 1558, 2021 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-33452381

RESUMO

The anterior cruciate ligament (ACL) is the most frequently injured knee ligament. In previous studies, it was demonstrated that patients following ACL reconstruction may present motor deficits which may be related to increased risk of injury. The objective of the study was to determine whether players who have passed RTS assessment still have deficits in movement patterns or in neuromuscular control after such a serious injury as ACL rupture and reconstruction,. Sixty-five male football players (age 18-25 years), recruited from regional teams, were divided into three groups: (1) ACL group-subjects after ACL rupture and reconstruction (n = 24); (2) Mild Injury (MI) group-subjects after mild lower limb injuries (n = 21); and (3) Control (C) group-subjects without injuries (n = 20). For all groups, the Y-balance test, Functional Movement Screen (FMS) and Tuck Jump Assessment (TJA) were performed. For the Y-balance test in ACL group for the injured leg, significantly lower values were demonstrated for anterior reach ((ACL) 69.2 ± 5.7% vs. (MI) 74.8 ± 4.5% vs. (C) 74.0 ± 5.6%), at posterior-lateral reach ((ACL) 103.2 ± 6.4% vs. (C) 108.5 ± 6.0%) and composite score ((ACL) 93.9 ± 4.4% vs. (MI) 97.9 ± 4.3%) in comparison to the remaining two groups. In the FMS test, the ACL group had significantly lower composite score (12 ± 4 points) compared to the C group (15 ± 2 points). Also, compared to the remaining groups, subjects following ACL reconstruction demonstrated significantly lower performance in the TJA test related to the following elements: thighs do not reach parallel, thighs not equal side-to-side, foot placement not shoulder width apart, technique declines prior to 10 s and lower extremity valgus at landing. The authors have observed that athletes after ACL reconstruction still have deficits in movement patterns or in neuromuscular control despite passing the RTS and being cleared to perform sports. Creating a set of sufficiently sensitive assessment methods may significantly reduce the potential risk of injury due to the fact that diagnosed and monitored deficits may be treated on an ongoing basis. The authors suggest that individual elements of the Y-balance and TJA tests may be suitable for such specific assessment.


Assuntos
Lesões do Ligamento Cruzado Anterior/reabilitação , Relesões/prevenção & controle , Volta ao Esporte/normas , Adolescente , Ligamento Cruzado Anterior/fisiologia , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/métodos , Atletas , Teste de Esforço , Humanos , Joelho/cirurgia , Articulação do Joelho/fisiopatologia , Articulação do Joelho/cirurgia , Extremidade Inferior/cirurgia , Masculino , Atividade Motora/fisiologia , Movimento/fisiologia , Força Muscular/fisiologia , Volta ao Esporte/fisiologia , Futebol/fisiologia , Adulto Jovem
3.
Int J Sports Med ; 42(4): 336-343, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33096577

RESUMO

We sought to examine the relationship between upper-leg compartmental lean mass, muscle-specific strength, and explosive strength following anterior cruciate ligament reconstruction. Twleve adolescent female athletes with prior anterior cruciate ligament reconstruction were individually-matched by age (16.4±0.9 vs. 16.4±1.0 yrs.), body mass index (23.2±2.1 vs. 23.2±2.7 kg/m2), and sport to 12 female athlete controls. One total-body and 2 lateral-leg dual X-ray absorptiometry scans measured total/segmental body composition. Isokinetic dynamometry measured knee extensor/flexor peak torque. Squat jumps on force platforms measured bilateral peak vertical ground reaction force. Paired t-tests assessed lean mass, peak torque, and force between previously-injured athletes' legs and between previously-injured and control athletes' legs. Previously-injured athletes' involved vs. non-involved leg demonstrated lower total (7.13±0.75 vs. 7.43±0.99 kg; p<0.01) and anterior (1.49±0.27 vs. 1.61±0.23 kg; p<0.01) and posterior (1.90±0.19 vs. 2.02±0.21 kg; p=0.04) upper-leg lean mass. Involved leg peak torque (1.36±0.31; 1.06±0.27; 0.97±0.19 Nm/kg) was lower vs. non-involved leg (1.71±0.36; 1.24±0.33; 1.04±0.15 Nm/kg; p<0.01-0.02) for extension at 60 and 120°/sec and flexion at 60°/sec and vs. controls' 'matched' leg (1.77±0.40 Nm/kg; p=0.01) for extension at 60°/sec. Involved leg force (296±45N) was lower vs. non-involved leg (375±55N; p<0.01) and vs. controls' 'matched' leg (372±88N; p=0.02). One-year post-anterior cruciate ligament reconstruction, adolescent female athletes' involved leg demonstrated relative muscle dysfunction.


Assuntos
Reconstrução do Ligamento Cruzado Anterior/efeitos adversos , Músculo Esquelético/fisiopatologia , Complicações Pós-Operatórias/fisiopatologia , Volta ao Esporte/fisiologia , Absorciometria de Fóton , Adolescente , Lesões do Ligamento Cruzado Anterior/fisiopatologia , Atletas , Basquetebol/fisiologia , Fenômenos Biomecânicos/fisiologia , Composição Corporal , Estudos de Casos e Controles , Intervalos de Confiança , Teste de Esforço/métodos , Feminino , Ginástica/fisiologia , Humanos , Articulação do Joelho/fisiologia , Perna (Membro)/anatomia & histologia , Força Muscular/fisiologia , Esqui/fisiologia , Torque
4.
Int J Sports Med ; 42(4): 344-349, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33017852

RESUMO

Current recommendations for return-to-play decision-making involve comparison of the injured limb to the uninjured limb. However, the use of the uninjured limb as a comparison for hop testing lacks empirical evidence. Thus, the purpose of this study was to determine the effects of lower extremity injury on limb symmetry and performance on the single-leg hop for distance. Two-hundred thirty-six adolescent athletes completed the single-leg hop for distance before the beginning of the season (pre-injury). Forty-four adolescent athletes sustained a lower extremity injury (22 ankle and 12 knee) and missed at least three days of sports participation. All individuals had completed the single-leg hop for distance before the beginning of the season (pre-injury) and at discharge (post-injury). Injured limb single-leg hop for distance significantly decreased at return-to-play from pre-injury with a mean decrease of 48.9 centimeters; the uninjured limb also significantly decreased, with a mean decrease of 33.8 centimeters. Limb symmetry did not significantly change pre- to post-injury with a mean difference of 1.5%. Following a lower extremity injury, single-leg hop for distance performance degrades not only for the injured limb but also the uninjured limb. However, limb symmetry did not change following a lower extremity injury.


Assuntos
Traumatismos da Perna/fisiopatologia , Desempenho Físico Funcional , Recuperação de Função Fisiológica/fisiologia , Volta ao Esporte/fisiologia , Adolescente , Traumatismos do Tornozelo/fisiopatologia , Basquetebol/lesões , Intervalos de Confiança , Tomada de Decisões , Feminino , Futebol Americano/lesões , Guias como Assunto , Humanos , Traumatismos do Joelho/fisiopatologia , Perna (Membro)/anatomia & histologia , Extremidade Inferior/lesões , Masculino , Estudos Prospectivos , Voleibol/lesões
5.
Can J Cardiol ; 37(8): 1165-1174, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33248208

RESUMO

The COVID-19-related pandemic has resulted in profound health, financial, and societal impacts. Organized sporting events, from recreational to the Olympic level, have been cancelled to both mitigate the spread of COVID-19 and protect athletes and highly active individuals from potential acute and long-term infection-associated harms. COVID-19 infection has been associated with increased cardiac morbidity and mortality. Myocarditis and late gadolinium enhancement as a result of COVID-19 infection have been confirmed. Correspondingly, myocarditis has been implicated in sudden cardiac death of athletes. A pragmatic approach is required to guide those who care for athletes and highly active persons with COVID-19 infection. Members of the Community and Athletic Cardiovascular Health Network (CATCHNet) and the writing group for the Canadian Cardiovascular Society/Canadian Heart Rhythm Society Joint Position Statement on the Cardiovascular Screening of Competitive Athletes recommend that highly active persons with suspected or confirmed COVID-19 infection refrain from exercise for 7 days after resolution of viral symptoms before gradual return to exercise. We do not recommend routine troponin testing, resting 12-lead electrocardiography, echocardiography, or cardiac magnetic resonance imaging before return to play. However, medical assessment including history and physical examination with consideration of resting electrocardiography and troponin can be considered in the athlete manifesting new active cardiac symptoms or a marked reduction in fitness. If concerning abnormalities are encountered at the initial medical assessment, then referral to a cardiologist who cares for athletes is recommended.


Assuntos
COVID-19 , Morte Súbita Cardíaca/prevenção & controle , Miocardite , Aptidão Física , Volta ao Esporte , Medicina Esportiva , Atletas , COVID-19/diagnóstico , COVID-19/epidemiologia , COVID-19/fisiopatologia , COVID-19/terapia , Canadá , Aptidão Cardiorrespiratória , Controle de Doenças Transmissíveis/métodos , Morte Súbita Cardíaca/etiologia , Ecocardiografia/métodos , Humanos , Miocardite/complicações , Miocardite/fisiopatologia , Miocardite/terapia , Miocardite/virologia , Exame Físico/métodos , Volta ao Esporte/fisiologia , Volta ao Esporte/normas , SARS-CoV-2 , Medicina Esportiva/normas , Medicina Esportiva/tendências
6.
Arthroscopy ; 37(1): 381-387, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32562759

RESUMO

PURPOSE: The purpose of the current study is to systematically review the current evidence in the literature to ascertain rates of return to play after ACLR with extra-articular augmentation (EA). METHODS: A literature search was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were included if they evaluated and reported on return to play after ACLR + EA; case studies and review articles were excluded. The outcomes measured focused on (1) return to play, (2) return to play at the same or higher level, and (3) timing of return to play. Qualitative analysis and quantitative analysis were performed using SPSS. RESULTS: Overall, 19 studies met our inclusion criteria. Among patients undergoing primary ACLR, 82.8% to 100% were able to return to play, with 64% to 100% able to return at the same or higher level of play. All professional athletes were able to return to play, and 85.7% to 100% were able to return to the same level of preoperative play. The mean time to return was 5 to 11 months in those undergoing primary ACLR + EA. Among those undergoing revision ACLR, 50% to 88.4% were able to return to play, with 41.5% to 77.8% able to return at the same or higher level of play. None of the 5 studies that compared rate of return to play (at any level) between ACLR + EA and ACLR alone found a significant difference between them. However, among the 6 studies that compared rate of return to play at the same level between ACLR + EA and ACLR alone, 2 studies found a significantly higher rate of return to play with ACLR + EA. CONCLUSION: ACLR + EA resulted in high levels of return to play in those undergoing either primary or revision ACLR. Additionally, comparative studies of patients undergoing primary ACLR with or without EA reported similarly high rates of return to play. LEVEL OF EVIDENCE: Level IV, systematic review of level I to IV studies.


Assuntos
Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/métodos , Atletas , Volta ao Esporte/fisiologia , Humanos
7.
J Athl Train ; 55(7): 707-716, 2020 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-32702111

RESUMO

CONTEXT: Depressed patient-reported outcomes (PROs) are directly related to suboptimal recovery after anterior cruciate ligament reconstruction (ACLR). Various PROs commonly used after ACLR can provide a gross estimation of function but do not fully elucidate the causes of self-perceived disability. OBJECTIVE: To more fully characterize the factors driving responses on PROs. DESIGN: Cross-sectional study. A mixed-methods approach was used, in which qualitative interviews were conducted alongside administration of PROs to uncover the themes behind a participant's PRO responses. SETTING: Laboratory. PATIENTS OR OTHER PARTICIPANTS: Twenty-one individuals with unilateral ACLR (age = 20.90 ± 2.86 years, height = 172.0 ± 11.03 cm; mass = 71.52 ± 13.59 kg, postsurgery = 3.66 ± 3.03 years). MAIN OUTCOME MEASURE(S): Patient-reported outcome measures were administered and qualitative interviews were conducted. The PROs consisted of the International Knee Documentation Committee form, Knee Injury and Osteoarthritis Outcomes Score (KOOS), ACL-Return to Sport after Injury (ACL-RSI) scale, and Tampa Scale of Kinesiophobia (TSK). A hierarchical cluster analysis was used to identify subgroups based on PRO responses. Qualitative interviews provided supplemental insight into perceived disability. Independent t tests examined cluster differences for themes. Spearman ρ correlations indicated associations between PRO responses and themes. RESULTS: Two clusters (perceived high or low disability) emerged. Individuals with low perceived disability scored better on all PROs (P < .05) except for the KOOS-Activities of Daily Living. Internal and external facilitators or barrier subthemes emerged from the interviews. A significant difference was present between clusters and themes. Lower TSK andgreater ACL-RSI and KOOS-Quality of Life scores were associated with more perceived facilitators. CONCLUSIONS: Participants with greater internal motivation and confidence and a support network had improved PROs. Those with avoidance tendencies, fear, lack of clear expectations, and less social support scored worse on PROs. The TSK, ACL-RSI, and KOOS-Quality of Life scales were best able to capture the constructs associated with perceived wellness, which reinforces their utility in recovery.


Assuntos
Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/reabilitação , Pessoas com Deficiência , Qualidade de Vida , Volta ao Esporte , Estudos Transversais , Pessoas com Deficiência/psicologia , Pessoas com Deficiência/reabilitação , Feminino , Humanos , Masculino , Medidas de Resultados Relatados pelo Paciente , Volta ao Esporte/fisiologia , Volta ao Esporte/psicologia , Autoimagem , Adulto Jovem
8.
Phys Ther Sport ; 44: 143-150, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32512505

RESUMO

OBJECTIVE: To examine the proportion of skeletally immature anterior cruciate ligament reconstructed (ACLR) patients who achieve ≥90% of lower extremity recovery at 6-9 months post-operatively. DESIGN: Cross-sectional study. SETTING: Biomechanical laboratory. PARTICIPANTS: Skeletally immature ACLR patients. MAIN OUTCOME MEASURE(S): Muscular strength (quadriceps, hamstrings, hip abductors, and hip extensors), dynamic balance (anterior reach, posteromedial reach, and posterolateral reach), and functional hops tests (single hop, triple hops, cross-over hops, and 6 m timed hops) were examined. The primary outcome variable was the proportion of the study patients whose limb symmetry index (LSI) were ≥90% during return to sport (RTS) tests. RESULTS: A total of 105 skeletally immature ACLR patients who are planning to return to sporting activities (age: 13.4 ± 1.4 years) were enrolled. The proportion of skeletally immature ACLR patients who achieved ≥90% of LSI in all four strength, three balance, and four hop tests were 20.0%, 65.4%, and 27.8%. In those who completed all test battery (72/105), only 4.2% of skeletally immature ACLR patients demonstrated ≥90% of LSI in all RTS tests. CONCLUSION: A small proportion of skeletally immature ACLR patients demonstrated ≥90% of lower extremity recovery approximately at 7 months following ACLR.


Assuntos
Lesões do Ligamento Cruzado Anterior/reabilitação , Reconstrução do Ligamento Cruzado Anterior/métodos , Músculos Isquiossurais/fisiopatologia , Força Muscular/fisiologia , Músculo Quadríceps/fisiopatologia , Volta ao Esporte/fisiologia , Esportes/fisiologia , Adolescente , Lesões do Ligamento Cruzado Anterior/fisiopatologia , Lesões do Ligamento Cruzado Anterior/cirurgia , Estudos Transversais , Feminino , Seguimentos , Humanos , Masculino , Período Pós-Operatório , Fatores de Tempo
9.
J Athl Train ; 55(7): 699-706, 2020 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-32511713

RESUMO

CONTEXT: After a lower extremity injury, patients often return to sport (RTS) when the injured limb's performance on unilateral hopping tests is similar to that of the uninjured limb. However, the exact target symmetry value patients must reach before the RTS is unclear. OBJECTIVE: To identify variables that predict limb symmetry index (LSI) values on 6 unilateral hopping tests in healthy, physically active adults. DESIGN: Cross-sectional study. SETTING: Research laboratory. PATIENTS OR OTHER PARTICIPANTS: In total, 275 healthy, physically active adults, consisting of recreational athletes (n = 198), National Collegiate Athletic Association Division I student-athletes (n = 56), and Army Reserve Officer Training Corps cadets (n = 21), volunteered to participate (143 men, 132 women, age = 20.16 ± 2.19 years, height = 172.66 ± 10.22 cm, weight = 72.64 ± 14.29 kg). INTERVENTION(S): Each participant completed 3 speed (6-m crossover-hop, side-hop, figure-8 hop) and 3 distance (triple-crossover-hop, lateral-hop, medial-hop) functional performance tests on both limbs. MAIN OUTCOME MEASURE(S): Mean performance of the dominant and nondominant limbs and LSI values. Two multiple regression models were used to find variables that might help to predict a participant's LSI for each functional performance test. RESULTS: The models helped to predict limb symmetry for 10 of the 12 multiple regressions. Unilateral limb performance was the best predictor of LSI values, as it was statistically significant in 11 of the 12 regression models. Sex and body mass index were significant predictor variables for the side hop and figure-8 hop, respectively. CONCLUSIONS: We found significant predictor variables that clinicians can use in the absence of baseline testing to determine patient-specific LSI values. Individualizing RTS decisions in this way may help to minimize subjectivity in the decision-making process and ensure a safe and timely return to competition.


Assuntos
Traumatismos em Atletas , Teste de Esforço/métodos , Deformidades Adquiridas do Pé , Traumatismos da Perna , Volta ao Esporte , Adulto , Traumatismos em Atletas/complicações , Traumatismos em Atletas/reabilitação , Estudos Transversais , Tomada de Decisões , Feminino , Deformidades Adquiridas do Pé/diagnóstico , Deformidades Adquiridas do Pé/etiologia , Deformidades Adquiridas do Pé/fisiopatologia , Humanos , Traumatismos da Perna/complicações , Traumatismos da Perna/psicologia , Traumatismos da Perna/reabilitação , Masculino , Desempenho Físico Funcional , Volta ao Esporte/fisiologia , Volta ao Esporte/psicologia
11.
J Athl Train ; 55(7): 691-698, 2020 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-32396470

RESUMO

CONTEXT: Understanding the factors that predict return to sport (RTS) after anterior cruciate ligament reconstruction facilitates clinical decision making. OBJECTIVE: To develop a clinical decision algorithm that could predict RTS and non-RTS based on the differences in the variables after anterior cruciate ligament reconstruction. DESIGN: Cross-sectional study. SETTING: University laboratory. PATIENTS OR OTHER PARTICIPANTS: A total of 150 athletes in any sport involving deceleration, jumping, cutting, or turning enrolled in the study. All participants answered the International Knee Documentation Committee and Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) questionnaires and performed balance and isokinetic tests. MAIN OUTCOME MEASURE(S): The classification and regression tree (CART) was used to determine the clinical decision algorithm associated with RTS at any level and RTS at the preinjury level. The diagnostic accuracy of the CART was verified. RESULTS: Of the 150 participants, 57.3% (n = 86) returned to sport at any level and 12% (n = 18) returned to sport at the preinjury level. The interactions among the peak torque extension at 300°/s >93.55 Nm, ACL-RSI score >27.05 (P = .06), and postoperative time >7.50 months were associated with RTS at any level identified by CART and were factors associated with RTS. An ACL-RSI score >72.85% was the main variable associated with RTS at the preinjury level. The interaction among an ACL-RSI score of 50.40% to 72.85%, agonist : antagonist ratio at 300°/s ≤63.6%, and anteroposterior stability index ≤2.4 in these participants was the second factor associated with RTS at the preinjury level. CONCLUSIONS: Athletes who had more quadriceps strength tended to RTS at any level more quickly, even with less-than-expected psychological readiness. Regarding a return at the preinjury level, psychological readiness was the most important factor in not returning, followed by a better agonist : antagonist ratio and better balance.


Assuntos
Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/reabilitação , Traumatismos em Atletas , Regras de Decisão Clínica , Teste de Esforço/métodos , Volta ao Esporte , Adulto , Traumatismos em Atletas/fisiopatologia , Traumatismos em Atletas/psicologia , Traumatismos em Atletas/reabilitação , Estudos Transversais , Feminino , Humanos , Masculino , Força Muscular , Equilíbrio Postural , Prognóstico , Músculo Quadríceps , Volta ao Esporte/fisiologia , Volta ao Esporte/psicologia , Inquéritos e Questionários
12.
Sports Med Arthrosc Rev ; 28(2): 66-70, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32345928

RESUMO

Although the incidence of anterior cruciate ligament injuries continues to rise, return to sport (RTS) rates remain low and risk of the second injury remains high. No gold-standard criteria exist for medical clearance to RTS after anterior cruciate ligament reconstruction. The lack of consensus may be driven by the multifactorial nature of the clinical decision that includes a combination of physical and psychological factors. Tools such as the Quality of Movement Assessment, which identifies physical deficits and faulty movement patterns to provide targeted recommendations for safe RTS, and the Anterior Cruciate Ligament Return to Sport after Injury Scale, which determines psychological readiness by measuring an athlete's emotions, confidence, and risk appraisal, have been developed in recent years. This review summarizes the existing evidence regarding RTS and highlights the need for a comprehensive evaluation of an athlete's readiness to return.


Assuntos
Reconstrução do Ligamento Cruzado Anterior , Volta ao Esporte/fisiologia , Volta ao Esporte/psicologia , Humanos
13.
Phys Ther Sport ; 42: 82-90, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31954959

RESUMO

OBJECTIVES: To describe feasibility, adherence, acceptability, and outcomes of a cognitive-behavioral-based physical therapy (CBPT-ACLR) intervention for improving postoperative recovery after anterior cruciate ligament reconstruction (ACLR). DESIGN: Pilot study. SETTING: Academic medical center. PARTICIPANTS: Eight patients (mean age [SD] = 20.1 [2.6] years, 6 females) participated in a 7-session telephone-based CBPT-ACLR intervention beginning preoperatively and lasting 8 weeks after surgery. MAIN OUTCOME MEASURES: At 6 months, patients completed Knee Injury and Osteoarthritis Outcome Score (KOOS) sports/recreation and quality of life (QOL) subscales, International Knee Documentation Committee (IKDC), Tampa Scale of Kinesiophobia (TSK), Pain Catastrophizing Scale (PCS), and Knee Self-Efficacy Scale (K-SES), return to sport (Subjective Patient Outcome for Return to Sports), and satisfaction. Minimal clinically important difference (MCID) was used for meaningful change. RESULTS: Seven (88%) patients completed all sessions. Seven (88%) patients exceeded MCID on the TSK, 6 (75%) on the PCS, 5 (63%) on the KOOS sports/recreation subscale, 4 (50%) on the IKDC, and 3 (38%) on the KOOS QOL subscale. Three (38%) patients returned to their same sport at the same level of effort and performance. All patients were satisfied with their recovery. CONCLUSIONS: A CBPT-ACLR program is feasible and acceptable for addressing psychological risk factors after ACLR.


Assuntos
Lesões do Ligamento Cruzado Anterior/reabilitação , Reconstrução do Ligamento Cruzado Anterior/métodos , Articulação do Joelho/fisiopatologia , Modalidades de Fisioterapia , Qualidade de Vida , Amplitude de Movimento Articular/fisiologia , Volta ao Esporte/fisiologia , Adolescente , Adulto , Lesões do Ligamento Cruzado Anterior/fisiopatologia , Lesões do Ligamento Cruzado Anterior/cirurgia , Feminino , Humanos , Masculino , Projetos Piloto , Período Pós-Operatório , Adulto Jovem
14.
Knee ; 27(2): 509-517, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31926669

RESUMO

PURPOSE: The present study provides insight into patient satisfaction with return to sports after unicompartmental knee arthroplasty (UKA) and to what type of activities patients return. This is important because indications for UKA have expanded and younger and more active patients undergo surgery currently. METHODS: Patients who received a UKA were contacted between 12 and 24 months' post-surgery, receiving a questionnaire to evaluate postoperative satisfaction with return to sports, level of return, type of activities performed pre- and postoperatively, and (activity) outcome scores (NRS, UCLA, HAAS). Descriptive statistical analysis focused on the influence of patients' sex and age, and a regression model was fitted to assess the predictors for high satisfaction postoperatively. RESULTS: One hundred and sixty-four patients (179 UKAs) with a mean age of 62.3 years responded at an average follow-up of 20.2 months. Preoperatively, 132 patients (81%) participated in sports, which increased to 147 patients (90%) after UKA. Analyzing outcomes for each knee individually, satisfaction with return to sports was recorded in 83% (149/179). Return to a higher or similar level was reported in 85.4% of the cases (117/137). Most common sports after UKA were cycling (45%), swimming (38%), and stationary cycling (27%). Overall, 93.9% of patients were able to return to low impact sports, 63.9% to intermediate and 32.7% to high impact sports. Regarding activity scores, preoperative NRS score improved from 6.40 ±â€¯2.10 to 1.33 ±â€¯1.73 postoperatively (p < .001). The mean preoperative UCLA score improved from 5.93 ±â€¯2.19 to 6.78 ±â€¯1.92 (p < .001) and HAAS score from 9.13 ±â€¯3.55 to 11.08 ±â€¯2.83 postoperatively (p < .001). Regression analyses showed that male sex, preoperative UCLA score and sports participation predicted high activity scores postoperatively. CONCLUSION: The vast majority of patients undergoing medial UKA returned to sports postoperatively, of which over 80% was satisfied with their restoration of sports ability. Male patients, patients aged ≥70, and patients who participated in low-impact sports preoperatively achieved the highest satisfaction rates. Regarding type of sports, male patients and patients aged ≤55 were most likely to return to high and intermediate impact sports. This study may offer valuable information to help manage patients' expectations regarding their ability to return to sports based on demographics and type of preoperative sporting activities. LEVEL OF EVIDENCE: Case series; Level of evidence IV.


Assuntos
Artroplastia do Joelho/métodos , Articulação do Joelho/cirurgia , Satisfação do Paciente , Recuperação de Função Fisiológica , Volta ao Esporte/fisiologia , Adulto , Idoso , Feminino , Humanos , Articulação do Joelho/fisiopatologia , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Inquéritos e Questionários
15.
Clin J Sport Med ; 30(6): e186-e193, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-30418218

RESUMO

OBJECTIVES: It is well known that alterations in landing mechanics persist for years after anterior cruciate ligament reconstruction (ACL-R). Nevertheless, existing literature is controversial in reporting successful or unsuccessful recovery of prelanding muscle activation timing after ACL-R. The study aimed at comparing myoelectric and kinematic patterns during landing tasks between ACL-R and healthy subjects. DESIGN: Cross-sectional study. SETTING: Institutional research laboratory. PATIENTS AND INTERVENTION: Fifteen male athletes after ACL-R using patellar tendon and 11 using hamstrings autograft at the time of return to sport were recruited. Fifteen healthy athletes served as control group. Participants performed 4 different single-leg landing tasks arriving onto a force plate. MAIN OUTCOME MEASURES: Electromyographic (EMG) activity of knee extensors and flexors, normalized vertical ground reaction force (vGRF), and knee angular displacement were recorded. RESULTS: In all the tasks, preimpact EMG duration was longer in ACL-R (112 ± 28 ms in the knee extensors; 200 ± 34 ms in the knee flexors) compared with healthy participants (74 ± 19 ms in the knee extensors; 153 ± 29 ms in the knee flexors; P < 0.05). Initial contact (IC) and maximum postimpact knee angle were lower in ACL-R (9 ± 7 degrees at IC; 39 ± 12 degrees at maximum flexion) compared with healthy participants (17 ± 9 degrees at IC; 52 ± 15 degrees at maximum flexion; P < 0.05). Normalized vGRF was higher in ACL-R compared with healthy participants (3.4 ± 0.5 and 2.7 ± 0.6; P < 0.05). CONCLUSIONS: At the time of return to sport, ACL-R subjects showed altered motor control strategies of single-leg landings. These alterations may lead to uncoordinated movement, hence increasing the risk of reinjury.


Assuntos
Reconstrução do Ligamento Cruzado Anterior , Fenômenos Biomecânicos/fisiologia , Músculos Isquiossurais/fisiologia , Músculo Quadríceps/fisiologia , Recuperação de Função Fisiológica , Volta ao Esporte , Análise de Variância , Lesões do Ligamento Cruzado Anterior/etiologia , Lesões do Ligamento Cruzado Anterior/fisiopatologia , Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/métodos , Autoenxertos , Estudos de Casos e Controles , Estudos Transversais , Eletromiografia , Músculo Grácil/transplante , Tendões dos Músculos Isquiotibiais/transplante , Humanos , Articulação do Joelho/fisiologia , Masculino , Força Muscular/fisiologia , Avaliação de Resultados em Cuidados de Saúde , Ligamento Patelar/transplante , Volta ao Esporte/fisiologia , Fatores de Tempo , Adulto Jovem
16.
Knee Surg Sports Traumatol Arthrosc ; 28(1): 233-244, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31250056

RESUMO

PURPOSE: The purpose of this study was to determine patient-related and treatment-related predictors of superior and inferior function in sport and recreational activities 1 year after an Achilles tendon rupture. METHODS: This study is based on a multicentre cohort from 4 previous randomised controlled trials. All the patients who had responded to the Foot and Ankle Outcome Score (FAOS) at the 1-year follow-up were included. All the patients had a clinically verified Achilles tendon rupture and patients who underwent surgery were treated within 96 h of the time of rupture. Patients were excluded in the event of a previous Achilles tendon rupture or the presence of other lifestyle diseases. The primary outcomes of the study were reported in the 20th and 80th percentiles of the FAOS subscale, function in sports and recreational activities. RESULTS: A total of 285 (84% men) patients with an average age of 40.0 (SD 8.4) years were included. Smoking increased the odds of superior self-reported FAOS sport and recreation [OR 4.59 (95% CI 1.58-13.32), p = 0.005] compared with non-smoking, while being female [OR 0.38 (95% CI 0.16-0.93), p = 0.035] and every increment of one unit in BMI [OR 0.89 (95% CI 0.81-0.99), p = 0.029] reduced the odds. No variable was statistically significant when attempting to predict which patients report inferior FAOS sport and recreation. The recovery of symmetry in heel-rise tests had no effect on 1-year FAOS sport and recreation. Patient-reported outcomes had a good-to-excellent explanatory capacity of superior and inferior 1-year function in sport and recreational activities (AUC = 0.87-0.93). CONCLUSION: BMI is a modifiable risk factor, which, when lowered, may be associated with less impairment in sports 1 year after an Achilles tendon rupture. Females appear to perceive more limitations than males. Unexpectedly, smokers experience less limitations in foot and ankle function. Patients who report no functional limitation in sport are characterised by an overall perception of adequate foot, ankle and Achilles function, despite not having recovered symmetry in the heel-rise test. LEVEL OF EVIDENCE: I.


Assuntos
Tendão do Calcâneo/lesões , Recuperação de Função Fisiológica/fisiologia , Recreação/fisiologia , Volta ao Esporte/fisiologia , Ruptura/fisiopatologia , Traumatismos dos Tendões/fisiopatologia , Tendão do Calcâneo/fisiopatologia , Tendão do Calcâneo/cirurgia , Adulto , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Ensaios Clínicos Controlados Aleatórios como Assunto , Ruptura/reabilitação , Ruptura/cirurgia , Traumatismos dos Tendões/reabilitação , Traumatismos dos Tendões/cirurgia , Resultado do Tratamento
17.
Knee Surg Sports Traumatol Arthrosc ; 28(7): 2203-2212, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31679068

RESUMO

PURPOSE: This study aimed to identify independent predictive factors for return to sports (RTS) after anterior cruciate ligament (ACL) reconstruction in competitive-level athletes and to determine optimal cut-off values for these factors at 6 months after surgery. METHODS: A total of 124 competitive athletes (50 males and 74 females; mean age, 17.0 years; preinjury Tegner activity scale > 7) who underwent primary ACL reconstruction were enrolled. Assessments at 6 months after surgery consisted of knee functional tests [quadriceps index, hamstrings index, and single-leg hop for distance (SLH)] and 2 self-report questionnaires [IKDC subjective score and ACL-Return to Sport after Injury scale (ACL-RSI)]. At 1 year after surgery, athletes were classified into the RTS group (n = 101) or non-RTS group (n = 23) based on self-reported sports activities. After screening possible predictive factors of RTS, multivariate logistic regression and receiver operating characteristic curve analyses were performed to identify independent factors. RESULTS: Multivariate logistic regression analysis identified SLH (odds ratio, 2.861 per 10 unit increase; P < 0.001) and ACL-RSI (odds ratio, 1.810 per 10 unit increase; P = 0.001) at 6 months as independent predictors of RTS at 1 year after surgery. Optimal cut-off values of SLH and ACL-RSI were 81.3% (sensitivity = 0.891; specificity = 0.609) and 55 points (sensitivity = 0.693; specificity = 0.826), respectively. CONCLUSION: In competitive athletes, SLH < 81% and ACL-RSI < 55 points at 6 months after surgery were associated with a greater risk of unsuccessful RTS at 1 year after surgery. SLH and ACL-RSI at 6 months could serve as screening tools to identify athletes who have difficulties with returning to sports after ACL reconstruction. LEVEL OF EVIDENCE: III.


Assuntos
Reconstrução do Ligamento Cruzado Anterior/reabilitação , Desempenho Físico Funcional , Recuperação de Função Fisiológica , Volta ao Esporte/estatística & dados numéricos , Adolescente , Adulto , Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/psicologia , Atletas/psicologia , Feminino , Músculos Isquiossurais/fisiopatologia , Humanos , Joelho/cirurgia , Articulação do Joelho/fisiologia , Articulação do Joelho/cirurgia , Modelos Logísticos , Escore de Lysholm para Joelho , Masculino , Músculo Quadríceps/fisiopatologia , Volta ao Esporte/fisiologia , Volta ao Esporte/psicologia , Autorrelato , Esportes/psicologia , Inquéritos e Questionários , Adulto Jovem
18.
J Shoulder Elbow Surg ; 29(3): 587-592, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31859036

RESUMO

BACKGROUND: Rehabilitation following elbow ulnar collateral ligament reconstruction in baseball pitchers relies on a progression of pitching activities to ensure protection and gradual strengthening of the reconstructed ligament. The purpose of this study was to determine the medial elbow torque associated with pitches at various effort levels and determine whether radar gun assistance improves players' abilities to accurately match partial-effort pitches with true references based on maximum pitch velocity. METHODS: Thirty-seven healthy high school and collegiate baseball pitchers were included in this study. Participants were excluded if they were injured, recovering from injury, or otherwise not currently pitching at full effort. Pitch parameters were collected using a validated wearable sensor. Participants threw 5 pitches at 50%, 75%, and 100% subjective effort. Pitchers then threw 5 pitches at 50% maximum velocity and 75% maximum velocity, as measured by a radar gun. RESULTS: Thirty-seven pitchers completed this study. Pitches thrown at 50% and 75% partial effort were significantly faster and generated higher elbow torque than did pitches thrown at 50% and 75% velocity, respectively (P < .001). A 10% decrease in percentage of maximum velocity was associated with a 13% decrease in percentage of maximum elbow torque (ß coefficient = 1.3, R2 = 0.81, P < .001). CONCLUSION: Pitchers generate higher-than-intended forces when throwing at 50% and 75% effort during a subjective partial-effort throwing protocol. Use of a radar gun to guide partial-effort throwing during throwing rehabilitation programs may protect the reconstructed elbow from excess medial torque.


Assuntos
Beisebol/fisiologia , Ligamento Colateral Ulnar/lesões , Articulação do Cotovelo/fisiopatologia , Radar , Volta ao Esporte/fisiologia , Reconstrução do Ligamento Colateral Ulnar , Adolescente , Beisebol/lesões , Ligamento Colateral Ulnar/fisiopatologia , Ligamento Colateral Ulnar/cirurgia , Articulação do Cotovelo/cirurgia , Humanos , Masculino , Amplitude de Movimento Articular/fisiologia , Torque , Adulto Jovem
19.
Arthroscopy ; 35(11): 3090-3096, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31699261

RESUMO

PURPOSE: (1) To examine the timeline of return to sport (RTS) and return to work (RTW) after high tibial osteotomy (HTO) with concomitant medial meniscal allograft transplant (MAT), (2) to evaluate the degree of function on RTS and RTW, and (3) to identify reasons patients do not return to sport- or work-related activity. METHODS: Patients undergoing HTO plus MAT were reviewed retrospectively at a minimum of 2 years postoperatively. The exclusion criterion was any concomitant procedure except cartilage restoration for focal full-thickness medial femoral condylar defects. Patients completed a subjective sport and work questionnaire, a visual analog scale for pain, the Single Assessment Numeric Evaluation, and a satisfaction questionnaire. RESULTS: Twenty-two patients (aged 35.1 ± 8.1 years) were included at 9.3 ± 3.7 years postoperatively. Sixteen patients participated in sports within 3 years before surgery, and 14 patients (87.5%) returned to sport by 9.7 ± 3.8 months postoperatively. Only 7 patients (43.8%) returned to their preinjury status. Eighteen patients were employed within 3 years before surgery, and all patients returned to work; however, only 16 patients (88.9%) returned at the same occupational intensity by 3.1 ± 2.4 months. The rates of RTW for light-, medium-, and heavy-intensity occupations were 100%, 75.0%, and 85.7%, respectively, whereas the duration of RTW was 2.1 months, 2.3 months, and 4.8 months, respectively. Of the patients, 20 (90.9%) reported at least 1 complaint postoperatively, with 13 patients (59.1%) returning to the operating room for recurrent symptoms, including 1 patient who received a knee replacement at 7.75 years postoperatively. CONCLUSIONS: In patients with medial meniscal deficiency and varus deformity, HTO plus MAT provided high rates of RTS (87.5%) and RTW (100%) by 9.7 months and 3.1 months, respectively. It is imperative that clinicians manage expectations because patients may RTS and RTW after HTO plus MAT; however, return to high-intensity activities or occupations may be unlikely or delayed. LEVEL OF EVIDENCE: Level IV, retrospective case series.


Assuntos
Traumatismos do Joelho/cirurgia , Articulação do Joelho/cirurgia , Meniscos Tibiais/transplante , Osteotomia/métodos , Volta ao Esporte/fisiologia , Retorno ao Trabalho , Adulto , Aloenxertos , Feminino , Humanos , Traumatismos do Joelho/fisiopatologia , Traumatismos do Joelho/reabilitação , Articulação do Joelho/fisiopatologia , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Retrospectivos , Adulto Jovem
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