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Orthopaedics & Traumatology, Surgery &... Oct 2019Knee brace has been commonly used as a device to protect the graft after reconstruction of anterior cruciate ligament (ACL). Studies have focused on the effects of... (Meta-Analysis)
Meta-Analysis
The effect of knee bracing on the knee function and stability following anterior cruciate ligament reconstruction: A systematic review and meta-analysis of randomized controlled trials.
BACKGROUND
Knee brace has been commonly used as a device to protect the graft after reconstruction of anterior cruciate ligament (ACL). Studies have focused on the effects of braces after ACL reconstruction, and controversial results were reported. The current meta-analysis was conducted to identify whether knee braces could provide superior clinical outcomes on knee functional scores and stability evaluations.
HYPOTHESIS
Knee braces could not provide superior clinical outcomes on knee functional scores and stability evaluations.
MATERIALS AND METHODS
Two reviewers independently retrieved the literature on PubMed, Embase and the Cochrane Central Register of Controlled Trials (CENTRAL). Data related to the knee functional scores and stability evaluations, including International Knee Documentation Committee (IKDC) evaluation, Lachman test, manual anterior drawer test, single leg hop test, pivot shift test, side-to-side difference, Lysholm score and Tegner score, were extracted and pooled using meta-analysis with fixed or random- effect models when applicable.
RESULTS
A total of 7 studies with 440 participants were finally included. The IKDC objective score was pooled using the odds ratio (OR) as effect size, which was demonstrated to be non-significantly different between the brace and no brace groups. All of the other clinical outcomes, including Lysholm score, Tegner score, side-to-side difference, single-leg hop test and VAS pain score, were pooled using the standard mean difference (SMD) as effect size. At final follow up, the aforementioned clinical outcomes were demonstrated to be similar between the brace and non-brace groups.
DISCUSSION
Knee bracing does not appear to improve the clinical outcomes on the function and stability for ACL-reconstructed knees. Thus, bracing for patients treated with ACL reconstruction should not be recommended routinely.
LEVEL OF EVIDENCE
I, Meta-analysis.
Topics: Anterior Cruciate Ligament; Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament Reconstruction; Braces; Humans; Knee Joint; Randomized Controlled Trials as Topic; Range of Motion, Articular
PubMed: 31279767
DOI: 10.1016/j.otsr.2019.04.015 -
Journal of Sport Rehabilitation Jul 2022Unilateral training of the uninjured limb could be a useful therapeutic tool to induce cross-education in periods of immobilization, however, the effectiveness of this... (Meta-Analysis)
Meta-Analysis
Effectiveness of Unilateral Training of the Uninjured Limb on Muscle Strength and Knee Function of Patients With Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis of Cross-Education.
CONTEXT
Unilateral training of the uninjured limb could be a useful therapeutic tool to induce cross-education in periods of immobilization, however, the effectiveness of this training in patients with anterior cruciate ligament (ACL) reconstruction is unknown.
OBJECTIVE
To determine the effectiveness of unilateral training of the uninjured limb on muscle strength and knee function in patients with ACL reconstruction.
DESIGN
Systematic review and meta-analysis.
EVIDENCE ACQUISITION
An electronic search was performed in the MEDLINE, LILACS, CENTRAL, Embase, Scopus, Web of Science, CINAHL, SPORTDiscus, and PEDro databases from inception until March 2021. The authors included randomized clinical trials that evaluated the effectiveness of unilateral training of the uninjured limb on muscle strength and knee function in patients after ACL reconstruction.
EVIDENCE SYNTHESIS
Seven clinical trials met the eligibility criteria, and for the quantitative synthesis, 5 studies were included. The standardized mean difference for isometric quadriceps strength was 0.60 at 8 to 12 weeks (95% confidence interval, 0.29 to 0.92; P = .01; I2 = 6%). There was a high quality of evidence according to the Grading of Recommendation, Assessment, Development and Evaluation rating. Four studies assessed knee function through different self-administered questionnaires at 8, 24, and 26 weeks. Only one study reported significant differences in knee function at 8 weeks, favoring the unilateral training group.
CONCLUSIONS
There was a moderate to high quality of evidence, with statistical significance that the addition of unilateral training to standard rehabilitation improved the cross-education of quadriceps strength after ACL reconstruction. More research is needed to assess the consistency of these results. International Prospective Register of Systematic Reviews registration number: CRD42020199950.
Topics: Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament Reconstruction; Humans; Knee; Lower Extremity; Muscle Strength; Quadriceps Muscle
PubMed: 35279020
DOI: 10.1123/jsr.2021-0204 -
The Physician and Sportsmedicine Nov 2020: Recent research demonstrates a connection between psychological factors and return to play following a musculoskeletal sports injury. Although it has been shown that... (Meta-Analysis)
Meta-Analysis
: Recent research demonstrates a connection between psychological factors and return to play following a musculoskeletal sports injury. Although it has been shown that psychological factors can influence when and if an athlete returns to play, it is unclear if the implementation of psychosocial interventions during the recovery process can address these factors and potentially increase the likelihood of return to play after physical recovery from injury. : To examine the efficacy of interventions designed to address psychosocial factors that influence return to play after sports injuries. : A systematic review was performed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Pubmed, Embase, and Google Scholar databases were searched from the earliest entry through May 2018. Search terms included 'psychology,' 'sports injury,' 'anterior cruciate ligament injury,' 'anterior cruciate ligament reconstruction,' 'intervention,' 'return to play,' and 'return to sport.' Studies were included and reviewed if they reported on the efficacy of a psychosocial intervention program in injured athletes. : Initial searches of Pubmed, Embase, and Google Scholar databases identified 560 articles, 329 articles, and 34,400 hits, respectively. After inclusion and exclusion criteria were applied, eight articles remained that met inclusion criteria. Interventions of relaxation/guided imagery, positive self-talk, goal setting, counseling, emotional/written disclosure, and modeling videos were found to be effective interventions for promoting recovery after a musculoskeletal sports injury. These interventions facilitated positive mood changes, pain management, exercise compliance, and rehabilitation adherence. No study examined the effect of psychosocial interventions on return to play. : This systematic review demonstrates that psychosocial interventions can facilitate post-injury recovery in athletes by promoting a positive emotional state and rehabilitation adherence. Further research is necessary to determine the most effective psychosocial interventions for specific psychological factors, the ideal duration of interventions, the best method of implementation following a sports injury, and the impact of these interventions on return to play.
Topics: Affect; Anterior Cruciate Ligament Injuries; Athletic Injuries; Humans; Pain Management; Patient Compliance; Psychosocial Intervention; Return to Sport
PubMed: 32186423
DOI: 10.1080/00913847.2020.1744486 -
The Journal of Orthopaedic and Sports... Jul 2018Background There is controversy surrounding the early use of open-kinetic-chain (OKC) quadriceps-strengthening exercises following anterior cruciate ligament... (Meta-Analysis)
Meta-Analysis
The Effect of Open- Versus Closed-Kinetic-Chain Exercises on Anterior Tibial Laxity, Strength, and Function Following Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis.
Background There is controversy surrounding the early use of open-kinetic-chain (OKC) quadriceps-strengthening exercises following anterior cruciate ligament reconstruction (ACLR) due to the belief that increased strain on the graft could cause damage. Objectives To determine whether OKC quadriceps exercises result in differences in anterior tibial laxity, strength, function, quality of life, or adverse events in the ACLR population, when compared to closed-kinetic-chain (CKC) quadriceps exercises. Methods Seven electronic databases (MEDLINE, Embase, AMED, CINAHL, SPORTDiscus, PEDro, and the Cochrane Central Register of Controlled Trials) were searched through April 2017. A systematic review with meta-analysis was conducted on randomized controlled trials comparing OKC versus CKC exercises following ACLR. Outcomes of interest were tibial laxity, strength, and function. A methodological quality assessment of the included studies was completed, and the results were synthesized using meta-analysis and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results Ten studies were included in the review. The meta-analysis demonstrated low- to moderate-quality evidence of no between-group differences in anterior tibial laxity, strength, or patient-reported function at any time point. Meta-analysis was unable to be performed for functional outcomes. Conclusion There was limited to moderate-quality evidence of no difference in anterior tibial laxity, strength, patient-reported function, or physical function with early or late introduction of OKC exercises in the ACLR population, when compared to CKC exercises, at all follow-up time points. Level of Evidence Therapy, level 1a. J Orthop Sports Phys Ther 2018;48(7):552-566. Epub 23 Apr 2018. doi:10.2519/jospt.2018.7656.
Topics: Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament Reconstruction; Exercise Test; Exercise Therapy; Humans; Joint Instability; Muscle Strength; Quality of Life; Tibia
PubMed: 29685058
DOI: 10.2519/jospt.2018.7656 -
Sports Health 2022Only 55% of the athletes return to competitive sports after an anterior cruciate ligament (ACL) injury. Athletes younger than 25 years who return to sports have a second...
CONTEXT
Only 55% of the athletes return to competitive sports after an anterior cruciate ligament (ACL) injury. Athletes younger than 25 years who return to sports have a second injury rate of 23%. There may be a mismatch between rehabilitation contents and the demands an athlete faces after returning to sports. Current return-to-sports (RTS) tests utilize closed and predictable motor skills; however, demands on the field are different. Neurocognitive functions are essential to manage dynamic sport situations and may fluctuate after peripheral injuries. Most RTS and rehabilitation paradigms appear to lack this aspect, which might be linked to increased risk of second injury.
OBJECTIVE
This systematic and scoping review aims to map existing evidence about neurocognitive and neurophysiological functions in athletes, which could be linked to ACL injury in an integrated fashion and bring an extensive perspective to assessment and rehabilitation approaches.
DATA SOURCES
PubMed and Cochrane databases were searched to identify relevant studies published between 2005 and 2020 using the keywords , , , , , , , and .
STUDY SELECTION
Studies investigating either neurocognitive or neurophysiological functions in athletes and linking these to ACL injury regardless of their design and technique were included.
STUDY DESIGN
Systematic review.
LEVEL OF EVIDENCE
Level 3.
DATA EXTRACTION
The demographic, temporal, neurological, and behavioral data revealing possible injury-related aspects were extracted and summarized.
RESULTS
A total of 16 studies were included in this review. Deficits in different neurocognitive domains and changes in neurophysiological functions could be a predisposing risk factor for, or a consequence caused by, ACL injuries.
CONCLUSION
Clinicians should view ACL injuries not only as a musculoskeletal but also as a neural lesion with neurocognitive and neurophysiological aspects. Rehabilitation and RTS paradigms should consider these changes for assessment and interventions after injury.
Topics: Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament Reconstruction; Athletes; Humans; Reinjuries; Return to Sport
PubMed: 34236003
DOI: 10.1177/19417381211029265 -
Clinical Rehabilitation Jan 2017To evaluate the effectiveness of pre-operative exercise physiotherapy rehabilitation on the outcomes of treatment following anterior cruciate ligament injury. (Review)
Review
OBJECTIVE
To evaluate the effectiveness of pre-operative exercise physiotherapy rehabilitation on the outcomes of treatment following anterior cruciate ligament injury.
METHODS
The following databases were searched: PubMed, Ovid, The Cochrane Library and Web of Science. Studies published between the inception of the databases and December 2015 were sought using appropriate keywords in various combinations. This search was supplemented with a manual search of the references of selected studies. Studies were assessed for methodological quality using the Physiotherapy Evidence Database scale.
RESULTS
A total of 500 studies were identified, of which eight studies met the inclusion criteria and were included in the present review. The average Physiotherapy Evidence Database score for the studies included was 5.8, which reflects an overall moderate methodological quality. The eight studies investigated a total of 451 subjects of which 71% ( n=319) were males. The age of the participants in the eight studies ranged from 15 to 57 years. The duration of the intervention in the studies ranged from 3 to 24 weeks. This review found that pre-operative physiotherapy rehabilitation is effective for improving the outcomes of treatment following anterior cruciate ligament injury, including increasing knee-related function and improving muscle strength. However, whilst there was a significant improvement in quality of life from baseline following intervention, no significant difference in quality of life was found between the control and intervention groups.
CONCLUSIONS
There is evidence to suggest that pre-operative physiotherapy rehabilitation is beneficial to patients with anterior cruciate ligament injury.
Topics: Adolescent; Adult; Anterior Cruciate Ligament Injuries; Exercise Therapy; Female; Humans; Male; Middle Aged; Preoperative Care; Treatment Outcome; Young Adult
PubMed: 26879746
DOI: 10.1177/0269215516628617 -
BMC Musculoskeletal Disorders Apr 2022The incidence of anterior cruciate ligament (ACL) injuries represents a large burden of knee injuries in both the general and sporting populations, often requiring...
BACKGROUND
The incidence of anterior cruciate ligament (ACL) injuries represents a large burden of knee injuries in both the general and sporting populations, often requiring surgical intervention. Although there is much research on complete ACL tears including outcomes and indications for surgery, little is known about the short- and long-term outcomes of non-operative, physiotherapy led intervention in partial ACL tears. The primary aim of this study was to evaluate studies looking at the effectiveness of physiotherapy led interventions in improving pain and function in young and middle-aged adults with partial ACL tears. Additionally, the secondary aim was to evaluate the completeness of exercise prescription in randomised trials for physiotherapy led interventions in the management in partial ACL tears.
METHODS
A comprehensive and systematic search was performed on six databases (Medline, CINAHL, EMBASE, PEDro, Scopus, SPORTDiscus and Cochrane). The search strategy consisted of two main concepts: (i) partial ACL tears, and (ii) non-operative management. 7,587 papers were identified by the search. After screening of eligible articles by two independent reviewers, 2 randomised studies were included for analysis. The same two reviewers assessed the completeness of reporting using the Toigio and Boutellier mechanobiological exercise descriptions and Template for Intervention Description and Replication (TIDieR) checklist. Group mean standard deviations (SD) for the main outcomes was extracted from both papers for analysis. Prospero Registration Number: CRD42020179892.
RESULTS
The search strategy identified two studies; one looking at Tai Chi and the other Pilates. The analysis indicated that Tai Chi was significant in reducing pain scores and both Tai Chi and Pilates were found to increase Muscle Peak Torque Strength (MPTS) at 180 degrees. Furthermore, Tai Chi showed a significant increase in proprioception.
CONCLUSIONS
Physiotherapy led interventions such as Pilates, and Tai Chi may improve pain, proprioception and strength in young and middle-aged adults with partial ACL tears, however full scale, high-quality randomised studies are required with long term outcomes recorded.
Topics: Adult; Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament Reconstruction; Exercise Movement Techniques; Humans; Middle Aged; Pain; Physical Therapy Modalities; Proprioception; Randomized Controlled Trials as Topic; Tai Ji; Treatment Outcome
PubMed: 35395764
DOI: 10.1186/s12891-022-05278-w -
Surgery Jun 2023We conducted a systematic review of randomized clinical trials on treating low anterior resection syndrome to help inform current practice. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
We conducted a systematic review of randomized clinical trials on treating low anterior resection syndrome to help inform current practice.
METHODS
This Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic review of randomized clinical trials involved different treatments for low anterior resection syndrome. The risk of bias 2 tool was used to assess the risk of bias. The main outcomes were improvement in low anterior resection syndrome after treatment assessed by change in low anterior resection syndrome, fecal incontinence scores, and adverse treatment effects.
RESULTS
After an initial screening of 1,286 studies, 7 randomized clinical trials were included. Sample sizes ranged between 12 to 104 patients. Posterior tibial nerve stimulation was the most frequently assessed treatment in 3 randomized clinical trials. The weighted mean difference between posterior tibial nerve stimulation and medical treatment or sham therapy in follow-up low anterior resection syndrome score (-3.31, P = .157) was insignificant. Transanal irrigation reduced major low anterior resection syndrome symptoms by 61.5% compared with 28.6% after posterior tibial nerve stimulation with a significantly lower 6-month follow-up low anterior resection syndrome score. Pelvic floor training achieved better improvement in low anterior resection syndrome than standard care (47.8% vs 21.3%) at 6 months, but this was not maintained at 12 months (40.0% vs 34.9%). Ramosetron was associated with a greater short-term improvement in major low anterior resection syndrome (23% vs 8%) and a lower low anterior resection syndrome score (29.5 vs 34.6) at 4-weeks follow-up than Kegels or Sitz baths. No significant improvement in bowel function was noted after probiotics use as probiotics and placebo had similar follow-up low anterior resection syndrome scores (33.3 vs 36).
CONCLUSION
Transanal irrigation was associated with improvement in low anterior resection syndrome according to 2 trials, and ramosetron showed promising short-term results in one trial. Posterior tibial nerve stimulation had a marginal benefit compared with standard care. In contrast, pelvic floor training was associated with short-term symptomatic improvement, and probiotics showed no tangible improvement in low anterior resection syndrome symptoms. Firm conclusions cannot be drawn due to the small number of trials published.
Topics: Humans; Low Anterior Resection Syndrome; Postoperative Complications; Rectal Neoplasms; Randomized Controlled Trials as Topic
PubMed: 37012144
DOI: 10.1016/j.surg.2023.02.010 -
British Journal of Sports Medicine Sep 2019To describe the criteria used to clear athletes to return to sport (RTS) following primary ACL reconstruction.
OBJECTIVE
To describe the criteria used to clear athletes to return to sport (RTS) following primary ACL reconstruction.
DESIGN
Scoping review.
DATA SOURCES
MEDLINE, Embase, CINAHL and SPORTDiscus electronic databases were searched using keywords related to ACL and RTS.
ELIGIBILITY CRITERIA
Prospective or retrospective studies reporting at least one RTS criterion for athletes who had primary ACL reconstruction with an autograft.
RESULTS
In total, 209 studies fulfilled the inclusion criteria. RTS criteria were categorised into six domains: time, strength, hop testing, clinical examination, patient-report and performance-based criteria. From the 209 included studies, time was used in 178 studies (85%), and in 88 studies (42%) was the sole RTS criterion. Strength tests were reported in 86 studies (41%). Sixteen different hop tests were used in 31 studies (15%). Clinical examination was used in 54 studies (26%), patient report in 26 studies (12%) and performance-based criteria in 41 studies (20%).
SUMMARY
Time and impairment-based measures dominated RTS criteria, despite sport being a complex physical and biopsychosocial activity with demands across all aspects of function. Time was included as a criterion in 85% of studies, and over 80% of studies allowed RTS before 9 months. Whether RTS tests are valid-do they predict successful RTS?-is largely unknown.
Topics: Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament Reconstruction; Athletic Injuries; Athletic Performance; Exercise Test; Humans; Muscle Strength; Patient Reported Outcome Measures; Recovery of Function; Return to Sport; Time Factors; Transplantation, Autologous
PubMed: 30712009
DOI: 10.1136/bjsports-2018-099982 -
Journal of Esthetic and Restorative... Jun 2022To assess and evaluate the collum angle (CA) of the anterior teeth of the permanent dentition. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To assess and evaluate the collum angle (CA) of the anterior teeth of the permanent dentition.
METHODS
A search in seven databases for articles that had measured the CA in sagittal malocclusions was conducted until November 30, 2021. The risk of bias was assessed using the Modified Newcastle Ottawa scale. CA measurements using Cone Beam Computed Tomography or lateral cephalograms were included. The CA data were summarized by random-effects inverse generic meta-analyses.
RESULTS
Qualitative analysis of the 17 selected articles revealed that four were rated as "very good," 12 as "good" and 1 as "satisfactory." CA was 4.7° (95% CI of 3.1 to 6.4) and 2.0° (95% CI of 0.1 to 3.9) greater in Class II division 2 and Class III malocclusions respectively, than in Class I malocclusion cases.
CONCLUSION
Majority of the studies were rated as good or very good. Most studies evaluated the CA of the maxillary central incisors in Class II division 2 malocclusion. Studies assessing other maxillary anterior and mandibular anterior teeth are required.
CLINICAL SIGNIFICANCE
Practice of esthetic dentistry for teeth with increased CA is of clinical importance since the angle would determine the longevity and esthetic/cosmetic success of the rehabilitation. Placement of dental implants in areas of missing teeth with increased collum angle leads to excessive stress between the fixture and abutment leading to gingival recession. Thus, knowledge about the collum angle of anterior teeth and its variations in sagittal malocclusions would enable precise treatment planning in the field of esthetic dentistry.
Topics: Cone-Beam Computed Tomography; Humans; Incisor; Malocclusion; Malocclusion, Angle Class II; Malocclusion, Angle Class III; Maxilla
PubMed: 35156761
DOI: 10.1111/jerd.12886