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International Journal of Sports... Aug 2018With the increasing number of individuals participating in sports every year, injury - specifically anterior cruciate ligament (ACL) injury - remains an inherent risk...
BACKGROUND
With the increasing number of individuals participating in sports every year, injury - specifically anterior cruciate ligament (ACL) injury - remains an inherent risk factor for participants. The majority of ACL injuries occur from a non-contact mechanism, and there is a high physical and financial burden associated with injury. Understanding the risk factors for ACL injury may aid in the development of prevention efforts.
PURPOSE
The purpose of this review was to synthesize and appraise existing literature for risk factors associated with non-contact anterior cruciate ligament (ACL) injury in both sexes.
STUDY DESIGN
Systematic review.
METHODS
An electronic literature search was conducted utilizing the MEDLINE database and The Cochrane library for articles available through February 2016. All titles and abstracts were reviewed and full text articles meeting eligibility criteria were assessed in detail to determine inclusion or exclusion. Articles reviewed in full text were reviewed for scientific evidence of risk factors for ACL injury. Results from studies were extracted and initially classified as either intrinsic or extrinsic risk factors, and then further categorized based upon the evidence presented in the studies meeting inclusion criteria. Data extracted from eligible studies included general study characteristics (study design, sample characteristics), methodology, and results for risk factors included.
RESULTS
Principal findings of this systematic review identified the following risk factors for ACL injury in both sexes: degrading weather conditions, decreased intercondylar notch index or width, increased lateral or posterior tibial plateau slope, decreased core and hip strength, and potential genetic influence.
CONCLUSIONS
Neuromuscular and biomechanical risk factors may be addressed through neuromuscular preventative training programs. Though some extrinsic and other inherent physiological factors tend to be non-modifiable, attempts to improve upon those modifiable factors may lead to a decreased incidence of ACL injury.
LEVEL OF EVIDENCE
2a.
PubMed: 30140551
DOI: No ID Found -
Sports Medicine (Auckland, N.Z.) May 2022The anterior cruciate ligament (ACL) plays a major role in knee proprioception and is thus responsible for maintaining knee joint stability and functionality. The... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The anterior cruciate ligament (ACL) plays a major role in knee proprioception and is thus responsible for maintaining knee joint stability and functionality. The available evidence suggests that ACL reconstruction diminishes somatosensory feedback and proprioceptive functioning, which are vital for adequate joint positioning and movement control.
OBJECTIVE
The aim of this systematic review and meta-analysis was to investigate the effect of an ACL rupture on knee proprioception after arthroscopic ACL repair surgery or conservative treatment.
METHODS
A systematic review with meta-analysis was conducted according to the Preferred Reporting Guidelines for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The literature search was performed in the following databases from inception to 10th October 2020: PubMed, Web of Science, SPORTDiscus, Cochrane Library and Scopus. Randomized and non-randomized studies that evaluated proprioception using the joint position sense (JPS) and threshold to detection of passive motion (TTDPM) techniques at 15°-30° knee flexion with an external healthy control group in a time period between 6 and 24 months post injury or operation were included in the analysis.
RESULTS
In total, 4857 studies were identified, from which 11 were included in the final quantitative analysis. The results demonstrated that proprioception after arthroscopic ACL repair surgery was significantly lower than in the healthy control group (JPS: standardized mean difference [SMD] 0.57, 95% confidence interval [CI] 0.27-0.87, p < 0.01, n = 6 studies; TTDPM: SMD 0.77, 95% CI 0.20-1.34, p < 0.01, n = 4 studies). There were no significant differences in proprioception between the conservative treatment group and the healthy control group (JPS: SMD 0.57, 95% CI - 0.69 to 1.84, p = 0.37, n = 4 studies; TTDPM: SMD 0.82, 95% CI - 0.02 to 1.65, p = 0.05, n = 2 studies), although measures for TTDPM were close to statistical significance.
CONCLUSION
The findings of the present systematic review and meta-analysis revealed that knee proprioception is persistently compromised 6-24 months following surgical treatment of ACL tears compared with healthy controls. The reduced kinesthetic awareness after ACL surgery is of high relevance for optimizing individual treatment plans in these patients. As the current literature is still scarce about the exact underlying mechanisms, further research is needed.
TRIAL REGISTRATION
The present systematic review was registered in PROSPERO (CRD42021198617).
Topics: Anterior Cruciate Ligament; Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament Reconstruction; Humans; Knee Joint; Proprioception
PubMed: 34854058
DOI: 10.1007/s40279-021-01600-z -
British Journal of Sports Medicine Jul 2015Recurrent instability following a first-time anterior traumatic shoulder dislocation may exceed 26%. We systematically reviewed risk factors which predispose this... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Recurrent instability following a first-time anterior traumatic shoulder dislocation may exceed 26%. We systematically reviewed risk factors which predispose this population to events of recurrence.
METHODS
A systematic review of studies published before 1 July 2014. Risk factors which predispose recurrence following a first-time traumatic anterior shoulder dislocation were documented and rates of recurrence were compared. Pooled ORs were analysed using random-effects meta-analysis.
RESULTS
Ten studies comprising 1324 participants met the criteria for inclusion. Recurrent instability following a first-time traumatic anterior shoulder dislocation was 39%. Increased risk of recurrent instability was reported in people aged 40 years and under (OR=13.46), in men (OR=3.18) and in people with hyperlaxity (OR=2.68). Decreased risk of recurrent instability was reported in people with a greater tuberosity fracture (OR=0.13). The rate of recurrent instability decreased as time from the initial dislocation increased. Other factors such as a bony Bankart lesion, nerve palsy and occupation influenced rates of recurrent instability.
CONCLUSIONS
Sex, age at initial dislocation, time from initial dislocation, hyperlaxity and greater tuberosity fractures were key risk factors in at least two good quality cohort studies resulting in strong evidence as concluded in the GRADE criteria. Although bony Bankart lesions, Hill Sachs lesions, occupation, physiotherapy treatment and nerve palsy were risk factors for recurrent instability, the evidence was weak using the GRADE criteria-these findings relied on poorer quality studies or were inconsistent among studies.
Topics: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Disease Susceptibility; Female; Humans; Joint Instability; Male; Middle Aged; Recurrence; Risk Factors; Sex Factors; Shoulder Dislocation; Young Adult
PubMed: 25900943
DOI: 10.1136/bjsports-2014-094342 -
Sports Health 2023The risk factors for anterior cruciate ligament (ACL) tear for athletes participating in pivoting sports includes young age and female sex. A previous meta-analysis has... (Meta-Analysis)
Meta-Analysis Review
CONTEXT
The risk factors for anterior cruciate ligament (ACL) tear for athletes participating in pivoting sports includes young age and female sex. A previous meta-analysis has reported a reinjury rate of 15% after ACL reconstruction (ACLR) for athletes across all sports. To the best of the authors' knowledge, this is the first systematic review and meta-analysis of available literature reporting outcomes after ACLR in soccer players.
OBJECTIVE
To review and aggregate soccer-specific outcomes data after ACLR found in current literature to help guide a more tailored discussion regarding expectations and prognosis for soccer players seeking operative management of ACL injuries.
DATA SOURCES
A comprehensive search of publications was performed using PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and SPORTDiscus databases.
STUDY SELECTION
Inclusion criteria consisted of original studies, level of evidence 1 to 4, studies reporting clinical and patient-reported outcomes (PROs) after primary ACLR in soccer players at all follow-up length.
STUDY DESIGN
The primary outcomes of interest were graft failure/reoperation rates, ACL injury in contralateral knee, return to soccer time, and PROs.
LEVEL OF EVIDENCE
Level 4.
DATA EXTRACTION
Search of literature yielded 32 studies for inclusion that involved 3112 soccer players after ACLR.
RESULTS
The overall graft failure/reoperation rate ranged between 3.0% and 24.8% (mean follow-up range, 2.3-10 years) and the combined ACL graft failure and contralateral ACL injury rate after initial ACLR was 1.0% to 16.7% (mean follow-up range, 3-10 years); a subgroup analysis for female and male players revealed a secondary ACL injury incidence rate of 27%, 95% CI (22%, 32%) and 10%, 95% CI (6%, 15%), respectively. Soccer players were able to return to play between 6.1 and 11.1 months and the majority of PROs showed favorable scores at medium-term follow-up.
CONCLUSION
Soccer players experience high ACL injury rates after primary ACLR and demonstrated similar reinjury rates as found in previous literature of athletes who participate in high-demand pivoting sports.
Topics: Humans; Male; Female; Soccer; Anterior Cruciate Ligament Injuries; Reinjuries; Knee Joint; Return to Sport
PubMed: 36988238
DOI: 10.1177/19417381231160167 -
PloS One 2023Eumenorrheic women experience cyclic variations in sex hormones attributed to the menstrual cycle (MC) which can impact anterior cruciate ligament (ACL) properties, knee...
Effects of the menstrual cycle phase on anterior cruciate ligament neuromuscular and biomechanical injury risk surrogates in eumenorrheic and naturally menstruating women: A systematic review.
BACKGROUND
Eumenorrheic women experience cyclic variations in sex hormones attributed to the menstrual cycle (MC) which can impact anterior cruciate ligament (ACL) properties, knee laxity, and neuromuscular function. This systematic review aimed to examine the effects of the MC on ACL neuromuscular and biomechanical injury risk surrogates during dynamic tasks, to establish whether a particular MC phase predisposes women to greater ACL injury risk.
METHODS
PubMed, Medline, SPORTDiscus, and Web of Science were searched (May-July 2021) for studies that investigated the effects of the MC on ACL neuromuscular and biomechanical injury risk surrogates. Inclusion criteria were: 1) injury-free women (18-40 years); 2) verified MC phases via biochemical analysis and/or ovulation kits; 3) examined neuromuscular and/or biomechanical injury risk surrogates during dynamic tasks; 4) compared ≥1 outcome measure across ≥2 defined MC phases.
RESULTS
Seven of 418 articles were included. Four studies reported no significant differences in ACL injury risk surrogates between MC phases. Two studies showed evidence the mid-luteal phase may predispose women to greater risk of non-contact ACL injury. Three studies reported knee laxity fluctuated across the MC; two of which demonstrated MC attributed changes in knee laxity were associated with changes in knee joint loading (KJL). Study quality (Modified Downs and Black Checklist score: 7-9) and quality of evidence were low to very low (Grading of Recommendations Assessment Development and Evaluation: very low).
CONCLUSION
It is inconclusive whether a particular MC phase predisposes women to greater non-contact ACL injury risk based on neuromuscular and biomechanical surrogates. Practitioners should be cautious manipulating their physical preparation, injury mitigation, and screening practises based on current evidence. Although variable (i.e., magnitude and direction), MC attributed changes in knee laxity were associated with changes in potentially hazardous KJLs. Monitoring knee laxity could therefore be a viable strategy to infer possible ACL injury risk.
Topics: Humans; Female; Anterior Cruciate Ligament; Anterior Cruciate Ligament Injuries; Menstruation; Joint Instability; Knee Joint; Menstrual Cycle; Biomechanical Phenomena
PubMed: 36701354
DOI: 10.1371/journal.pone.0280800 -
British Journal of Sports Medicine Jan 2018The primary objective was to calculate the rate of return to sport (RTS) following anterior cruciate ligament (ACL) reconstruction in elite athletes. Secondary... (Meta-Analysis)
Meta-Analysis Review
Eighty-three per cent of elite athletes return to preinjury sport after anterior cruciate ligament reconstruction: a systematic review with meta-analysis of return to sport rates, graft rupture rates and performance outcomes.
OBJECTIVES
The primary objective was to calculate the rate of return to sport (RTS) following anterior cruciate ligament (ACL) reconstruction in elite athletes. Secondary objectives were to estimate the time taken to RTS, calculate rates of ACL graft rupture, evaluate postsurgical athletic performance and identify determinants of RTS.
DESIGN
Pooled RTS and graft rupture rates were calculated using random effects proportion meta-analysis. Time to RTS, performance data and determinants of RTS were synthesised descriptively.
DATA SOURCES
MEDLINE, EMBASE, AMED, CINAHL, AMI, PEDro, SPORTDiscus and The Cochrane Library were searched from inception to 19 January 2016. Hand searching of 10 sports medicine journals and reference checking were also performed.
ELIGIBILITY CRITERIA FOR SELECTING STUDIES
Studies were included if they reported the ratio of elite athletes who returned to their preinjury level of sport following ACL reconstruction. Twenty-four studies were included.
RESULTS
The pooled RTS rate was 83% (95% CI 77% to 88%). The mean time to RTS ranged from 6 to 13 months. The pooled graft rupture rate was 5.2% (95% CI 2.8% to 8.3%). Six out of nine studies that included a noninjured control group found no significant deterioration in athletic performance following ACL reconstruction. Indicators of greater athletic skill or value to the team were associated with RTS.
SUMMARY AND CONCLUSIONS
Eighty-three per cent of elite athletes returned to sport following ACL reconstruction, while 5.2% sustained a graft rupture. Most athletes who returned to sport performed comparably with matched, uninjured controls. This information may assist in guiding expectations of athletes and clinicians following ACL reconstruction.
Topics: Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament Reconstruction; Athletes; Athletic Performance; Humans; Recovery of Function; Return to Sport; Rupture
PubMed: 28223305
DOI: 10.1136/bjsports-2016-096836 -
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 -
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 -
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 -
Orthopaedic Journal of Sports Medicine May 2019Variables affecting return to sport after anterior cruciate ligament reconstruction (ACLR) are multifactorial. The nonphysical factors germane to successful return to... (Review)
Review
BACKGROUND
Variables affecting return to sport after anterior cruciate ligament reconstruction (ACLR) are multifactorial. The nonphysical factors germane to successful return to play (RTP) are being increasingly recognized.
PURPOSE
To (1) evaluate the available evidence base for psychological factors relating to RTP after ACLR, (2) identify psychological factors affecting RTP after ACLR, and (3) understand currently available metrics used to assess psychological RTP readiness.
STUDY DESIGN
Systematic review; Level of evidence, 4.
METHODS
A review of the MEDLINE database was performed for studies reporting RTP after ACLR. Studies reporting on the psychological determinants of RTP were included. Demographic, methodological, and psychometric properties of the included studies were extracted. Weighted analysis was performed after patients were pooled across included studies.
RESULTS
Of 999 studies identified in the initial search, 28 (2.8%) studies, comprising 2918 patients, were included; 19 studies (n = 2175 patients) reported RTP rates. The mean time for RTP was 17.2 months. There was a 63.4% rate of RTP, and 36.6% of patients returning to sport were not able to perform at their prior level of play. Of the 795 patients who did not achieve RTP, 514 (64.7%) cited a psychological reason for not returning. Fear of reinjury was the most common reason (n = 394; 76.7%); other psychological factors included lack of confidence in the treated knee (n = 76; 14.8%), depression (n = 29; 5.6%), and lack of interest/motivation (n = 13; 2.5%). The Tampa Scale for Kinesiophobia, the Hospital Anxiety and Depression Scale, the ACL-Return to Sport after Injury scale, and the Knee Self-Efficacy Scale were reported measures for assessing the influence of psychology on RTP.
CONCLUSION
Psychological factors play an important role in RTP after ACLR. Among studies evaluating the impact of psychology on RTP, there was a delay in returning as well as lower RTP rates compared with the previously reported normative literature. Fear of reinjury was the most commonly reported impediment to RTP. The psychosocial measures identified in this review may have a role in RTP protocols for assessing mental resiliency; however, their roles need to be further investigated and validated in patients who have undergone ACLR.
PubMed: 31205965
DOI: 10.1177/2325967119845313