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Chiropractic & Manual Therapies Dec 2022Clinicians rely on certain physical examination tests to diagnose and potentially grade ankle sprains and ankle instability. Diagnostic error and inaccurate prognosis...
INTRODUCTION
Clinicians rely on certain physical examination tests to diagnose and potentially grade ankle sprains and ankle instability. Diagnostic error and inaccurate prognosis may have important repercussions for clinical decision-making and patient outcomes. Therefore, it is important to recognize the diagnostic value of orthopaedic tests through understanding the reliability and validity of these tests.
OBJECTIVE
To systematically review and report evidence on the reliability and validity of orthopaedic tests for the diagnosis of ankle sprains and instability.
METHODS
PubMed, CINAHL, Scopus, and Cochrane databases were searched from inception to December 2021. In addition, the reference list of included studies, located systematic reviews, and orthopaedic textbooks were searched. All articles reporting reliability or validity of physical examination or orthopaedic tests to diagnose ankle instability or sprains were included. Methodological quality of the reliability and the validity studies was assessed with The Quality Appraisal for Reliability studies checklist and the Quality Assessment of Diagnostic Accuracy Studies-2 respectively. We identified the number of times the orthopaedic test was investigated and the validity and/or reliability of each test.
RESULTS
Overall, sixteen studies were included. Three studies assessed reliability, eight assessed validity, and five evaluated both. Overall, fifteen tests were evaluated, none demonstrated robust reliability and validity scores. The anterolateral talar palpation test reported the highest diagnostic accuracy. Further, the anterior drawer test, the anterolateral talar palpation, the reverse anterior lateral drawer test, and palpation of the anterior talofibular ligament reported the highest sensitivity. The highest specificity was attributed to the anterior drawer test, the anterolateral drawer test, the reverse anterior lateral drawer test, tenderness on palpation of the proximal fibular, and the squeeze test.
CONCLUSION
Overall, the diagnostic accuracy, reliability, and validity of physical examination tests for the assessment of ankle instability were limited. Physical examination tests should not be used in isolation, but rather in combination with the clinical history to diagnose an ankle sprain. Preliminary evidence suggests that the overall validity of physical examination for the ankle may be better if conducted five days after the injury rather than within 48 h of injury.
Topics: Humans; Ankle; Reproducibility of Results; Ankle Joint; Physical Examination; Joint Instability; Ankle Injuries
PubMed: 36536446
DOI: 10.1186/s12998-022-00470-0 -
British Journal of Sports Medicine Jan 2023The primary aim was to evaluate risk factors for surgical site infections after anterior cruciate ligament reconstruction (ACLR). The secondary aim was to investigate... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
The primary aim was to evaluate risk factors for surgical site infections after anterior cruciate ligament reconstruction (ACLR). The secondary aim was to investigate the surgical site infection incidence rate and the mean time to postoperative surgical site infection symptoms.
DESIGN
Systematic review and meta-analysis.
DATA SOURCES
PubMed, Embase and Web of Science were searched from database inception to September 2021 and updated in April 2022.
ELIGIBILITY CRITERIA
Quantitative, original studies reporting potential risk factors for surgical site infections after ACLR were included.
RESULTS
Twenty-three studies with 3871 infection events from 469 441 ACLRs met the inclusion criteria. Male sex (OR 1.78, p< 0.00001), obesity (OR 1.82, p=0.0005), tobacco use (OR 1.37, p=0.01), diabetes mellitus (OR 3.40, p=0.002), steroid use history (OR 4.80, p<0.00001), previous knee surgery history (OR 3.63, p=0.02), professional athlete (OR 4.56, p=0.02), revision surgery (OR 2.05, p=0.04), hamstring autografts (OR 2.83, p<0.00001), concomitant lateral extra-articular tenodesis (OR 3.92, p=0.0001) and a long operating time (weighted mean difference 8.12, p=0.005) were identified as factors that increased the risk of surgical site infections (superficial and deep) after ACLR. Age, outpatient or inpatient surgery, bone-patellar tendon-bone autografts or allografts and a concomitant meniscus suture did not increase the risk of surgical site infections. The incidence of surgical site infections after ACLR was approximately 1% (95% CI 0.7% to 1.2%). The mean time from surgery to the onset of surgical site infection symptoms was approximately 17.1 days (95% CI 13.2 to 21.0 days).
CONCLUSION
Male sex, obesity, tobacco use, diabetes mellitus, steroid use history, previous knee surgery history, professional athletes, revision surgery, hamstring autografts, concomitant lateral extra-articular tenodesis and a long operation time may increase the risk of surgical site infections after ACLR. Although the risk of surgical site infections after ACLR is low, raising awareness and implementing effective preventions for risk factors are priorities for clinicians to reduce the incidence of surgical site infections due to its seriousness.
Topics: Humans; Male; Surgical Wound Infection; Bone-Patellar Tendon-Bone Grafting; Anterior Cruciate Ligament Reconstruction; Risk Factors; Obesity; Steroids; Anterior Cruciate Ligament Injuries; Knee Joint
PubMed: 36517215
DOI: 10.1136/bjsports-2022-105448 -
Physical Therapy in Sport : Official... Mar 2022to evaluate the effectiveness of preoperative exercise programmes on quadriceps strength prior to and following anterior cruciate ligament (ACL) reconstruction. (Review)
Review
OBJECTIVES
to evaluate the effectiveness of preoperative exercise programmes on quadriceps strength prior to and following anterior cruciate ligament (ACL) reconstruction.
DESIGN
Systematic review.
METHODS
a systematic review was undertaken, included studies were evaluated using the Modified Downs and Black checklist which is appropriate for determining the quality of randomised and non-randomised studies. Scientific databases searched included PubMED, EBSCO Health, CINAHL, Medline, and Cochrane Library databases from inception to March 2021.
RESULTS
Ten studies met the inclusion criteria. There were six randomised studies and four prospective studies. The level of evidence is categorised as 'limited' due to heterogenicity and only six studies reported quadriceps strength increases. Five studies demonstrated preoperative exercise of 4-16 weeks duration can significantly increase preoperative quadriceps strength. One study demonstrated preoperative OKC exercise produced significantly stronger preoperative quadriceps compared to CKC exercise. One study showed no between group (intervention vs control) quadriceps strength difference pre or 12 weeks postoperatively.
CONCLUSIONS
4-16 weeks of preoperative exercise could increase quadriceps strength preoperatively but any persistent postoperative strength benefit from undertaking a standardised preoperative intervention is unclear. There is considerable variation and methodological limitations across the included studies and the composition of optimal preoperative ACLR exercise is currently unknown.
Topics: Anterior Cruciate Ligament; Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament Reconstruction; Humans; Muscle Strength; Preoperative Exercise; Prospective Studies; Quadriceps Muscle
PubMed: 34933208
DOI: 10.1016/j.ptsp.2021.12.004 -
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 -
The American Journal of Sports Medicine Oct 2022The best type of autograft for anterior cruciate ligament (ACL) reconstruction remains debatable. (Meta-Analysis)
Meta-Analysis
Quadriceps Tendon Autograft Versus Bone-Patellar Tendon-Bone and Hamstring Tendon Autografts for Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis.
BACKGROUND
The best type of autograft for anterior cruciate ligament (ACL) reconstruction remains debatable.
HYPOTHESIS
Compared with bone-patellar tendon-bone (BPTB) and hamstring tendon (HT) autografts, the quadriceps tendon (QT) autograft has comparable graft survival as well as clinical function and pain outcomes.
STUDY DESIGN
Meta-analysis; Level of evidence, 4.
METHODS
A systematic literature search was conducted in PubMed, Embase, Scopus, and the Cochrane Library to July 2020. Randomized controlled trials (RCTs) and observational studies reporting comparisons of QT versus BPTB or HT autografts for ACL reconstruction were included. All analyses were stratified according to study design: RCTs or observational studies.
RESULTS
A total of 24 studies were included: 7 RCTs and 17 observational studies. The 7 RCTs included 388 patients, and the 17 observational studies included 19,196 patients. No significant differences in graft failure ( = .36), the International Knee Documentation Committee (IKDC) subjective score ( = .39), or the side-to-side difference in stability ( = .60) were noted between QT and BPTB autografts. However, a significant reduction in donor site morbidity was noted in the QT group compared with the BPTB group (risk ratio [RR], 0.17 [95% CI, 0.09-0.33]; < .001). No significant differences in graft failure ( = .57), the IKDC subjective score ( = .25), or the side-to-side stability difference ( = .98) were noted between QT and HT autografts. However, the QT autograft was associated with a significantly lower rate of donor site morbidity than the HT autograft (RR, 0.60 [95% CI, 0.39-0.93]; = .02). A similar graft failure rate between the QT and control groups was observed after both early and late full weightbearing, after early and late full range of motion, and after using the QT autograft with a bone plug and all soft tissue QT grafts. However, a significantly lower rate of donor site morbidity was observed in the QT group compared with the control group after both early and late full weightbearing, after early and late full range of motion, and after using the QT autograft with a bone plug and all soft tissue QT grafts. No difference in effect estimates was seen between RCTs and observational studies.
CONCLUSION
The QT autograft had comparable graft survival, functional outcomes, and stability outcomes compared with BPTB and HT autografts. However, donor site morbidity was significantly lower with the QT autograft than with BPTB and HT autografts.
Topics: Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament Reconstruction; Autografts; Bone-Patellar Tendon-Bone Grafting; Hamstring Tendons; Humans; Patellar Ligament; Tendons; Transplantation, Autologous
PubMed: 34494906
DOI: 10.1177/03635465211030259 -
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 -
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 -
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 -
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