-
British Journal of Sports Medicine May 2023This guideline was developed to inform clinical practice on rehabilitation after anterior cruciate ligament reconstruction (ACLR) and was performed in accordance with...
This guideline was developed to inform clinical practice on rehabilitation after anterior cruciate ligament reconstruction (ACLR) and was performed in accordance with the Appraisal of Guidelines for REsearch & Evaluation II (AGREE II) instrument and used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. A Guideline Development Group systematically searched and reviewed evidence using randomised clinical trials and systematic reviews to evaluate the effectiveness of rehabilitation interventions and guide clinicians and patients on the content of the optimal rehabilitation protocol after ACLR.The guideline targets patients during rehabilitation after ACLR and investigates the effectiveness of the available interventions to the physiotherapist, alone or in combination (eg, exercise, modalities, objective progression criteria). Exercise interventions should be considered the mainstay of ACLR rehabilitation. However, there is little evidence on the dose-response relationship between volume and/or intensity of exercise and outcomes. Physical therapy modalities can be helpful as an adjunct in the early phase of rehabilitation when pain, swelling and limitations in range of motion are present. Adding modalities in the early phase may allow earlier pain-free commencement of exercise rehabilitation. Return to running and return to training/activity are key milestones for rehabilitation after ACLR. However, there is no evidence on which progression or discharge criteria should be used.While there is a very low level of certainty for most components of rehabilitation, most of the recommendations provided in this guideline were agreed to by expert clinicians. This guideline also highlights several new elements of ACLR management not reported previously.
Topics: Humans; Anterior Cruciate Ligament Injuries; Exercise Therapy; Physical Therapy Modalities; Exercise; Anterior Cruciate Ligament Reconstruction
PubMed: 36731908
DOI: 10.1136/bjsports-2022-106158 -
International Journal of Environmental... Apr 2021Anterior cruciate ligament (ACL) injuries are the most common ligament injury of the knee, accounting for between 100,000 and 200,000 injuries among athletes per year.... (Review)
Review
Anterior cruciate ligament (ACL) injuries are the most common ligament injury of the knee, accounting for between 100,000 and 200,000 injuries among athletes per year. ACL injuries occur via contact and non-contact mechanisms, with the former being more common in males and the later being more common in females. These injuries typically require surgical repair and have relatively high re-rupture rates, resulting in a significant psychological burden for these individuals and long rehabilitation times. Numerous studies have attempted to determine risk factors for ACL rupture, including hormonal, biomechanical, and sport- and gender-specific factors. However, the incidence of ACL injuries continues to rise. Therefore, we performed a systematic review analyzing both ACL injury video analysis studies and studies on athletes who were pre-screened with eventual ACL injury. We investigated biomechanical mechanisms contributing to ACL injury and considered male and female differences. Factors such as hip angle and strength, knee movement, trunk stability, and ankle motion were considered to give a comprehensive, joint by joint analysis of injury risk and possible roles of prevention. Our review demonstrated that poor core stability, landing with heel strike, weak hip abduction strength, and increased knee valgus may contribute to increased ACL injury risk in young athletes.
Topics: Anterior Cruciate Ligament; Anterior Cruciate Ligament Injuries; Athletes; Biomechanical Phenomena; Female; Humans; Knee Joint; Male
PubMed: 33917488
DOI: 10.3390/ijerph18073826 -
Journal of Conservative Dentistry : JCD 2021This study investigated the clinical longevity of direct anterior composite restorations. Clinical studies exploring survival of anterior light-cured composite... (Review)
Review
This study investigated the clinical longevity of direct anterior composite restorations. Clinical studies exploring survival of anterior light-cured composite restorations with minimum of 2 years of follow-up were screened and reasons related to failure of direct anterior composite restorations were noted. PubMed, LILIACS, ProQuest, CENTRAL, and MEDLINE databases were searched with no restriction on date. Articles obtainable in the English language solely were enclosed during this study. Furthermore, articles to which reviewers had access were solely enclosed in ProQuest. Reference lists of eligible studies were hand searched. Initially, four reviewers screened the titles/abstracts of 947 studies. Out of those studies, a total of 47 articles were selected for full text reading, from which 25 studies were selected for qualitative synthesis. The studies that were enclosed evaluated the clinical performance of composite class III and class IV restorations (11 studies), which were placed due to caries, fracture, or replaced old restorations, veneers and full coverage restorations placed for esthetic reasons (9 studies), restorations in worn teeth (4 studies) with one study including combination of three type of studies listed above. A total of 75,637 restorations were evaluated and annual failure rates were in the range of 0% to 27.11% with survival rates ranging from 28.6% to 100%. Class III restorations had lower failure rates than alternative restorations. Fracture was the main cause of failure of restorations. The factors related to failure of restoration were adhesive technique, type of composite resin used, replacement of restoration first placed, and time required to make up the restorations.
PubMed: 35399771
DOI: 10.4103/jcd.jcd_527_21 -
International Journal of Environmental... Nov 2022Despite the restoration of the mechanical stability of the knee joint after ACL reconstruction (ACLR), patients often experience postoperative limitations. To our... (Review)
Review
Despite the restoration of the mechanical stability of the knee joint after ACL reconstruction (ACLR), patients often experience postoperative limitations. To our knowledge, there are no systematic reviews analyzing additional physiotherapy interventions implementing standard rehabilitation programs in the early postoperative phase after ACLR. The objective of this study was to analyze the additional physiotherapy interventions implemented in standard rehabilitation programs that improve early-stage ACLR rehabilitation. For this systematic review, we followed the PRISMA guidelines. In March 2022 we conducted a literature review using electronic databases. Primary outcomes were pain, edema, muscle strength, ROM, and knee function. The risk of bias and scientific quality of included studies were assessed with the RoB 2, ROBINS-I and PEDro scale. For the review, we included 10 studies that met the inclusion criteria (total = 3271). The included studies evaluated the effectiveness of Kinesio Taping, Whole-body vibration, Local Vibration Training, Trigger Point Dry Needling, High Tone Power Therapy, alternating magnetic field, and App-Based Active Muscle Training Program. Most of the additional physiotherapy interventions improved pain, edema, ROM, knee muscle strength, or knee function in early-stage postoperative ACL rehabilitation. Except for one study, no adverse events occurred in the included studies, which demonstrates the safety of the discussed physiotherapy interventions. Further in-depth research is needed in this area.
Topics: Humans; Anterior Cruciate Ligament Reconstruction; Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament; Knee Joint; Pain
PubMed: 36497965
DOI: 10.3390/ijerph192315893 -
Journal of Sport and Health Science May 2023For the past 30 years, the hamstring (H)-to-quadriceps (Q) (H:Q) torque ratio has been considered an important index of muscle strength imbalance around the knee joint.... (Review)
Review
BACKGROUND
For the past 30 years, the hamstring (H)-to-quadriceps (Q) (H:Q) torque ratio has been considered an important index of muscle strength imbalance around the knee joint. The purpose of this systematic review was to examine the value of H:Q torque ratio as an independent risk factor for hamstring and anterior cruciate ligament (ACL) injuries.
METHODS
Database searches were performed to identify all relevant articles in PubMed, MEDLINE, Cochrane Library, and Scopus. Prospective studies evaluating the conventional (concentric H:Q), functional (eccentric H: concentric Q), and mixed (eccentric H at 30°/s: concentric Q at 240°/s) H:Q ratios as risk factors for occurrence of hamstring muscle strain or ACL injury were considered. Risk of bias was assessed using the Quality In Prognosis Studies tool.
RESULTS
Eighteen included studies reported 585 hamstrings injuries in 2945 participants, and 5 studies documented 128 ACL injuries in 2772 participants. Best evidence synthesis analysis indicated that there is very limited evidence that H:Q strength ratio is an independent risk factor for hamstring and ACL injury, and this was not different between various ratio types. Methodological limitations and limited evidence for ACL injuries and some ratio types might have influenced these results.
CONCLUSION
The H:Q ratio has limited value for the prediction of ACL and hamstring injuries. Monitoring strength imbalances along with other modifiable factors during the entire competitive season may provide a better understanding of the association between H:Q ratio and injury.
Topics: Humans; Anterior Cruciate Ligament; Hamstring Muscles; Anterior Cruciate Ligament Injuries; Muscle, Skeletal; Torque; Prospective Studies; Leg Injuries
PubMed: 35065297
DOI: 10.1016/j.jshs.2022.01.002 -
International Journal of Sports... Dec 2020The gluteus medius (GMed) and gluteus minimus (GMin) muscle segments demonstrate different responses to pathology and ageing, hence it is important in rehabilitation...
BACKGROUND
The gluteus medius (GMed) and gluteus minimus (GMin) muscle segments demonstrate different responses to pathology and ageing, hence it is important in rehabilitation that prescribed therapeutic exercises can effectively target the individual segments with adequate exercise intensity for strengthening.
PURPOSE
The purpose of this systematic review was to evaluate whether common therapeutic exercises generate at least high ( > 40% maximum voluntary isometric contraction (MVIC)) electromyographic (EMG) activity in the GMed (anterior, middle and posterior) and GMin (anterior and posterior) segments.
METHODS
Seven databases (MEDLINE, EMBASE, CINAHL, AusSPORT, PEDro, SPORTdiscus and Cochrane Library) were searched from inception to May 2018 for terms relating to gluteal muscle, exercise, and EMG. The search yielded 6918 records with 56 suitable for inclusion. Quality assessment, data extraction and data analysis were then undertaken with exercise data pooled into a meta-analysis where two or more studies were available for an exercise and muscle segment.
RESULTS
For the GMed, different variations of the hip hitch/ pelvic drop exercise generated at least high activity in all segments. The dip test, and isometric standing hip abduction are other options to target the anterior GMed segment, while isometric standing hip abduction can be used for the posterior GMed segment. For the middle GMed segment, the single leg bridge; side-lying hip abduction with hip internal rotation; lateral step-up; standing hip abduction on stance or swing leg with added resistance; and resisted side-step were the best options for generating at least high activity. Standing isometric hip abduction and different variations of the hip hitch/ pelvic drop exercise generated at least high activity in all GMin segments, while side-lying hip abduction, the dip test, single leg bridge and single leg squat can also be used for targeting the posterior GMin segment.
CONCLUSION
The findings from this review provide the clinician with confidence in exercise prescription for targeting individual GMed and GMin segments for potential strengthening following injury or ageing.
LEVEL OF EVIDENCE
Level 1.
WHAT IS KNOWN ABOUT THE SUBJECT
Previous reviews on GMed exercises have been based on single electrode, surface EMG measures at middle GMed segment. It is not known whether these exercises effectively target the other segments of GMed or the GMin at a sufficient intensity for strengthening.
WHAT THIS STUDY ADDS TO EXISTING KNOWLEDGE
This review provides the clinician with confidence in exercise prescription of common therapeutic exercises to effectively target individual GMed and GMin segments for potential strengthening.
PubMed: 33344003
DOI: 10.26603/ijspt20200856 -
British Journal of Sports Medicine Nov 2022Compare the effectiveness of primarily surgical versus primarily rehabilitative management for anterior cruciate ligament (ACL) rupture. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Compare the effectiveness of primarily surgical versus primarily rehabilitative management for anterior cruciate ligament (ACL) rupture.
DESIGN
Living systematic review and meta-analysis.
DATA SOURCES
Six databases, six trial registries and prior systematic reviews. Forward and backward citation tracking was employed.
ELIGIBILITY CRITERIA
Randomised controlled trials that compared primary reconstructive surgery and primary rehabilitative treatment with or without optional reconstructive surgery.
DATA SYNTHESIS
Bayesian random effects meta-analysis with empirical priors for the OR and standardised mean difference and 95% credible intervals (CrI), Cochrane RoB2, and the Grading of Recommendations Assessment, Development and Evaluation approach to judge the certainty of evidence.
RESULTS
Of 9514 records, 9 reports of three studies (320 participants in total) were included. No clinically important differences were observed at any follow-up for self-reported knee function (low to very low certainty of evidence). For radiological knee osteoarthritis, we found no effect at very low certainty of evidence in the long term (OR (95% CrI): 1.45 (0.30 to 5.17), two studies). Meniscal damage showed no effect at low certainty of evidence (OR: 0.85 (95% CI 0.45 to 1.62); one study) in the long term. No differences were observed between treatments for any other secondary outcome. Three ongoing randomised controlled trials were identified.
CONCLUSIONS
There is low to very low certainty of evidence that primary rehabilitation with optional surgical reconstruction results in similar outcome measures as early surgical reconstruction for ACL rupture. The findings challenge a historical paradigm that anatomic instability should be addressed with primary surgical stabilisation to provide optimal outcomes.
PROSPERO REGISTRATION NUMBER
CRD42021256537.
Topics: Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament Reconstruction; Bayes Theorem; Humans; Knee Joint; Osteoarthritis, Knee
PubMed: 36038357
DOI: 10.1136/bjsports-2021-105359 -
PloS One 2020Systematic review.
STUDY DESIGN
Systematic review.
BACKGROUND AND OBJECTIVES
Preoperative neuromuscular function is predictive for knee function and return to sports (RTS) after reconstruction of the anterior cruciate ligament (ACL). The aim of this review was to examine the potential benefits of prehabilitation on pre-/postoperative objective, self-reported and RTS-specific outcomes.
METHODS
A systematic search was conducted within three databases. From the 1.071 studies screened, two randomized control trials (RCTs), two control trials (CTs) and two cohort studies (CS) met the inclusion criteria. Methodological quality rating adopted the PEDro- (RCT, CT) or Newcastle-Ottawa-Scale (CS).
RESULTS AND CONCLUSIONS
Methodological quality of the included studies was moderate (PEDro score: 6.5 ± 1.7; range 4 to 9). Two studies reported higher increases of the maximal quadriceps torque from baseline to pre-reconstruction: one study in the limb symmetry index (LSI), and one in both legs of the prehabilitation group compared to the controls. At 12-weeks post-reconstruction, one study (from two) indicated that the prehabilitation group had a lesser post-operative decline in the single-leg-hop for distance LSI (clinically meaningful). Similar findings were found in terms of quadriceps strength LSI (one study). At both pre-reconstruction (three studies) and two-year post-surgery (two studies), the prehabilitation groups reached significantly higher self-reported knee function (clinically meaningful) than the controls. RTS tended to be faster (one study). At two years post-surgery, RTS rates (one study) were higher in the prehabilitation groups. The results provide evidence for the relevance of prehabilitation prior to ACL-reconstruction to improve neuromuscular and self-reported knee function as well as RTS. More high quality confirmatory RCTs are warranted.
REGISTRATION NUMBER
PROSPERO 2017: CRD42017065491.
Topics: Anterior Cruciate Ligament; Anterior Cruciate Ligament Injuries; Clinical Trials as Topic; Female; Humans; Male; Postoperative Complications; Preoperative Period; Plastic Surgery Procedures; Recovery of Function; Return to Sport
PubMed: 33112865
DOI: 10.1371/journal.pone.0240192 -
Journal of Spine Surgery (Hong Kong) Mar 2020The anterior approach to the cervical spine is commonly utilized for a variety of degenerative, traumatic, neoplastic, and infectious indications. While many potential... (Review)
Review
The anterior approach to the cervical spine is commonly utilized for a variety of degenerative, traumatic, neoplastic, and infectious indications. While many potential complications overlap with those of the posterior approach, the distinct anatomy of the anterior neck also presents a unique set of hazards. We performed a systematic review of the literature to assess the etiology, presentation, natural history, and management of these complications. Following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), a PubMed search was conducted to evaluate clinical studies and case reports of patients who suffered a complication of anterior cervical spine surgery. The search specifically included articles concerning adult human subjects, written in the English language, and published from 1989 to 2019. The PubMed search yielded 240 articles meeting our criteria. The overall rates of complications were as follows: dysphagia 5.3%, esophageal perforation 0.2%, recurrent laryngeal nerve palsy 1.3%, infection 1.2%, adjacent segment disease 8.1%, pseudarthrosis 2.0%, graft or hardware failure 2.1%, cerebrospinal fluid leak 0.5%, hematoma 1.0%, Horner syndrome 0.4%, C5 palsy 3.0%, vertebral artery injury 0.4%, and new or worsening neurological deficit 0.5%. Morbidity rates in anterior cervical spine surgery are low. Nevertheless, the unique anatomy of the anterior neck presents a wide variety of potential complications involving vascular, aerodigestive, neural, and osseous structures.
PubMed: 32309668
DOI: 10.21037/jss.2020.01.14 -
International Journal of Environmental... Jun 2022This systematic review and meta-analysis compared the isokinetic strength of the muscular knee joint between quadriceps tendon autografts (QTAs) and hamstring tendon... (Meta-Analysis)
Meta-Analysis Review
A Systematic Review and Meta-Analysis of Strength Recovery Measured by Isokinetic Dynamometer Technology after Anterior Cruciate Ligament Reconstruction Using Quadriceps Tendon Autografts vs. Hamstring Tendon Autografts or Patellar Tendon Autografts.
BACKGROUND
This systematic review and meta-analysis compared the isokinetic strength of the muscular knee joint between quadriceps tendon autografts (QTAs) and hamstring tendon autografts (HTAs) or patellar tendon autografts (PTAs) after anterior cruciate ligament (ACL) reconstruction by determining the isokinetic angular velocity and follow-up time points. The functional outcomes and knee stability at the same time points were also compared using isokinetic technology.
METHODS
Two independent reviewers searched the Medline (via PubMed search engine), Scopus, Web of Science and Cochrane Library databases to include full text comparative studies that assessed isokinetic strength test following ACL reconstruction. The DerSimonian and Laird method was used.
RESULTS
In total, ten studies were included; seven compared studies QTAs vs. HTAs, and three compared QTAs vs. PTAs. Five studies were included in the meta-analysis. Isokinetic strength data were reported 3, 6, 12 and 24 months after ACL reconstruction.
CONCLUSIONS
The QTAs showed better and significant results with knee flexion compared with HTAs, similar results to PTAs at 6 and 12 months. While HTAs showed better and significant results with knee extension at 6 months and similar results at 12 months compared to QTAs. Furthermore, a standardized isokinetic strength test must be followed to achieve a more specific conclusion and better clinical comparison among participants.
Topics: Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament Reconstruction; Autografts; Hamstring Tendons; Humans; Patellar Ligament; Technology; Tendons
PubMed: 35682357
DOI: 10.3390/ijerph19116764