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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 -
Sports Medicine (Auckland, N.Z.) Feb 2021Neuromuscular deficits are common following knee injuries and may contribute to early-onset post-traumatic osteoarthritis, likely mediated through quadriceps dysfunction. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Neuromuscular deficits are common following knee injuries and may contribute to early-onset post-traumatic osteoarthritis, likely mediated through quadriceps dysfunction.
OBJECTIVE
To identify how peri-articular neuromuscular function changes over time after knee injury and surgery.
DESIGN
Systematic review with meta-analyses.
DATA SOURCES
PubMed, Web of Science, Embase, Scopus, CENTRAL (Trials).
ELIGIBILITY CRITERIA FOR SELECTING STUDIES
Moderate and high-quality studies comparing neuromuscular function of muscles crossing the knee joint between a knee-injured population (ligamentous, meniscal, osteochondral lesions) and healthy controls. Outcomes included normalized isokinetic strength, muscle size, voluntary activation, cortical and spinal-reflex excitability, and other torque related outcomes.
RESULTS
A total of 46 studies of anterior cruciate ligament (ACL) and five of meniscal injury were included. For ACL injury, strength and voluntary activation deficits were evident (moderate to strong evidence). Cortical excitability was not affected at < 6 months (moderate evidence) but decreased at 24+ months (moderate evidence). Spinal-reflex excitability did not change at < 6 months (moderate evidence) but increased at 24+ months (strong evidence). We also found deficits in torque variability, rate of torque development, and electromechanical delay (very limited to moderate evidence). For meniscus injury, strength deficits were evident only in the short-term. No studies reported gastrocnemius, soleus or popliteus muscle outcomes for either injury. No studies were found for other ligamentous or chondral injuries.
CONCLUSIONS
Neuromuscular deficits persist for years post-injury/surgery, though the majority of evidence is from ACL injured populations. Muscle strength deficits are accompanied by neural alterations and changes in control and timing of muscle force, but more studies are needed to fill the evidence gaps we have identified. Better characterisation and therapeutic strategies addressing these deficits could improve rehabilitation outcomes, and potentially prevent PTOA.
TRIAL REGISTRATION NUMBER
PROSPERO CRD42019141850.
Topics: Anterior Cruciate Ligament; Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament Reconstruction; Humans; Knee Injuries; Knee Joint; Muscle Strength
PubMed: 33247378
DOI: 10.1007/s40279-020-01386-6 -
Orthopaedic Journal of Sports Medicine Dec 2020Anterior cruciate ligament (ACL) tears are debilitating injuries frequently suffered by athletes. ACL reconstruction is indicated to restore knee stability and allow...
BACKGROUND
Anterior cruciate ligament (ACL) tears are debilitating injuries frequently suffered by athletes. ACL reconstruction is indicated to restore knee stability and allow patients to return to prior levels of athletic performance. While existing literature suggests that patient-reported outcomes are similar between bone-patellar tendon-bone (BTB) and hamstring tendon (HT) autografts, there is less information comparing return-to-sport (RTS) rates between the 2 graft types.
PURPOSE
To compare RTS rates among athletes undergoing primary ACL reconstruction using a BTB versus HT autograft.
STUDY DESIGN
Systematic review; Level of evidence, 4.
METHODS
The MEDLINE, Embase, and Cochrane Library databases were searched, and studies that reported on RTS after primary ACL reconstruction using a BTB or HT autograft were included. Studies that utilized ACL repair techniques, quadriceps tendon autografts, graft augmentation, double-bundle autografts, allografts, or revision ACL reconstruction were excluded. RTS information was extracted and analyzed from all included studies.
RESULTS
Included in the review were 20 articles investigating a total of 2348 athletes. The overall RTS rate in our cohort was 73.2%, with 48.9% returning to preinjury levels of performance and a rerupture rate of 2.4%. The overall RTS rate in patients after primary ACL reconstruction with a BTB autograft was 81.0%, with 50.0% of athletes returning to preinjury levels of performance and a rerupture rate of 2.2%. Patients after primary ACL reconstruction with an HT autograft had an overall RTS rate of 70.6%, with 48.5% of athletes returning to preinjury levels of performance and a rerupture rate of 2.5%.
CONCLUSION
ACL reconstruction using BTB autografts demonstrated higher overall RTS rates when compared with HT autografts. However, BTB and HT autografts had similar rates of return to preinjury levels of performance and rerupture rates. Less than half of the athletes were able to return to preinjury sport levels after ACL reconstruction with either an HT or BTB autograft.
PubMed: 33403206
DOI: 10.1177/2325967120964919 -
Sports Health 2020Anterior cruciate ligament (ACL) reconstruction (ACLR) is frequently performed in patients younger than 20 years whose goal is to return to sport (RTS). Varying reinjury...
CONTEXT
Anterior cruciate ligament (ACL) reconstruction (ACLR) is frequently performed in patients younger than 20 years whose goal is to return to sport (RTS). Varying reinjury rates have been reported, and the factors responsible are unclear. Studies differ with regard to age, graft type, surgical techniques, postoperative rehabilitation, RTS guidelines, and methods used to determine ACL failures.
OBJECTIVE
To determine RTS rates; the effect of participation in high-risk sports, sex, and graft type on ACL reinjury rates; and whether objective test criteria before RTS correlate with lower reinjury rates.
DATA SOURCES
A systematic review of the literature from inception to May 31, 2019, was conducted using the PubMed and Cochrane databases.
STUDY SELECTION
Studies on transphyseal ACLR in athletes <20 years old with a minimum mean follow-up of 2 years that reported reinjury rates, the number that RTS, and detailed the type of sport were included.
STUDY DESIGN
Systematic review.
LEVEL OF EVIDENCE
Level 4.
RESULTS
A total of 1239 patients in 8 studies were included; 87% returned to sport and 80% resumed high-risk activities. Of the patients, 18% reinjured the ACL graft and/or the contralateral ACL. Nine percent of patellar tendon autografts and 15% of hamstring autografts failed (odds ratio [OR], 0.52; = 0.002). Of reinjuries, 90% occurred during high-risk sports. Male patients had a significantly higher rate of ACL graft failure than female patients (OR, 1.64; = 0.01). There was no sex-based effect on contralateral ACL injuries. Only 1 study cited objective criteria for RTS.
CONCLUSION
A high percentage of athletes returned to sport, but 1 in 5 suffered reinjuries to either knee. Male patients were more likely to reinjure the ACL graft. Objective criteria for RTS were rarely mentioned or not detailed. The need for testing of knee stability, strength, neuromuscular control, agility, and psychological measures before RTS remains paramount in young athletes.
Topics: Adolescent; Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament Reconstruction; Autografts; Child; Exercise Test; Hamstring Tendons; Humans; Patellar Ligament; Recurrence; Return to Sport; Risk Factors; Sex Factors; Young Adult
PubMed: 32374646
DOI: 10.1177/1941738120912846 -
Orthopaedic Journal of Sports Medicine May 2023The open Latarjet (OL) procedure and arthroscopic Latarjet (AL) procedure are able to treat recurrent anterior shoulder instability (RASI) with high success rates.
BACKGROUND
The open Latarjet (OL) procedure and arthroscopic Latarjet (AL) procedure are able to treat recurrent anterior shoulder instability (RASI) with high success rates.
PURPOSE
To evaluate the clinical efficacy and postoperative revisions and complications between the OL and AL procedures in the treatment of RASI.
STUDY DESIGN
Systematic review; Level of evidence, 3.
METHODS
MEDLINE, Embase, and the Cochrane Library were searched to retrieve and include cohort studies comparing the OL and AL procedures for RASI. Clinical outcomes were compared, and results were reported as odds ratios (ORs) or mean differences (MDs) with 95% CIs.
RESULTS
Eleven clinical trials with 1217 patients were included. There were no differences between the procedures in pain score, Rowe score, Walch-Duplay score, external rotation, persistent apprehension, instability, recurrence, revisions attributed to recurrent instability, overall complications, wound infection, hematoma, graft complications, screw-related complications, or osteoarthritis. When compared with the OL procedure, the AL procedure had a significantly lower nonunion rate (OR, 9.92; 95% CI, 1.71 to 57.71; = .01); however, the AL procedure had a longer operation time (MD, -24.49; 95% CI, -48.44 to -0.54; = .05), lower Western Ontario Shoulder Instability Index score (MD, 97.27; 95% CI, 21.91 to 172.63; = .01), higher revision rate (OR, 0.39; 95% CI, 0.16 to 0.95; = .04), and greater screw deviation (MD, -6.41; 95% CI, -10.25 to -2.57; = .001).
CONCLUSION
For most outcome measures, no difference was seen between the OL and AL procedures. The AL procedure had a lower Western Ontario Shoulder Instability Index score and a higher revision rate and appeared to have a significant learning curve. However, the AL procedure resulted in a lower nonunion rate.
PubMed: 37346777
DOI: 10.1177/23259671231174476 -
Acta Ortopedica Brasileira 2022This study proposes to systematically review the literature and compare data on (1) function, (2) pain, (3) return to sport, and (4) complications after anterior... (Review)
Review
OBJECTIVE
This study proposes to systematically review the literature and compare data on (1) function, (2) pain, (3) return to sport, and (4) complications after anterior cruciate ligament (ACL) reconstruction with quadriceps tendon autograft (QT) and hamstring tendon autograft (HT).
METHODS
In June 2021, a systematic review of the EMBASE, MEDLINE/PubMed, Cochrane Central Register of Controlled Trials, and LILACS databases was performed, based on PRISMA guidelines. The search strategy included the keywords: "Previous Cruciate Ligament Reconstruction," "ACL reconstruction," "quadriceps tendon autograft," "quadriceps graft," "Hamstring-Tendon Autografts." Meta-analyses were performed using Review Manager software (RevMan Web).
RESULTS
There were no significant differences between the two groups regarding function according to Lysholm score (MD 3.01; CI-0.30, 6.33, p = 0.08), the presence of pain (RR 0.89; CI-0.57, 1.39, p = 0.60), and re-rupture (RR 0.60; IC-0.19, 1.88, p = 0.38).
CONCLUSION
QT and HT autografts show comparatively good results in ACL reconstruction without significant differences regarding function, pain, and rupture after surgical intervention.
PubMed: 36561474
DOI: 10.1590/1413-785220223006e256048 -
Orthopaedic Journal of Sports Medicine Oct 2023Identifying risk factors for an infection after anterior cruciate ligament reconstruction (ACLR) and following targeted preventive strategies can effectively reduce this... (Review)
Review
BACKGROUND
Identifying risk factors for an infection after anterior cruciate ligament reconstruction (ACLR) and following targeted preventive strategies can effectively reduce this potentially serious complication.
PURPOSE
To perform a systematic review and meta-analysis to identify the risk factors for an infection after ACLR.
STUDY DESIGN
Systematic review; Level of evidence, 4.
METHODS
The PubMed, Embase, and Web of Science databases were searched from inception to September 1, 2022, for prospective and retrospective studies investigating risk factors for any type of infection after ACLR. Odds ratios (ORs) or mean differences were calculated for potential risk factors if ≥2 studies assessed the same risk factor. A qualitative analysis of variables was performed if a meta-analysis could not be conducted.
RESULTS
A total of 17 studies with 141,991 patients were included in this review. The overall pooled infection rate was 0.86% (range, 0.24%-5.50%). There were 20 risk factors identified for analysis. Of these, 7 variables independently increased the odds of an infection after ACLR: (1) male sex (OR, 1.90 [95% CI, 1.33-2.73]), (2) diabetes (OR, 2.69 [95% CI, 1.66-4.35]), (3) hamstring tendon autograft (OR, 2.51 [95% CI, 2.03-3.10]), (4) revision ACLR (OR, 2.31 [95% CI, 1.22-4.37]), (5) professional athlete status (OR, 6.21 [95% CI, 1.03-37.38]), (6) lateral tenodesis (OR, 3.45 [95% CI, 1.63-7.28]), and (7) corticosteroid use (OR, 7.83 [95% CI, 3.68-16.63]). No significant associations were found between postoperative infections and age, body mass index, smoking, meniscal repair, or outpatient surgery.
CONCLUSION
This review revealed that an increased risk of infections after ACLR was associated with male sex, diabetes, hamstring tendon autograft, revision surgery, professional athlete status, lateral tenodesis, and steroid use. Knowledge of the risk factors associated with an infection after ACLR may facilitate the identification of high-risk cases and the implementation of preventive measures to mitigate the serious consequences of this complication.
PubMed: 37846316
DOI: 10.1177/23259671231200822 -
Cerebrovascular Diseases (Basel,... 2023Extensive randomized controlled clinical trials for endovascular thrombectomy in anterior circulation large vessel occlusions (internal carotid arteries and M1 segment... (Review)
Review
BACKGROUND
Extensive randomized controlled clinical trials for endovascular thrombectomy in anterior circulation large vessel occlusions (internal carotid arteries and M1 segment of middle cerebral arteries) have been published over the past decade, but there have not been randomized controlled trials for distal arterial occlusions to date. Distal arterial occlusion randomized controlled trials are essential to decide on patient selection, imaging criteria, and endovascular approach to improve the outcome and reduce complications.
SUMMARY
The definition of distal arterial occlusion is however unclear, and we believe that a uniform nomenclature of distal arterial occlusions is essential for the design of robust randomized controlled studies. We undertook a systematic literature review and comprehensive analysis of 70 articles looking at distal arterial occlusions and previous attempts at classifying them as well as comparing their similarities and differences with a more selective look at the middle cerebral artery. Thirty-two articles were finally deemed suitable and included for this review. In this review article, we present 3 disparate classifications of distal arterial occlusions, namely, classical/anatomical, functional/imaging, and structural/calibre, and compare the similarities and differences between them.
KEY MESSAGES
We propose the adoption of functional/imaging classification to guide the identification of distal arterial occlusions with the M2 segment starting at the point of bifurcation of the middle cerebral artery trunk/M1 segment. With regards to the anterior temporal artery, we propose that it will be considered a branch of the M1 and only be considered as the M2 segment if it is a holo-temporal artery. We believe that this is a practical method of classification in the time-critical decision-making period.
Topics: Humans; Stroke; Treatment Outcome; Endovascular Procedures; Arterial Occlusive Diseases; Infarction, Middle Cerebral Artery; Thrombectomy; Retrospective Studies
PubMed: 36423598
DOI: 10.1159/000526873