Background: Patient-reported outcomes and return-to-play (RTP) rates are inferior after revision anterior cruciate ligament reconstruction (ACLR) compared with primary ACLR. Physical properties such as maximal, explosive, and reactive strength influence reinjury and RTP rates after ACLR. No study has compared these outcomes between revision and primary ACLR. Purpose: To compare maximal, explosive, and reactive strength of the ACLR limb, as well as patient-reported outcomes and RTP rates between primary and revision ACLR at 9 months after surgery. Study Design: Cohort study; Level of evidence, 2. Methods: A comparative study was performed at 9 months after surgery for 344 male athletes who had undergone ACLR (298 primary, 46 revision). Maximal strength of the ACLR limb was measured by means of isokinetic dynamometry. Explosive strength was measured by use of single-leg countermovement jump height, and reactive strength was measured by single-leg drop jump. Patient-reported outcomes and responses to RTP questionnaires were recorded for both groups. Results: The primary ACLR group had higher scores than the revision ACLR group for single-leg countermovement jump height ( P = .02) and single-leg drop jump reactive strength index ( P = .01) on the ACLR limb. No significant difference was observed between groups on maximal strength of the quadriceps or hamstring, and no significant difference in limb symmetry index was observed between groups on any strength or jump test. The primary ACLR group demonstrated higher scores on the Marx Activity Rating Scale ( P = .03) and the Anterior Cruciate Ligament–Return to Sport after Injury scale ( P < .001). Athletes in the primary ACLR group were more likely to have returned to sport ( P < .001). Conclusion: At 9 months after surgery, athletes who had undergone revision ACLR achieved maximal strength similar to that of athletes who had undergone primary ACLR. However, athletes who had revision ACLR demonstrated lower scores on explosive and reactive strength tests. Athletes who underwent revision ACLR had lower RTP rates at 9 months after surgery, potentially due to explosive and reactive strength deficits and lower perceived readiness for RTP.
ObjectivesComplex regional pain syndrome (CRPS) is a persistent pain condition which is often misunderstood and poorly managed. Qualitative studies are needed to explore the lived experience of the condition and to better understand patient perspectives on their management experiences and needs. The aim of this study was to explore the lived experience of CRPS in Australia, including exploration of their perceptions of care and advice received from healthcare professionals.MethodsA qualitative study with individual in-depth semi-structured, face-to-face interviews was performed (n=15, 80% female, average time elapsed since diagnosis 3.8 years). Qualitative data were analysed using an inductive thematic analysis approach.ResultsFour main themes with associated subthemes were identified, representing the participants’ journey: (1) Life Changing Impact of CRPS (Subthemes: Impact on self, Impact on others); (2) Variable Experiences of Care (Subthemes: Helpful experiences of care, Unhelpful experiences of care); (3) Making Sense of CRPS (Subthemes: Knowledge and understanding, Dealing with unpredictability); and (4) Perceptions on Lessons Learned from Living with CRPS (Subthemes: Acceptance was an important part of the journey, Trial and error was necessary to find an individual way forward, Coping strategies).ConclusionsThe themes identified align to and expand on prior qualitative research findings in people with CRPS. It highlights the challenges people face related to their personal self, their close relationships and their social and work roles. It highlights the difficulties these people have in finding reliable, trust-worthy information. These findings suggest that healthcare professionals may benefit from education about how to better support people with CRPS, including helping people to navigate to the right care. Engaging people with CRPS in the development of educational resources should be a future research goal. It is recommended that patient perspectives are incorporated into the development of care pathways for CRPS.
Objective Hip and groin pain is highly prevalent in sub‐elite Gaelic Athletic Association (GAA) athletes, but its prevalence at the elite level is unknown. The aims of this study were to report hip and groin pain prevalence in elite male athletes, to report changes in Copenhagen Hip and Groin Outcome Score (HAGOS) across two seasons and to assess if previous hip and groin pain or pre‐season HAGOS could predict future hip and groin pain. Methods During the 2017 and 2018 pre‐season male Gaelic Players Association (GPA) playing members were invited to complete two questionnaires. The first questionnaire collected demographic information including age, GAA code played (Gaelic football or Hurling) and prevalence of hip and groin pain in the previous season. The second questionnaire was the HAGOS. Step‐wise logistic regression models were fitted to HAGOS subscales, to examine if pre‐season HAGOS subscale scores could predict future hip and groin pain. Results The prevalence of hip and groin pain across the elite GAA cohort was 38%. Hip and groin pain in the previous season was the strongest predictor of future hip and groin pain (r2=0.19, AUC=0.73, 95% CI 1.76–2.27) whereas pre‐season HAGOS subscale scores had limited and no additional predictive ability (AUC 0.05–0.18). Conclusions Hip and groin pain prevalence is high in elite male GAA, with one in three athletes reporting pain. Previous season hip and groin pain is the strongest predictor of future hip and groin pain, while pre‐season HAGOS scores have limited ability to predict future hip and groin pain.
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