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Arthroscopic MAT in professional soccer players allowed a return to play at the same level (Tegner score of 10) in 75% of the cases at 36-month follow-up.

Background:Rehabilitation of soccer players after anterior cruciate ligament reconstruction is usually performed without sport-specific guidelines, and the final phases are often left to the team coaches. The possibility of changing this approach has not yet been investigated.Study Design:Case series.Hypothesis:A specific rehabilitation protocol for soccer players, with direct control of the last on-field rehabilitation phases, may lead to complete functional recovery.Methods:Fifty competitive soccer players who followed a sport-specific rehabilitation protocol for soccer were evaluated during the recovery period until their return to competition. The assessment of the functional outcomes was performed using the Knee Outcome Survey–Sports Activity Scale and isokinetic and aerobic fitness tests.Results:The average start of on-field rehabilitation was 90 ± 26 days after surgery; the average time to return to the competitions was 185 ± 52 days. The improvement in the Knee Outcome Survey–Sports Activity Scale during on-field rehabilitation was significant (P < 0.01; from 79 ± 15% to 96 ± 7%). The isokinetic and aerobic fitness tests showed a significant improvement of muscle strength (knee extensors, +55%, P < 0.01; knee flexors, +86%, P < 0.01) and aerobic threshold (+23%, P < 0.01) from the beginning to the end of on-field rehabilitation.Conclusions:Adding on-field rehabilitation to the traditional protocols after anterior cruciate ligament reconstruction may safely lead to complete functional recovery in soccer players.

Study Design: Case report. Background: To present the rehabilitative course, decision-making, and clinical milestones that allowed a top-level professional soccer player to return to full competitive activity 90 days after surgery. Case Description: The patient was a 35-year-old forward player who sustained an isolated complete tear of the left anterior cruciate ligament (ACL) in the midst of the competitive 2001-2002 season. He was in contention for a position on the Italian World Cup Team that was to be played 135 days after his injury, only if he demonstrated that he could return to play at the highest level before the team was selected. The patient underwent an arthroscopically assisted ACL reconstruction with a double-loop semitendinosus-gracilis autograft 4 days after the injury. Eight days after surgery he began rehabilitation at a rate of 2 sessions a day, 5 days a week, plus 1 session every Saturday morning. These sessions were performed in a pool for aquatic exercises, in a gymnasium for flexibility, coordination, and strength exercises, and on a soccer field for recovery of technical and tactical skills, with continuous monitoring of training intensity. Outcomes: The surgical technique and the progressive rehabilitation program allowed the patient to play for 20 minutes in an official First Division soccer game 77 days after surgery and to play a full game 90 days after surgery. Eighteen months postsurgery, the player had participated in 62 First Division matches, scoring 26 times, and had received no further treatment for his knee. Discussion: This case report suggests that early return to high-level competition after ACL reconstruction is possible in some instances. Some factors that may have favored the early return include optimal physical fitness before surgery, a strong psychological determination, an isolated ACL lesion, a properly placed and tensioned graft, a personalized progression of volume and intensity of exercise loads, and an appropriate density of rehabilitative training consisting of a mix of gymnasium, pool, and field exercises. J Orthop Sport Phys Ther 2005;35:52-66.

After ACL reconstruction, accelerated rehabilitation allows professional soccer players to return to official matches within 4-6 months of surgery, but in many cases accelerated rehabilitation is impossible. This retrospective study investigated the variables that affect the time to return to competition of professional soccer players after ACL reconstruction. Between October and December 2002, a questionnaire designed for this study was administered to the players competing in the Italian First Division (Series A) who previously reported an ACL reconstruction. Among 479 players surveyed, we identified 38 cases of arthroscopic ACL reconstruction (8%). The mean time to return to competition was 232±135 days from surgery (range, 76-791). In 12 cases (31.6%; group A), there was an isolated ACL rupture and these players returned to competition within 163±44 days after surgery (range, 76-231). Twenty cases were associated with one or more lesions (52.6%; group B), and these players returned to competition within 203±56 days after surgery (range, 146-329). Six cases reported complications after surgery or during rehabilitation (infections, swelling; 15.8%; group C) and returned to competition within 456±203 days after surgery (range, 233-791; p<0.001compared to groups A and B). In this study, a fast (<4 months) return to competition was achieved only in three cases of isolated ACL rupture (8%). Accelerated rehabilitation (<6 months) seems to be possible only in cases of isolated ACL reconstruction or when only the medial meniscus is involved as an associated lesion. The time to return to competition after ACL reconstruction was independent of the surgical technique used and must be considered the consequence of the complexity of the injury to the knee.

Lesions of the quadriceps muscle (QM) are frequently seen by sonographers, and in most cases they are the result of sports-related trauma. An accurate assessment of the severity of the lesion is essential, particularly when the patient is a professional athlete. In most cases, careful history-taking and a thorough physical examination are sufficient for making the diagnosis and indicating the most suitable imaging studies for each case. Clinical assessment alone, however, may not be sufficient for distinguishing contusions from small, partial tears or for estimating the size of a tear. Therefore, at least in patients who are professional athletes, imaging studies are necessary to plan appropriate therapy that will allow prompt functional recovery.Muscles cannot be visualized with conventional radiography, but it is used routinely in prepubertal patients because it can detect apophyseal detachments, which are the most frequent muscle lesion in this age group. Radiography is also useful when myositis ossificans is suspected. Magnetic resonance imaging, thanks to its excellent tissue contrast, allows simultaneous assessment of muscle, joint, and bone planes. It remains a second-line study due to its high cost and relatively low availability. It is also associated with various contraindications, the most important of which is the presence of a cardiac pacemaker. Ultrasonography has a number of advantages, including widespread availability, absence of contraindications, and low cost. It can also be used for dynamic studies of the muscle during contraction and relaxation, and if doubts arise, scans can easily be obtained of the contralateral muscle for comparison purposes. These qualities make it an excellent tool for follow-up of patients with QM lesions, when follow-up is necessary. This article reviews the anatomy of the QM, the technique used for standard ultrasound examination of this muscle, its normal appearance on ultrasound, and the sonographic characteristics of the most common traumatic lesions that affect it.Sommario Le lesioni del muscolo quadricipite (MQ) sono frequenti nella pratica ecografica quotidiana e, nella gran maggioranza dei casi, sono secondarie a traumi, per lo più sportivi. Un'accurata valutazione della gravità delle lesioni è necessaria, in particolare quando siano coinvolti sportivi di alto livello. * Corresponding author. CIM SA, Route de Malagnou 40a,

Background: Anterior cruciate ligament (ACL) injuries represent a significant burden to rugby players. Improving our understanding of the patterns and biomechanics that result in ACL injury may aid in the design of effective prevention programs. Purpose: To describe, using video analysis, the mechanisms, situational patterns, and biomechanics of ACL injuries in professional rugby matches. Further aims were to document injuries according to pitch location and timing within the match. Study Design: Case series; Level of evidence, 4. Methods: A total of 62 ACL injuries were identified in players of the 4 most important rugby leagues across 4 consecutive seasons. We analyzed 57 (92%) injury videos for injury mechanism and situational patterns; biomechanical analysis was performed on indirect and noncontact ACL injuries only (38 cases available). Three reviewers independently evaluated each video. Results: More injuries occurred while attacking than defending (41 [72%] vs 16 [28%]; P < .01). Regarding mechanism, 18 (32%) injuries were direct contact; 15 (26%), indirect contact; and 24 (42%), noncontact. Most direct contact injuries involved being tackled directly to the knee (n = 10). Three situational patterns were identified for players who had a noncontact or indirect contact injury: offensive change of direction (COD) (n = 18), being tackled (n = 10), and pressing/tackling (n = 8). Injuries generally involved a knee-loading strategy in the sagittal plane, which was accompanied by knee valgus loading in most cases (94%). Overall, 73% of injuries occurred during the first 40 minutes of effective playing time. Conclusion: Most ACL injuries in professional male rugby players happened through a noncontact or indirect contact mechanism (68%). Three situational patterns were described, including offensive change of direction, being tackled, and pressing/tackling. Biomechanical analysis confirmed a multiplanar mechanism, with a knee-loading pattern in the sagittal plane accompanied by dynamic valgus. As most injuries occurred in the first 40 minutes, accumulated fatigue appears not to be a major risk factor for ACL injury.

It is important to optimise the functional recovery process in order to enhance patient outcomes after major injury such as anterior cruciate ligament reconstruction (ACLR). This requires in part more high-quality original research, but also an approach to translate existing research into practice to overcome the research to implementation barriers. This includes research on ACLR athletes, but also research on other pathologies, which with some modification can be valuable to the ACLR patient. One important consideration after ACLR is the recovery of hamstring muscle function, particularly when using ipsilateral hamstring autograft. Deficits in knee flexor strength after ACLR are associated with increased risk of knee osteoarthritis, altered gait and sport-type movement quality, and elevated risk of re-injury upon return to sport. After ACLR and the early post-operative period, there are often considerable deficits in hamstring function which need to be overcome as part of the functional recovery process. To achieve this requires consideration of many factors including the types of strength to recover (e.g., maximal and explosive, multiplanar not just uniplanar), specific programming principles (e.g., periodised resistance programme) and exercise selection. There is a need to know how to train the hamstrings, but also apply this to the ACLR athlete. In this paper, the authors discuss the deficits in hamstring function after ACLR, the considerations on how to restore these deficits and align this information to the ACLR functional recovery process, providing recommendation on how to recover hamstring function after ACLR. Key Points• A knee flexor strength deficit after ACL reconstruction is a strong risk factor for ACL re-injury • Overcoming deficits in hamstring function after ACL reconstruction is essential for optimal outcomes, satisfactory return to sport and re-injury risk reduction • Most of the information concerning the hamstrings is devoted to hamstring injury prevention and hamstring muscle injury rehabilitation, with a lack of information on hamstring rehabilitation after ACL reconstruction • Most training recommendations are focused on un-injured athletes and so needs to be adapted for the injured athlete • Understanding hamstring training considerations and applying this to the ACL reconstruction patient as part of the ACL functional recovery process is essential