Functional outcomes and return to sport following anterior cruciate ligament reconstruction in recreational athletes: A systematic review

Brzeszczyński, Filip; Turnbull, Kirsten; McLelland, Colin; MacDonald, Donnie; Lawson, Graham M.; Hamilton, David F.

doi:10.1016/j.knee.2022.04.005

Cited by 12 publications

(12 citation statements)

References 23 publications

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“…Previous research has also shown that returning to higher levels of sports is associated with a greater risk of sustaining a second ACL injury [ 31 ]. In the cohort included in this study, the rate of return to knee-strenuous sports, Tegner level ≥ 6, was 26–31% at 12 months follow-up, which is in line with previous research [ 32 ]. This, in turn, may partly explain the relatively low risk for a second ACL injury in our study, since almost two out of three patients had not yet returned to their pre-injury level of activity after ACL reconstruction.…”

Section: Discussionsupporting

confidence: 89%

A comparison between physical therapy clinics with high and low rehabilitation volumes of patients with ACL reconstruction

Simonsson,

Högberg,

Lindskog

et al. 2023

J Orthop Surg Res

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Background Treatment volume can impact outcomes after surgical procedures of the knee between surgeons with high- and low-patient-volumes. However, the difference between physical therapeutic clinics with high- and low-volumes has not been widely researched. This registry study aims to investigate how patient volume affects knee function outcomes after anterior cruciate ligament (ACL) reconstruction at physical therapy (PT) clinics in terms of odds for a second ACL injury, return to pre-injury level of activity, perceived knee function, and recovery of strength and hop performance. Method Data were extracted from the Project ACL, a local rehabilitation registry. High- and low-volume clinics were defined based on the number of patients who attended different clinics. High-volume clinics were defined as those with > 100 patient registrations in Project ACL during the study period while low-volume clinics were those with ≤ 100 patient registrations. High- and low-volume clinics were compared, based on muscle function and patient-reported outcomes across 4 follow-ups, 2-, 4-, 8-, and 12 months, during the first year after ACL reconstruction, and odds of second ACL injury up to 2 years after ACL reconstruction. Result Of the 115 rehabilitation clinics included, 111 were classified as low-volume clinics and included 733 patients, and 4 as high-volume clinics which included 1221 patients. There were 31 (1.6%) second ACL injuries to the ipsilateral or contralateral side within the first 12 months and 68 (4.0%) within 2 years. No difference in the incidence of a second ACL injury, within 12 months follow-up odds ratio (OR) 0.95 [95% CI 0.46–1.97] or within 2 years follow-up OR 1.13 [95% CI 0.68–1.88], was found between high- and low-volume clinics. There were early (2 months) and non-clinically relevant differences in patient-reported outcomes (PROs) and physical activity levels early after ACL reconstruction in favor of high-volume clinics. One year after ACL reconstruction, no differences were observed between high- and low-volume clinics in terms of PROs, muscle function, and return to pre-injury level of activity. Conclusion No clinically relevant difference in the incidence of secondary ACL injuries in patients who underwent rehabilitation after ACL reconstruction at high- or low-volume physical therapist clinics was found. In addition, no clinically relevant differences in outcomes were found during the first year in terms of patient-reported outcomes, recovery of muscle function, or return to pre-injury level of activity.

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Section: Discussionsupporting

confidence: 89%

A comparison between physical therapy clinics with high and low rehabilitation volumes of patients with ACL reconstruction

Simonsson,

Högberg,

Lindskog

et al. 2023

J Orthop Surg Res

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“…Patients who undergo ACLR present with fewer subsequent meniscal injuries, lower incidence of subsequent surgery and signiicantly improved activity levels compared to patients receiving non-operative management [10] and with approximately 55-59% of patients returning to preoperative level of sport or activity [8].…”

Section: Introductionmentioning

confidence: 99%

“…ACL reconstruction (ACLR) is a common treatment strategy employed to limit long term complications following ACL rupture, which may be offered as a first‐line treatment or following failed non‐operative management [24]. Patients who undergo ACLR present with fewer subsequent meniscal injuries, lower incidence of subsequent surgery and significantly improved activity levels compared to patients receiving non‐operative management [10] and with approximately 55–59% of patients returning to preoperative level of sport or activity [8].…”

Section: Introductionmentioning

confidence: 99%

Persistent knee extension deficits are common after anterior cruciate ligament reconstruction: a systematic review and meta-analysis of randomised controlled trials

Scholes¹,

Ektas²,

Harrison-Brown³

et al. 2023

Knee Surg Sports Traumatol Arthrosc

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PurposeKnee extension deficits complicate recovery from ACL injury and reconstruction; however, the incidence of knee extension loss is not well defined. The aim of this review was to identify the incidence of loss of extension (LOE) following ACL rupture and reconstruction, explore the definitions of knee extension deficits reported and identify prognostic factors affecting LOE incidence. MethodsA systematic search was conducted in Medline, Cochrane Library and PEDro for studies in publication up to November 2021, with no restrictions on publication year. References were screened and assessed for inclusion using predetermined eligibility criteria. Randomised controlled trials (RCTs) that quantified knee angle, loss of extension or incidence of extension deficit were included for quality assessment and data extraction. Statistical summaries were generated and meta‐analyses performed in two parts to examine: (i) the probability of a datapoint being zero incidence compared to a nonzero incidence and (ii) the relationship between the predictors and nonzero LOE incidence. ResultsA sample of 15,494 studies were retrieved using the search criteria, with 53 studies meeting eligibility criteria. The pooled results from 4991 participants were included for analysis, with 4891 participants who had undergone ACLR. The proportion of included studies judged at an overall low risk of bias was small (7.8%). The observed group and study were the most important predictors for whether a datapoint reported an incidence of extension deficit. Time to follow‐up (P < 0.001) and graft type (P = 0.02) were found to have a significant influence on nonzero LOE incidence (%). Covariate adjusted estimates of average LOE indicated 1 in 3 patients presenting with LOE at 12 month follow‐up, reducing to 1 in 4 at 2 years. ConclusionsThis review examined the definitions for the measurement and interpretation of postoperative knee extension and established the trajectory of knee extension deficit after ACL injury and reconstruction. While factors associated with loss of extension were identified, the exact trajectory of knee extension deficits was difficult to infer due to discrepancies in measurement techniques and patient variation. On average, 1 in 3 patients may present with loss of extension of at least 3 degrees at 12‐month follow‐up, decreasing to 1 in 4 at 2 years. These results may be used by clinicians as an upper threshold for acceptable complication rates following ACLR. Future work should focus on LOE as a clinically relevant complication of ACL injury and treatment with appropriate attention to standardisation of definitions, measurements and better understanding of natural history. PROSPERO registration numberCRD42018092295. Level of evidenceLevel I

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“…The primary objective of anterior cruciate ligament reconstruction (ACLR) is to effectively restore knee stability and facilitate the resumption of sports activities and everyday functional activities among patients [ 1 – 3 ]. Nevertheless, a number of studies have indicated that ACLR does not fully restore the typical structure and functionality of the knee [ 4 – 8 ].…”

Section: Introductionmentioning

confidence: 99%

Trends of Publications on Single- and Double-Bundle ACL Reconstructions over the Last 20 Years: A Bibliometric Analysis of the PubMed Literature

D’Ambrosi,

Kambhampati,

Vishwanathan

et al. 2023

JOIO

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Purpose To improve the clinical outcomes of anterior cruciate ligament reconstruction (ACLR), there have been attempts to reproduce anatomic reconstruction by modifying the single-bundle (SB) and double-bundle (DB) techniques. Although DB ACLR restores better rotational control compared to SB ACLR, it is still debatable whether there are higher clinical outcomes in favor of DB ACLR. We aimed to study the trends of publications on SB and DB ACLR techniques over the last 20 years. Methods For this bibliometric study, we performed a PubMed search on 31/05/2022 with a well-defined search strategy. The articles were downloaded into Excel software, and citations were determined from the iCite website for PubMed. The analysis was performed using SPSS software version 28.0.1. Data mining was performed using Orange software, Mac version 3.32.0, from the titles of all articles and each group of SB and DB ACLR. The output is presented as word clouds. Results A total of 10,530 publications were identified, of which 9699 publications (92.1%) pertained to SB-ACLR and 831 publications (7.9%) to DB-ACLR. There was a steady increase in the publications on SB-ACLR until 2012, followed by a steep increase that peaked in 2021. The highest number of publications on DB-ACLR was in 2012 (n = 76; 9.1%). The mean citations per year for SB-ACLR and DB-ACLR were 2.87 ± 4.31 and 2.74 ± 3.17, respectively. The most prolific journals publishing on this topic were Knee Surgery Sports Traumatology Arthroscopy, American Journal of Sports Medicine, and Arthroscopy. The top three articles that received the maximum number of citations were from Japanese authors. Conclusion The number of publications related to SB-ACLR was significantly higher than that related to DB-ACLR in the last 20 years. The publications related to DB-ACLR have decreased in the recent past, after reaching a peak in 2012. The citations per year of SB-ACLR and DB-ACLR were similar.

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Functional outcomes and return to sport following anterior cruciate ligament reconstruction in recreational athletes: A systematic review

Cited by 12 publications

References 23 publications

A comparison between physical therapy clinics with high and low rehabilitation volumes of patients with ACL reconstruction

A comparison between physical therapy clinics with high and low rehabilitation volumes of patients with ACL reconstruction

Persistent knee extension deficits are common after anterior cruciate ligament reconstruction: a systematic review and meta-analysis of randomised controlled trials

Trends of Publications on Single- and Double-Bundle ACL Reconstructions over the Last 20 Years: A Bibliometric Analysis of the PubMed Literature

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