Knee Function, Strength, and Resumption of Preinjury Sports Participation in Young Athletes Following Anterior Cruciate Ligament Reconstruction

Ithurburn, Matthew P.; Longfellow, Matthew A.; Thomas, Staci; Paterno, Mark V.; Schmitt, Laura C.

doi:10.2519/jospt.2019.8624

Cited by 58 publications

(57 citation statements)

References 45 publications

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“…1,8,17,19 In this study, we found the rate of sustained return to primary sport participation to be 73% for adolescent patients, suggesting that the majority of young patients are able to achieve their presurgery goal to return to sport. These findings are comparable with the 56%-97% return rates for highly competitive young athletes 11,12,19,27 and are higher than the 55%-65% reported by recreational adult athletes (mean age, 22-28 years). 1,8,17 Of the 27% unable to maintain sport participation after ACLR, 3 patients (4.1% of the study cohort) were able to return to their primary sport initially but did not sustain sport participation secondary to a subsequent knee injury.…”

Section: Discussionsupporting

confidence: 74%

Patient-Reported Outcomes, Return-to-Sport Status, and Reinjury Rates After Anterior Cruciate Ligament Reconstruction in Adolescent Athletes: Minimum 2-Year Follow-up

Fones

Kostyun

Cohen

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Significant variation exists in the published rates of return to sport after anterior cruciate ligament (ACL) reconstruction (ACLR). Functional outcomes and psychological response to injury have been implicated as factors that influence return to sport. Most studies focus on patients aged in the mid-20s, and less is known about this topic in adolescents. Purpose: To report midterm ACLR results for adolescent patients with regard to return to primary sport, patient-reported outcomes, and reinjury rate. Study Design: Case-control study; Level of evidence, 3. Methods: Adolescent athletes were contacted at a minimum of 2 years after ACLR. Patients completed 2 patient-reported outcome measures, the ACL--Return to Sport After Injury (ACL-RSI) and the International Knee Documentation Committee (IKDC) subjective form, and responded to questions regarding preinjury primary sport and level of competition, post-ACLR return to primary sport status, and reinjury. Results: A total of 74 patients (mean ± SD surgical age, 15.9 ± 1.5 years; follow-up age, 19.9 ± 2.0 years; response rate, 24.5%) completed the surveys at a mean of 4.0 ± 2.0 years after primary ACLR. Outcome scores averaged 90.3 ± 12.3 for IKDC and 81.6 ± 20.4 for ACL-RSI. Questionnaire responses indicated that 27.0% of patients did not return to or sustain primary sport participation after ACLR; the principal reasons were poor knee function, team/training change, and fear of another injury. Both IKDC and ACL-RSI scores were statistically lower in patients who did not successfully return to their primary sport in contrast to patients who successfully resumed their primary sport (IKDC, P = .026; ACL-RSI, P < .001). IKDC and ACL-RSI scores were moderately positively correlated with one another ( r Spearman = 0.60). There were 18 patients (reinjury rate, 24.3%) who suffered another ACL injury; 8 of these injuries included ipsilateral ACL graft tear (retear rate, 10.8%). Conclusion: In our cohort, 73% of adolescent patients successfully returned to their primary preinjury sport at a minimum of 2 years after ACLR. Both knee function and psychological responses to injury were important in determining an adolescent athlete’s return to sport. The findings support the use of the IKDC and ACL-RSI at midterm follow-up, with higher scores associated with a greater likelihood of adolescent patients returning to sport after ACLR.

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Section: Discussionsupporting

confidence: 74%

Patient-Reported Outcomes, Return-to-Sport Status, and Reinjury Rates After Anterior Cruciate Ligament Reconstruction in Adolescent Athletes: Minimum 2-Year Follow-up

Fones

Kostyun

Cohen

et al. 2020

Orthopaedic Journal of Sports Medicine

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“…However, only around half of ACLR athletes successfully return to their pre-injury level of sport participation 1 year after return to sport. 1 Further, the risk of a second ACL injury -to either the involved or uninvolved side -is higher in ACLR athletes 2,3 compared with individuals who have never injured their ACL. Given that young females with higher activity levels are the most vulnerable population for suffering a second ACL injury after ACLR and return to play, 4 the underlying risk factors for the increased risk of a second injury in this population continues to be closely investigated.…”

Section: O N L I N E F I R S Tmentioning

confidence: 99%

Explosive Quadriceps Strength Symmetry and Landing Mechanics Limb Symmetry After Anterior Cruciate Ligament Reconstruction in Females

Huang

Mulligan

Johnson

et al. 2021

Journal of Athletic Training

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Context Emerging evidence suggests that lower quadriceps rate of torque development (RTD) following anterior cruciate ligament reconstruction (ACLR) may be associated with altered landing mechanics. However, the influence of quadriceps RTD magnitude and RTD limb symmetry on landing mechanics limb symmetry remains unknown. Objective To assess the influence of quadriceps RTD magnitude and RTD limb symmetry on sagittal plane landing mechanics limb symmetry in females with and without ACLR during functional landing tasks. Design Cross-Sectional Study Setting Laboratory Patients or Other Participants Thirty-eight females (ACLR=19, 19.2±1.8 years-old, 164.1±7.0 cm, 63.8±7.6 kg, Time after surgery: 20.1±9.5 months; Control=19, 21.1±3.3 years-old, 167.3±7.3 cm, 67.3±9.3 kg). Main Outcome Measure(s) Landing mechanics were assessed during double-leg and single-leg jump-landing tasks (DL and SL), and a side-cut task (SC). Quadriceps RTD was collected during isometric muscle contractions. Separate stepwise multiple linear regression models determined the amount of variance in limb symmetry in sagittal plane knee moment at initial contact (IC), peak vertical ground reaction force (vGRF), and loading rate that could be explained by quadriceps RTD magnitude or RTD limb symmetry, group (ACLR or Control), and their interaction. Results In ACLR females, greater quadriceps RTD limb symmetry was associated with greater symmetry in sagittal plane knee moment at IC during DL (P=.004). Peak vGRF and loading rate could not be predicted by quadriceps RTD magnitude or RTD limb symmetry, group, or their interaction during all tasks. Conclusions Developing greater quadriceps RTD symmetry, but not RTD magnitude, likely enables more symmetrical sagittal plane knee landing mechanics during double-leg task in ACLR females, and thus may reduce the risk of a second ACL injury. Such protective effect was not found during single-leg tasks that may not allow for a compensatory landing mechanism of shifting load to the uninvolved limb as is possible during a double-leg task.

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“…[65,109]. Further, some commonly used metrics, such as bilateral symmetry, may not be as important as once thought, as hop testing symmetry does not mirror quad strength symmetry and restoring bilateral hop symmetry is not always effective for reducing ACL-reinjury [67,75,82,100,157]. Conversely, quadriceps strength deficits are well documented post ACLR and may provide a related indicator of residual deficits following surgery [120].…”

Section: The Problem: Anterior Cruciate Ligament Injuries In Youthmentioning

confidence: 99%

Can We Capitalize on Central Nervous System Plasticity in Young Athletes to Inoculate Against Injury?

Diekfuss

Hogg

Grooms

et al. 2020

J. of SCI. IN SPORT AND EXERCISE

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There are numerous physical, social, and psychological benefits of exercise, sport and play for youth athletes. However, dynamic activities come with a risk of injury that has yet to be abated, warranting novel therapeutics to promote injuryresistance and to keep an active lifestyle throughout the lifespan. The purpose of the present manuscript was to summarize the extant literature and potential connecting framework regarding youth brain development and neuroplasticity associated with musculoskeletal injury. This review provides the foundation for our proposed framework that utilizes the OPTIMAL (Optimizing Performance Through Intrinsic Motivation and Attention for Learning) theory of motor learning to elicit desirable biomechanical adaptations to support injury prevention (injury risk reduction), rehabilitation strategies, and exercise performance for youth physical activity and play across all facets of sport (Prevention Rehabilitation Exercise Play; PREP). We conclude that both young male and females are ripe for OPTIMAL PREP strategies that promote desirable movement mechanics by leveraging a unique time window for which their heightened state of central nervous system plasticity is capable of enhanced adaptation through novel therapeutic interventions.

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Knee Function, Strength, and Resumption of Preinjury Sports Participation in Young Athletes Following Anterior Cruciate Ligament Reconstruction

Cited by 58 publications

References 45 publications

Patient-Reported Outcomes, Return-to-Sport Status, and Reinjury Rates After Anterior Cruciate Ligament Reconstruction in Adolescent Athletes: Minimum 2-Year Follow-up

Patient-Reported Outcomes, Return-to-Sport Status, and Reinjury Rates After Anterior Cruciate Ligament Reconstruction in Adolescent Athletes: Minimum 2-Year Follow-up

Explosive Quadriceps Strength Symmetry and Landing Mechanics Limb Symmetry After Anterior Cruciate Ligament Reconstruction in Females

Can We Capitalize on Central Nervous System Plasticity in Young Athletes to Inoculate Against Injury?

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