Quadriceps Function, Knee Pain, and Self-Reported Outcomes in Patients With Anterior Cruciate Ligament Reconstruction

Lepley, Adam S.; Pietrosimone, Brian; Cormier, Marc L.

doi:10.4085/1062-6050-245-16

Cited by 56 publications

(57 citation statements)

References 47 publications

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“…In all, 54 (70%) studies were quantitative (involving longitudinal (30%),38–63 cross-sectional (27%)64–84 or case series (5%)85–88 designs), three (4%) included an intervention,89–91 18 (23%) studies were qualitative92–109 (consisting of seven (39%) descriptive, five (28%) case or narrative, three (17%) grounded theory, and three (17%) phenomenology approaches) and five (6%) mixed methods designs 110–114. Full details of study characteristics are summarised in online supplementary file 4.…”

Section: Resultsmentioning

confidence: 99%

Psychological, social and contextual factors across recovery stages following a sport-related knee injury: a scoping review

et al. 2020

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ObjectiveTo explore the role of psychological, social and contextual factors across the recovery stages (ie, acute, rehabilitation or return to sport (RTS)) following a traumatic time-loss sport-related knee injury.Material and methodsThis review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews and Arksey and O’Malley framework. Six databases were searched using predetermined search terms. Included studies consisted of original data written in English that identified or described a psychological, social or contextual factor related to recovery after a traumatic time-loss sport-related knee injury. Two authors independently conducted title–abstract and full-text reviews. Study quality was assessed using the Mixed Methods Appraisal Tool. Thematic analysis was undertaken.ResultsOf 7289 records, 77 studies representing 5540 participants (37% women, 84% anterior cruciate ligament tears, aged 14–60 years) were included. Psychological factors were investigated across all studies, while social and contextual factors were assessed in 39% and 21% of included studies, respectively. A cross-cutting concept of individualisation was present across four psychological (barriers to progress, active coping, independence and recovery expectations), two social (social support and engagement in care) and two contextual (environmental influences and sport culture) themes. Athletes report multiple barriers to recovery and valued their autonomy, having an active role in their recovery and diverse social support.ConclusionDiverse psychological, social and contextual factors are present and influence all stages of recovery following a traumatic sport-related knee injury. A better understanding of these factors at the time of injury and throughout rehabilitation could assist with optimising injury management, promoting RTS, and long-term health-related quality-of-life.

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Section: Resultsmentioning

confidence: 99%

Psychological, social and contextual factors across recovery stages following a sport-related knee injury: a scoping review

et al. 2020

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“…The use of unilateral outcomes eliminates the potential crossover effect commonly seen in individuals with bilateral quadriceps functional impairments after ACLR 7 , 21 , 56 and allows for clinicians to compare strength performance of injured individuals to normative outcomes for guidance in the recovery process. Furthermore, involved limb isometric quadriceps strength is a significantly better predictor of self-reported knee function 45 and psychological readiness to return to sport 33 when compared with limb symmetry strength and is a primary focus of this meta-analysis.…”

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confidence: 99%

Quadriceps Strength and Volitional Activation After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis

et al. 2019

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Context: Quadriceps function is a significant contributor to knee joint health that is influenced by central and peripheral factors, especially after anterior cruciate ligament reconstruction (ACLR). Objective: To assess differences of unilateral quadriceps isometric strength and activation between the involved limb and contralateral limb of individuals with ACLR and healthy controls. Data Sources: Web of Science, SportDISCUS, PubMed, CINAHL, and the Cochrane Database were all used during the search. Study Selection: A total of 2024 studies were reviewed. Twenty-eight studies including individuals with a unilateral history of ACLR, isometric knee extension strength normalized to body mass, and quadriceps activation measured by central activation ratios (CARs) through a superimposed burst technique were identified for meta-analysis. The methodological quality of relevant articles was assessed using a modified Downs and Black scale. Results of methodological quality assessment ranged from low to high quality (low, n = 10; moderate, n = 8; high, n = 10). Study Design: Meta-analysis. Level of Evidence: Level 2. Data Extraction: Means, standard deviations, and sample sizes were extracted from articles, and magnitude of between-limb and between-group differences were evaluated using a random-effects model meta-analysis approach to calculate combined pooled effect sizes (ESs) and 95% CIs. ESs were classified as weak ( d < 0.19), small ( d = 0.20-0.49), moderate ( d = 0.50-0.79), or large ( d > 0.80). Results: The involved limb of individuals with ACLR displayed lower knee extension strength compared with the contralateral limb (ES, –0.78; lower bound [LB], –0.99; upper bound [UB], –0.58) and healthy controls (ES, –0.76; LB, –0.98; UB, –0.53). The involved limb displayed a lower CAR compared with healthy controls (ES, –0.84; LB, –1.18; UB, –0.50) but not compared with the contralateral limb (ES, –0.15; LB, –0.37; UB, 0.07). The ACLR contralateral limb displayed a lower CAR (ES, –0.73; LB, –1.39; UB, –0.07) compared with healthy control limbs but similar knee extension strength (ES, –0.24; LB, –0.68; UB, –0.19). Conclusion: Individuals with ACLR have bilateral CAR deficits and involved limb strength deficits that persist years after surgery. Deficits in quadriceps function may have meaningful implications for patient-reported and objective outcomes, risk of reinjury, and long-term joint health after ACLR.

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“…In a study of patients who returned to sports a mean of 7 months after reconstruction, there was a negative association between the KOOS pain score and ACL-RSI score, which showed that psychological readiness was high when pain was low. 15 In the current study, TSK was identified as a significant factor related to psychological readiness. One study showed that viewing a contemporary art video that provides positive "insight," combined with adequate rehabilitation, could improve short-term clinical outcomes, including TSK score, in patients who underwent ACL reconstruction.…”

Section: Discussionmentioning

confidence: 67%

“…Second, there are limits to generalizing the results of this study to patients with significantly different characteristics, such as age and sex, surgical procedures, different sports, and postoperative days before return to a sport. 14,15 Participants in this study were young (average, 20 years), and 73% were women. This cohort is not representative of patients after ACL reconstruction in our practice as a whole.…”

Section: Discussionmentioning

confidence: 99%

Factors Associated With Psychological Readiness to Return to Sports With Cutting, Pivoting, and Jump-Landings After Primary ACL Reconstruction

Aizawa

Hirohata

Ohji

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: High psychological readiness is an important element for returning to sports after anterior cruciate ligament (ACL) reconstruction. Identifying factors that contribute to psychological readiness is essential for planning interventions to return to play. No studies have used multivariate analysis to clarify factors associated with psychological readiness to return to specific sports. Hypothesis: To identify factors that contribute to an athlete’s psychological readiness to return after ACL reconstruction to sports that require cutting, pivoting, and jump-landings. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Study participants were athletes who before injury had participated in sports with limited contact that required cutting, pivoting, and jump-landings (basketball, soccer, futsal, volleyball, badminton, tennis, and frisbee) and hoped to return to the same sport after reconstruction. Psychological readiness was measured using the Anterior Cruciate Ligament–Return to Sport After Injury Scale (ACL-RSI) in athletes more than 6 months after primary ACL reconstruction. To clarify factors associated with the ACL-RSI, univariate regression analysis and multivariate regression analysis were performed using the following independent variables: age, sex, body mass index, time from injury to reconstruction, time from reconstruction to testing, meniscal surgery, modified Tegner activity scale before injury, kinesiophobia, limb symmetry index of knee strength, limb symmetry indices of single-leg hop (SLH) distances, and subjective running ability. Results: Higher subjective running ability, a lower kinesiophobia score, and greater limb symmetry in the lateral SLH were positively associated with psychological readiness. Conclusion: The psychological readiness of athletes aiming to return after ACL reconstruction to limited-contact sports that require cutting, pivoting, and jump-landings was affected by subjective running ability, kinesiophobia, and asymmetry of lateral SLH distance. This information may be useful in planning appropriate interventions and thereby increasing the likelihood of an athlete’s returning to such sports.

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Quadriceps Function, Knee Pain, and Self-Reported Outcomes in Patients With Anterior Cruciate Ligament Reconstruction

Cited by 56 publications

References 47 publications

Psychological, social and contextual factors across recovery stages following a sport-related knee injury: a scoping review

Psychological, social and contextual factors across recovery stages following a sport-related knee injury: a scoping review

Quadriceps Strength and Volitional Activation After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis

Factors Associated With Psychological Readiness to Return to Sports With Cutting, Pivoting, and Jump-Landings After Primary ACL Reconstruction

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