Superior 2-Year Functional Outcomes Among Young Female Athletes After ACL Reconstruction in 10 Return-to-Sport Training Sessions: Comparison of ACL-SPORTS Randomized Controlled Trial With Delaware-Oslo and MOON Cohorts

Capin, Jacob J.; Failla, Mathew; Zarzycki, Ryan; Dix, Celeste; Johnson, Jessica L; Smith, Angela H.; Risberg, May Arna; Huston, Laura J.; Spindler, Kurt P.; Snyder‐Mackler, Lynn

doi:10.1177/2325967119861311

Cited by 26 publications

(33 citation statements)

References 54 publications

(112 reference statements)

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“…13 Additionally, an investigation by Capin et al concluded that there were no added benefits to including perturbation-based exercises to a post-operative RTS training program that incorporated strengthening, agility and plyometrics among young female athletes after ACL reconstruction. 74 Thus, further investigations of perturbation-based training regimes with various parameters (such as longer duration or increased training intensity) and alternative forms of NM training that combine perturbation training with other exercises that are safe for ACL-injured adolescent females (such as resistance training, cardiovascular conditioning, core strengthening and gait re-education), are still necessary to improve prevention and rehabilitation programs for those at-risk.…”

Section: Resultsmentioning

confidence: 99%

Safety and Effectiveness of a Perturbation-based Neuromuscular Training Program on Dynamic Balance in Adolescent Females: A Randomized Controlled Trial

Bulow

Anderson

Leiter

et al. 2021

International Journal of Sports Physical Therapy

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BackgroundAdolescent females are at much greater risk for ACL injury than their male counterparts when participating in the same sports. Preventative and pre-operative rehabilitation neuromuscular (NM) exercise programs are often recommended to improve knee function and reduce injury rates. The effectiveness of perturbation-based NM training program has been established in an adult population but has yet to be investigated in the at-risk adolescent female population. PurposeTo determine the effectiveness of a perturbation-based NM exercise program in a group of physically active adolescent females. Study DesignProspective randomized trial. MethodsTwenty-four healthy and an exploratory group of 10 ACL-injured females (ages 12-18) were equally randomized into a perturbation-based NM training or control group and evaluated before and after a five-week intervention period. The primary outcome of dynamic balance was measured using the Y-Balance test (YBT); secondary outcome measures included lower limb strength, proprioception, and flexibility. ResultsThe perturbation-based NM training intervention was safely completed by all participants but had no significant effect on YBT scoring, lower limb strength, proprioception or flexibility in either the healthy or ACL-injured groups. ConclusionsPerturbation-based NM training is safe, but may offer little preventative benefit for healthy or pre-operative rehabilitation benefit for ACL-injured adolescent females. Future research should examine whether the effectiveness of perturbation-based NM training is influenced by the length of the training intervention, training intensity, or when it is combined with other forms of prophylactic or pre-surgical rehabilitation frequently used with at-risk adolescent females who regularly participate in sport.

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Section: Resultsmentioning

confidence: 99%

Safety and Effectiveness of a Perturbation-based Neuromuscular Training Program on Dynamic Balance in Adolescent Females: A Randomized Controlled Trial

Bulow

Anderson

Leiter

et al. 2021

International Journal of Sports Physical Therapy

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“…Our cohort received evidence-based postoperative rehabilitation and the addition of return-to-sport training, which improved all functional outcome measures, including self-reported function, hop testing, and quadriceps strength. 4,5,9,13 Despite these improvements, aberrant gait biomechanics persisted. Our results suggest that current rehabilitation after ACLR may not be adequately targeting gait.…”

Section: Discussionmentioning

confidence: 99%

“…The majority of patients reached these return-to-sport milestones and subsequently were cleared to begin a return-to-sport progression (pending clearance from the surgeon); all returned to sport within 2 years, most to the same sport level. 9,10…”

Section: Methodsmentioning

confidence: 99%

Quadriceps Strength Symmetry Does Not Modify Gait Mechanics After Anterior Cruciate Ligament Reconstruction, Rehabilitation, and Return-to-Sport Training

et al. 2020

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Background: After anterior cruciate ligament (ACL) reconstruction (ACLR), biomechanical asymmetries during gait are highly prevalent, persistent, and linked to posttraumatic knee osteoarthritis. Quadriceps strength is an important clinical measure associated with preoperative gait asymmetries and postoperative function and is a primary criterion for return-to-sport clearance. Evidence relating symmetry in quadriceps strength with gait biomechanics is limited to preoperative and early rehabilitation time points before return-to-sport training. Purpose/Hypothesis: The purpose was to determine the relationship between symmetry in isometric quadriceps strength and gait biomechanics after return-to-sport training in athletes after ACLR. We hypothesized that as quadriceps strength symmetry increases, athletes will demonstrate more symmetric knee joint biomechanics, including tibiofemoral joint loading during gait. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Of 79 athletes enrolled in the ACL-SPORTS Trial, 76 were participants in this study after completing postoperative rehabilitation and 10 return-to-sport training sessions (mean ± SD, 7.1 ± 2.0 months after ACLR). All participants completed biomechanical walking gait analysis and isometric quadriceps strength assessment using an electromechanical dynamometer. Quadriceps strength was calculated using a limb symmetry index (involved limb value / uninvolved limb value × 100). The biomechanical variables of interest included peak knee flexion angle, peak knee internal extension moment, sagittal plane knee excursion at weight acceptance and midstance, quadriceps muscle force at peak knee flexion angle, and peak medial compartment contact force. Spearman rank correlation (ρ) coefficients were used to determine the relationship between limb symmetry indexes in quadriceps strength and each biomechanical variable; alpha was set to .05. Results: Of the 76 participants, 27 (35%) demonstrated asymmetries in quadriceps strength, defined by quadriceps strength symmetry <90% (n = 23) or >110% (n = 4) (range, 56.9%-131.7%). For the biomechanical variables of interest, 67% demonstrated asymmetry in peak knee flexion angle; 68% and 83% in knee excursion during weight acceptance and midstance, respectively; 74% in internal peak knee extension moment; 57% in medial compartment contact force; and 74% in quadriceps muscle force. There were no significant correlations between quadriceps strength index and limb symmetry indexes for any biomechanical variable after return-to-sport training ( P > .129). Conclusion: Among those who completed return-to-sport training after ACLR, subsequent quadriceps strength symmetry was not correlated with the persistent asymmetries in gait biomechanics. After a threshold of quadriceps strength is reached, restoring strength alone may not ameliorate gait asymmetries, and current clinical interventions and return-to-sport training may not adequately target gait.

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“…The presence of cross‐cultural DIF is of course most important if data from different countries or cultures are pooled into one dataset. This is typically done in international databases or when national clinical databases are pooled, but also randomized multicentre studies and studies including cohorts in different countries can be affected by cross‐cultural DIF, like the Delaware‐Oslo cohort of ACL patients 6,7 …”

Section: Introductionmentioning

confidence: 99%

How to translate and locally adapt a PROM. Assessment of cross‐cultural differential item functioning

Krogsgaard

Brodersen

Christensen

et al. 2020

Scandinavian Med Sci Sports

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Translating patient‐reported outcome measures (PROMs) can alter the meaning of items and undermine the PROM's psychometric properties (quantified as cross‐cultural differential item functioning [DIF]). The aim of this paper was to present the theoretical background for PROM translation, adaptation, and cross‐cultural validation, and assess how PROMs used in sports medicine research have been translated and adapted. We also assessed DIF for the Knee Injury and Osteoarthritis Outcome Score (KOOS) across Danish, Norwegian, and Swedish versions. We conducted a search in PubMed and Scopus to identify the method of translation, adaptation, and validation of PROMs relevant to musculoskeletal research. Additionally, 150 preoperative KOOS questionnaires were obtained from the Scandinavian knee ligament reconstruction registries, and cross‐cultural DIF was evaluated using confirmatory factor analysis and Rasch analysis. There were 392 studies identified, describing the translation of 61 PROMs. Ninety‐four percent were performed with forward‐backward technique. Forty‐nine percent used cognitive interviews to ensure appropriate wording, understandability, and adaptation to the target culture. Only two percent were validated according to modern test theory. No study assessed cross‐cultural DIF. One KOOS subscale showed no cross‐cultural DIF, two had DIF with respect to some (but not all) items, and thus conversion tables could be constructed, and two KOOS subscales could not be pooled. Most PROM translations are of undocumented quality, despite the common conclusion that they are valid and reliable. Scores from three of five KOOS subscales can be pooled across the Danish, Norwegian, and Swedish versions, but two of these must be adjusted for DIF.

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Superior 2-Year Functional Outcomes Among Young Female Athletes After ACL Reconstruction in 10 Return-to-Sport Training Sessions: Comparison of ACL-SPORTS Randomized Controlled Trial With Delaware-Oslo and MOON Cohorts

Cited by 26 publications

References 54 publications

Safety and Effectiveness of a Perturbation-based Neuromuscular Training Program on Dynamic Balance in Adolescent Females: A Randomized Controlled Trial

Safety and Effectiveness of a Perturbation-based Neuromuscular Training Program on Dynamic Balance in Adolescent Females: A Randomized Controlled Trial

Quadriceps Strength Symmetry Does Not Modify Gait Mechanics After Anterior Cruciate Ligament Reconstruction, Rehabilitation, and Return-to-Sport Training

How to translate and locally adapt a PROM. Assessment of cross‐cultural differential item functioning

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