Background:Successful return to sport after anterior cruciate ligament (ACL) reconstruction requires optimal physical and psychological recovery. The main validated tool to quantify a patient’s psychological readiness to return to sport after this surgery is the Anterior Cruciate Ligament–Return to Sport after Injury (ACL-RSI) scale.Purpose:The primary aim was to analyze the progression of the ACL-RSI score from preoperatively to 2-year follow-up. A secondary goal was to identify the factors associated with returning to the same preinjury sport.Study Design:Cohort study; Level of evidence, 2.Methods:This prospective study included athletes older than 16 years in all sports and levels of play who underwent primary and revision isolated ACL reconstruction from 2012 to 2015 and responded to all study questionnaires at 2-year follow-up. The primary outcome was the ACL-RSI score obtained preoperatively and at 4-month, 6-month, 1-year, and 2-year follow-up. The secondary outcomes were return to sport (running and the same preinjury sport) and various functional scores. The optimal threshold value of the ACL-RSI score for returning to the same preinjury sport was determined with the receiver operating characteristic curve. Multivariate analysis was performed to identify other factors associated with returning to the same sport at 2-year follow-up.Results:A total of 681 patients were analyzed (467 men, 214 women; mean age, 30.2 ± 9.5 years); 298 (43.8%) patients were professional or competitive athletes. The ACL-RSI score improved significantly over time: 41.3 ± 25.4 preoperatively, 55.1 ± 21.3 at 4 months, 58.3 ± 22.3 at 6 months, 64.7 ± 24.2 at 1 year, and 65.2 ± 25.3 at 2 years (P < .00001). At 2-year follow-up, 74.9% of patients had returned to running and 58.4% to their same preinjury sport. The ACL-RSI score was significantly higher in patients who had returned to sport and in those who returned to the same level of play or higher (P < .00001). The optimal ACL-RSI score threshold to return to the same sport at 2-year follow-up was ≥65. Multivariate analysis showed that the predictive factors of returning to the same preinjury sport at 2-year follow-up were primary reconstruction, professional or competitive level of play, an ACL-RSI score ≥60 at 6-month follow-up, and the absence of postoperative complications.Conclusion:The psychological ACL-RSI score improved regularly after ACL reconstruction and was strongly and significantly associated with return to sport.Registration:NCT02511158 (ClinicalTrials.gov identifier)
Letter to the editor on the outcomes in fracture patients infected with COVID-19. Dear editor, In January 2020, China's center of disease control identified a novel coronavirus(COVID-19) as responsible of a cluster of respiratory infections [1, 2]. This virus rapidly spread through the world, and the World Health Organization (WHO) declared the outbreak a Pandemic [3-5]. In France, the situation became worrisome and evolved quickly despite lockdown [6, 7]. Local health authorities urged hospitals to cancel scheduled surgeries and to deal only with emergent cases. In orthopedics, this meant dealing mainly with surgical trauma patients. Being conscious that patients with fracture are very susceptible to pneumonia, strict preventive and protective measures were offered to all patients [8, 9]. Some trauma patients presented with covid-19 infection and we wondered if these patients with emergent fractures (spine, hip, ankle..) should be operated. Available literature shows only one report from Wuhan reporting their experience with fracture patients infected with Covid-19, and one paper from Italy showing their experience on 13 Covid-19 operated trauma patients [10, 11]. Through this letter, we share with you our in-crisis experience as an orthopedic surgery department from France, so we can draw conclusions, lessons, and be ready for a possible second epidemic surge.
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