Does an Accelerated Program Give Equivalent Results in Both Elite Athletes and Nonathletes?

Abstract

Context: Although many researchers have investigated the functional outcomes of different accelerated rehabilitation programs after anterior cruciate ligament reconstruction (ACLR), the functional results of the same accelerated rehabilitation program following ACLR applied for both elite athletes and nonathletes have not yet been investigated. Objective: To examine the effects of the same accelerated anterior cruciate ligament rehabilitation program on pain and functionality of elite athletes and nonathletes. Design: Prospective preintervention–postintervention design. Setting: Physiotherapy department. Participants: Fifteen elite athletes and 15 nonathletes who underwent unilateral ACLR with autologous hamstring tendon graft. Intervention: All participants received the same protocol for 6 weeks (5 sessions in a week). Main Outcome Measures: Primary measurements were pain intensity, which was measured by visual analog scale, range of motion measurement using universal goniometer, and functionality, which was detected by Lysholm score. Secondary measurements were short form-36 and Beck Depression Inventory. Results: Higher Lysholm (P = .001) and Beck Depression Inventory (P = .03) scores were observed in the elite athlete group, and higher pain (P = .001) was observed in the nonathlete group at baseline assessments. Significant improvement detected for pain (P < .05), knee flexion range (P < .05), Lysholm score (P < .05), and Beck Depression Inventory (P < .05) compared with preintervention for both groups. Finally, after comparing the mean change values, the nonathlete group displayed greater decrease in pain level (P = .01) and participants in the elite athlete group further showed a greater decrease in depression level (P = .001). Conclusions: This study found that the same accelerated rehabilitation protocol provides significant improvements for pain, functionality, and depression in both elite athletes and nonathletes after ACLR. Clinicians should consider our results when applying an anterior cruciate ligament rehabilitation program for nonathlete groups.

Self-Reported Symptoms of Depression and Anxiety After ACL Injury: A Systematic Review

“…The 2 studies with very low quality were downgraded owing to risk of bias, imprecision, and indirectness of results (Table 3). There were 7 noncomparative studies 5,7-9,13,19,33 and 7 comparative studies 18,21,25,32,37,41,49 assessed with the MINORS. The noncomparative studies had a median score of 9 of 16 (range, [5][6][7][8][9][10][11], indicating that they were of fair quality.…”

“…c Assessment after rating the evidence using GRADE (high, moderate, low, very low). 18 30 ACLR 6 wk after ACLR Mainwaring (2010) 37 7 ACL injury 30 d Baranoff (2015) 5 44 ACLR 6 mo after ACLR Langford (2009) 32 87 ACLR 6 mo after ACLR Oztekin (2008) 41 30 ACL injury 3 wk after ACLR Filbay (2017) 19 162 ACLR 5-20 y after ACLR Tripp (2003) 49 20 ACLR N/A C ¸elebi (2015) 13 38 ACLR 6 wk after ACLR Brewer (2003) 7 91 ACL injury 24 mo after ACLR Brewer (2013) 8 91 ACL injury 24 mo after ACLR Anxiety Oztekin (2008) 41 30 ACL injury 3 wk after ACLR Hemsley (2010) 25 22 6 wk after ACLR N/A Tripp (2003) 49 20 ACLR N/A C ¸elebi (2015) 13 38 ACLR 6 wk after ACLR Filbay (2017) 19 162 5-20 years after ACLR N/A Lepley (2018) 33 20 6 mo after ACLR Brewer (2000) 9 61 ACL injury N/A Brewer (2003) 7 91 ACL injury 24 mo after ACLR Brewer (2013) 8 91 ACL injury 24 mo after ACLR Qualitative Carson (2012) 11 5 6-12 mo after ACLR Carson (2008) 12 1 Interview every 2 wk after ACLR a ACL, anterior cruciate ligament; ACLR, anterior cruciate ligament reconstruction; N/A: not applicable (due to the lack of reported data, or the use of an outcome measurement for which cut-offs were not found in the literature).…”

“…There was also no difference in the presence of anxiety symptoms between professional and recreational athletes. 18,25,49 However, professional rugby players were identified as having feelings of anxiety before return to sport. 11 A case study 12 of 1 rugby player reported perceived symptoms of anxiety directly after ACL reconstruction.…”

“…Symptoms of depression appeared to be more severe in elite athletes, and they decreased in all patient categories over time, from time of ACL reconstruction to 2 years after ACL reconstruction. 13,18,41 Prevalence of depression. When analyzing the prevalence of depression symptoms that result in a depressive disorder as based on cutoffs of self-reported PROs among patients with an ACL injury, 1 study 21 reported that 42% of the included patients (n ¼ 27) had major depressive disorder (MDD) before ACL reconstruction.…”

Anterior Cruciate Ligament Rehabilitation and Return to Sport: How Fast Is Too Fast?

“…Comparing the accelerated protocol to conservative patients in both elite athletes and nonathletes, Feyzio glu et al 19 found that accelerated rehabilitation decreased disability, depression, and pain; increased functionality; and improved quality of life. In the process of returning to sport, specific criteria, rather than timeline-based progression, should be used.…”