Functional performance testing and return to sport criteria in patients after anterior cruciate ligament injury 12–18 months after index surgery: A cross-sectional observational study

Leister, Iris; Kulnik, Stefan Tino; Kindermann, Harald; Ortmaier, Reinhold; Barthofer, Jürgen; Vasvary, Imre; Katzensteiner, Klaus; Mattiassich, Georg

doi:10.1016/j.ptsp.2019.01.010

Cited by 18 publications

(9 citation statements)

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“…To date, many studies have been published on biomechanics after ACL-R as summarised in several systematic reviews, [17][18][19][20][21][22][23] yet only few studies have reported on gait analysis (with a simple marker model) and functional hop testing in patients after ACL repair and dynamic intraligamentary stabilisation (DIS) (Ligamys). 24 25 While Leister et al 26 reported comparable single leg hop performance after primary ACL repair with InternalBrace augmentation and after ACL-R and the few available reviews and casecontrol studies on small numbers of patients have shown promising results regarding clinical outcomes, [27][28][29][30][31][32] to date, comprehensive clinical, socioeconomic and functional-biomechanical analyses after this procedure are scarce.…”

Section: Introductionmentioning

confidence: 99%

RetroBRACE: clinical, socioeconomic and functional–biomechanical outcomes 2 years after ACL repair and InternalBrace augmentation in comparison to ACL reconstruction and healthy controls—experimental protocol of a non-randomised single-centre comparative study

et al. 2022

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IntroductionDespite good clinical outcomes reported in the literature, to date, scientific evidence for the functional and biomechanical benefit of primary anterior cruciate ligament (ACL) repair with augmentation is scarce. We present an experimental protocol for a detailed multimodal (clinical, socioeconomic, functional and biomechanical) comparative study in patients after primary ACL repair and InternalBrace augmentation, patients after ACL reconstruction and healthy controls.Methods and analysisIn this non-randomised single-centre comparative study with prospective data collection with three arms (patients 2 years after ACL repair and InternalBrace augmentation; patients 2 years after ACL reconstruction using hamstring autografts; and healthy controls), 30 participants per study arm will be included. The study is designed as non-inferiority study with three arms. Required sample size was estimated based on data reported in the literature on muscle strength, proprioception and balance parameters, resulting in at least 28 participants per group. Outcome parameters include patient-reported outcome measures (EQ-5D-5L, Tegner Activity Scale, Knee Injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee and ACL-Return to Sports Injury Scale), socio-economic parameters, anterior tibial translation, range of motion and functional-biomechanical data of the lower extremities. Functional–biomechanical parameters include proprioception, isokinetic muscle strength, single-leg balance, walking, running and single-leg hops with additional lower extremity 3D joint kinematics and kinetics and muscle activity. These parameters will be compared between limbs in patients, between groups and to the current literature.Ethics and disseminationThe results of this study will be disseminated through peer-reviewed publications and presentations at national and international conferences. Ethical approval was obtained by the regional ethics board (Ethics Committee Northwest Switzerland EKNZ 2020–00551), and the study is registered at clinicaltrials.gov.Trial registration numberNCT04429165.

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Section: Introductionmentioning

confidence: 99%

RetroBRACE: clinical, socioeconomic and functional–biomechanical outcomes 2 years after ACL repair and InternalBrace augmentation in comparison to ACL reconstruction and healthy controls—experimental protocol of a non-randomised single-centre comparative study

et al. 2022

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“…Return to non-contact sports was allowed after muscular and proprioceptive conditions were regained at least 6 months after surgical intervention. Return to pivoting sports or high-risk contact sport activities was advised only after at least 12 months and after passing specific return-to-sports criteria [28][29][30].…”

Section: Post-operative Treatmentmentioning

confidence: 99%

Clinical and radiological results after Internal Brace suture versus the all-inside reconstruction technique in anterior cruciate ligament tears 12 to 18 months after index surgery

Mattiassich

Ortmaier

Kindermann

et al. 2020

Sportverletz Sportschaden

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Background Anterior cruciate ligament (ACL) injury can lead to reduced function, meniscal lesions, and early joint degeneration. Preservation of a torn ACL using the Internal Brace technique might re-establish normal knee kinematics, avoid donor-site morbidity due to tendon harvesting, and potentially maintain proprioception of the knee. Methods Fifty subjects were recruited for this study between December 2015 and October 2016. Two groups of individuals who sustained a unilateral ACL rupture were included: those who underwent surgery with preservation of the injured ACL (Internal Brace technique; IB) and those who underwent ACL reconstruction using a hamstring tendon graft (all-inside technique; AI). Subjective self-administered scores were used: the German version of the IKDC Subjective Knee Form (International Knee Documentation Committee), the German version of the WOMAC (Western Ontario and McMaster Universities Arthritis Index), SF-36 (short form), the German version of the KOOS (Knee Osteoarthritis Outcome Score), and the German version of themodified Lysholm Score by Lysholm and Gillquist. Anterior tibial translation was assessed using the KT-1000 Arthrometer (KT-1000 Knee Ligament Arthrometer, MEDmetric Corp., San Diego, CA, USA). Magnetic resonance evaluation was performed in all cases. Results Twenty-three subjects (46 %) were men, and the mean age was 34.7 years. The objective IKDC scores were “normal” in 15 and 14 patients, “nearly normal” in 11 and 7 patients, and “abnormal” in 1 and 2 patients, in the IB and AI groups, respectively. KT-1000 assessment showed a sideto-side difference of more than 3 mm on maximum manual testing in 11 (44 %) and 6 subjects (28.6 %) in the IB and AI groups, respectively. In the postoperative MRI, 20 (74 %) and 22 subjects (96 %) in the IB and AI groups had an intact ACL. Anterior tibial translation was significantly higher in the IB group compared with the AI group in the manual maximum test. Conclusions Preservation of the native ACL with the Internal Brace primary repair technique can achieve comparable results to ACL reconstruction using Hamstring autografts over a short term. Clinically relevant limitations such as a higher incidence of pathologic laxity, with patients more prone to pivot-shift phenomenon were observed during the study period.

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“…Functionally, ACL repair is thought to restore proprioception and natural knee mechanics, potentially reducing the risk of secondary knee osteoarthritis [ 8 , 10 – 12 ]. While comparable patient-reported outcomes [ 13 – 16 ], higher, non-inferior or lower anterior knee laxity [ 13 – 16 ] and comparable pivot-shift test results [ 14 , 15 ] have been reported in clinical exams after ACL-IB versus ACL-R, studies of the presumed mechanical benefit during motion tasks after augmented ACL repair are lacking [ 17 ]. This raises the question of whether, in addition to the surgical advantages, ACL-IB also results in a good functional-biomechanical outcome and whether this outcome is comparable to that in patients after the gold standard ACL-R. As the muscles spanning the knee joint can influence knee joint mechanics [ 18 , 19 ] and ACL loading [ 20 , 21 ], both biomechanical and muscle activity parameters must be considered to gain a comprehensive insight into the knee joint behaviour during locomotion.…”

Section: Introductionmentioning

confidence: 99%

Ambulatory knee biomechanics and muscle activity 2 years after ACL surgery: InternalBraceTM-augmented ACL repair versus ACL reconstruction versus healthy controls

Bühl,

Müller,

Nüesch

et al. 2023

BMC Musculoskelet Disord

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Background Little is known about knee mechanics and muscle control after augmented ACL repair. Our aim was to compare knee biomechanics and leg muscle activity during walking between the legs of patients 2 years after InternalBraceTM-augmented anterior cruciate ligament repair (ACL-IB) and between patients after ACL-IB and ACL reconstruction (ACL-R), and controls. Methods Twenty-nine ACL-IB, 27 sex- and age-matched ACL-R (hamstring tendon autograft) and 29 matched controls completed an instrumented gait analysis. Knee joint angles, moments, power, and leg muscle activity were compared between the involved and uninvolved leg in ACL-IB (paired t-tests), and between the involved legs in ACL patients and the non-dominant leg in controls (analysis of variance and posthoc Bonferroni tests) using statistical parametric mapping (SPM, P < 0.05). Means and 95% confidence intervals (CI) of differences in discrete parameters (DP; i.e., maximum/minimum) were calculated. Results Significant differences were observed in ACL-IB only in minimum knee flexion angle (DP: 2.4°, CI [-4.4;-0.5]; involved > uninvolved) and maximum knee flexion moment during stance (-0.07Nm/kg, CI [-0.13;-0.00]; involved < uninvolved), and differences between ACL-IB and ACL-R only in maximum knee flexion during swing (DP: 3.6°, CI [0.5;7.0]; ACL-IB > ACL-R). Compared to controls, ACL-IB (SPM: 0–3%GC, P = 0.015; 98–100%, P = 0.016; DP: -6.3 mm, CI [-11.7;-0.8]) and ACL-R (DP: -6.0 mm, CI [-11.4;-0.2]) had lower (maximum) anterior tibia position around heel strike. ACL-R also had lower maximum knee extension moment (DP: -0.13Nm/kg, CI [-0.23;-0.02]) and internal knee rotation moment (SPM: 34–41%GC, P < 0.001; DP: -0.03Nm/kg, CI [-0.06;-0.00]) during stance, and greater maximum semitendinosus activity before heel strike (DP: 11.2%maximum voluntary contraction, CI [0.1;21.3]) than controls. Conclusion Our results suggest comparable ambulatory knee function 2 years after ACL-IB and ACL-R, with ACL-IB showing only small differences between legs. However, the differences between both ACL groups and controls suggest that function in the involved leg is not fully recovered and that ACL tear is not only a mechanical disruption but also affects the sensorimotor integrity, which may not be restored after surgery. The trend toward fewer abnormalities in knee moments and semitendinosus muscle function during walking after ACL-IB warrants further investigation and may underscore the importance of preserving the hamstring muscles as ACL agonists. Level of evidence Level III, case-control study. Trial registration clinicaltrials.gov, NCT04429165 (12/06/2020).

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Functional performance testing and return to sport criteria in patients after anterior cruciate ligament injury 12–18 months after index surgery: A cross-sectional observational study

Cited by 18 publications

References 64 publications

RetroBRACE: clinical, socioeconomic and functional–biomechanical outcomes 2 years after ACL repair and InternalBrace augmentation in comparison to ACL reconstruction and healthy controls—experimental protocol of a non-randomised single-centre comparative study

RetroBRACE: clinical, socioeconomic and functional–biomechanical outcomes 2 years after ACL repair and InternalBrace augmentation in comparison to ACL reconstruction and healthy controls—experimental protocol of a non-randomised single-centre comparative study

Clinical and radiological results after Internal Brace suture versus the all-inside reconstruction technique in anterior cruciate ligament tears 12 to 18 months after index surgery

Ambulatory knee biomechanics and muscle activity 2 years after ACL surgery: InternalBraceTM-augmented ACL repair versus ACL reconstruction versus healthy controls

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