Noninjured Knees of Patients With Noncontact ACL Injuries Display Higher Average Anterior and Internal Rotational Knee Laxity Compared With Healthy Knees of a Noninjured Population

Mouton, Caroline; Theisen, Daniel; Meyer, Tim; Agostinis, H.; Nührenbörger, Christian; Pape, Dietrich; Seil, Romain

doi:10.1177/0363546515587080

Cited by 26 publications

(18 citation statements)

References 30 publications

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“…However, we did not control for injury mechanism in our analysis (noncontact versus contact injuries). Contralateral noninjured knees of patients with current noncontact ACL injuries have been observed to display greater mean static anterior and internal rotational knee laxity scores than healthy control knees, 30 and the combination of anterior and rotational laxity has been reported as a 3.18-times greater risk factor for suffering an ACL injury. 30 Further work is needed to better define this as a risk factor, including the absolute thresholds associated with injury risk for both anterior and rotational physiological laxity in both contact and noncontact injuries.…”

Section: Discussionmentioning

confidence: 99%

An Ecological Study of Anterior Cruciate Ligament Reconstruction, Part 1

McGrath

Waddington

Scarvell

et al. 2016

Orthopaedic Journal of Sports Medicine

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Background:Additional high-quality prospective studies are needed to better define the objective criteria used in relation to return-to-sport decisions after synthetic (ligament advanced reinforcement system [LARS]) and autograft (hamstring tendon [2ST/2GR]) anterior cruciate ligament (ACL) reconstruction in active populations.Purpose:To prospectively investigate and describe the recovery of objective clinical outcomes after autograft (2ST/2GR) and synthetic (LARS) ACL reconstructions, as well as to investigate the relationship between these clinimetric test outcomes and return-to-sport activity (Tegner activity scale [TAS] score) at 12 and 24 months postoperatively.Study Design:Case series; Level of evidence, 4.Methods:A total of 64 patients who underwent ACL reconstruction (32 LARS, 32 2ST/2GR autograft) and 32 healthy reference participants were assessed for joint laxity (KT-1000 arthrometer), clinical outcome (2000 International Knee Documentation Committee [IKDC] knee examination), and activity (TAS score) preoperatively and at 12, 16, 20, and 24 weeks and 12 and 24 months postoperatively.Results:There was no significant correlation observed between clinical results using the 2000 IKDC knee examination and TAS score at 24 months (r s = 0.188, P = .137), nor were results for side-to-side difference (r s = 0.030, P = .814) or absolute KT-1000 arthrometer laxity of the surgical leg at 24 months postoperatively (r s = 0.076, P = .553) correlated with return-to-sport activity. Nonetheless, return-to-sport rates within the surgical cohort were 81% at 12 months and 83% at 24 months, respectively. No statistically significant differences were observed between physiological laxity of the uninjured knee within the surgical group compared with healthy knees within the reference group (P = .522).Conclusion:The results indicate that although relatively high levels of return-to-sport outcomes were achieved at 24 months compared with those previously reported in the literature, correlations between objective clinical tests and return-to-sport outcomes may not occur. Clinical outcome measures may provide suitable baseline information; however, the results of this study suggest that clinicians may need to place greater emphasis on other outcome measures when seeking to objectively promote safe return to sport.

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Section: Discussionmentioning

confidence: 99%

An Ecological Study of Anterior Cruciate Ligament Reconstruction, Part 1

McGrath

Waddington

Scarvell

et al. 2016

Orthopaedic Journal of Sports Medicine

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“…At the same time, knee laxity decreases, making the younger person’s knee stiffer (Fig. 1 ) [ 13 , 14 ]. In addition, there is large interindividual variability in the timing of the cessation of growth and this is due to discrepancies between chronological and skeletal age.…”

Section: History and Current Evidencementioning

confidence: 99%

“I never made it to the pros…” Return to sport and becoming an elite athlete after pediatric and adolescent anterior cruciate ligament injury—Current evidence and future directions

Senorski

Seil

Svantesson

et al. 2017

Knee Surg Sports Traumatol Arthrosc

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The management of anterior cruciate ligament (ACL) injuries in the skeletally immature and adolescent patient remains an area of controversy in sports medicine. This study, therefore, summarizes and discusses the current evidence related to treating pediatric and adolescent patients who sustain an ACL injury. The current literature identifies a trend towards ACL reconstruction as the preferred treatment option for ACL injuries in the young, largely justified by the risk of further structural damage to the knee joint. Worryingly, a second ACL injury is all too common in the younger population, where almost one in every three to four young patients who sustain an ACL injury and return to high-risk pivoting sport will go on to sustain another ACL injury. The clinical experience of these patients emphasizes the rarity of an athlete who makes it to elite level after a pediatric or adolescent ACL injury, with or without reconstruction. If these patients are unable to make it to an elite level of sport, treatment should possibly be modified to take account of the risks associated with returning to pivoting and strenuous sport. The surveillance of young athletes may be beneficial when it comes to reducing injuries. Further research is crucial to better understand specific risk factors in the young and to establish independent structures to allow for unbiased decision-making for a safe return to sport after ACL injury. Level of evidence V.

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“…Therefore, such technologies could represent a potential aid in the follow-up evaluation of patients undergoing ACLR and in the RTS decision algorithm, since both anteroposterior and rotatory stability is required to safely RTS. This issue is relevant since Mouton et al 50 determined that both anterior and rotational knee laxity appear to be greater in the contralateral, non-injured knees of ACL-injured patients than in healthy controls, suggesting that increased physiological laxity could be a risk factor for (second) ACL injuries. 51 Increased laxity is associated with more hip adduction and knee valgus during drop landings in female patients.…”

Section: Tools To Determine Rtsmentioning

confidence: 99%

Clinical course and recommendations for patients after anterior cruciate ligament injury and subsequent reconstruction

et al. 2017

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Almost all athletes who have suffered an anterior cruciate ligament (ACL) injury expect a full return to sports at the same pre-injury level after ACL reconstruction (ACLR). Detailed patient information on the reasonable outcomes of the surgery may be essential to improve patient satisfaction.Pre-operative rehabilitation before ACLR should be considered as an addition to the standard of care to maximise functional outcomes after ACLR.We propose an optimised criterion-based rehabilitation programme within a biopsychosocial framework.No benchmark exists for evaluating return-to-sport (RTS) readiness after ACLR. Therefore, the authors propose a multi-factorial RTS test battery. A combination of both physical and psychological elements should be included in the RTS test battery.There is need for shared decision-making regarding RTS.Cite this article: EFORT Open Rev 2017;2:410-420. DOI: 10.1302/2058-5241.2.170011

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Noninjured Knees of Patients With Noncontact ACL Injuries Display Higher Average Anterior and Internal Rotational Knee Laxity Compared With Healthy Knees of a Noninjured Population

Cited by 26 publications

References 30 publications

An Ecological Study of Anterior Cruciate Ligament Reconstruction, Part 1

An Ecological Study of Anterior Cruciate Ligament Reconstruction, Part 1

“I never made it to the pros…” Return to sport and becoming an elite athlete after pediatric and adolescent anterior cruciate ligament injury—Current evidence and future directions

Clinical course and recommendations for patients after anterior cruciate ligament injury and subsequent reconstruction

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