Return to play following anterior cruciate ligament reconstruction: incorporating fatigue into a return to play functional battery. Part A: treadmill running

Connell, Richard; Milne, Ross; Paton, Bruce

doi:10.1136/bmjsem-2018-000375

Cited by 3 publications

(2 citation statements)

References 41 publications

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“…Other possible reasons for the higher risk of contralateral injuries include biomechanical changes or altered neuromuscular function after ACL reconstruction. 32 In a biomechanical analysis of patients who had undergone ACL reconstruction, Connell et al 4 found that during treadmill running, patients protected their reconstructed knee but consequently exposed the contralateral knee to greater internal rotation forces. Neuromuscular changes such as the H-reflex, quadriceps strength deficits, or changes related to donor site morbidity have been proposed as other potential risk factors for a contralateral ACL injury.…”

Section: Discussionmentioning

confidence: 99%

Higher Rate of Return to Preinjury Activity Levels After Anterior Cruciate Ligament Reconstruction With a Bone–Patellar Tendon–Bone Versus Hamstring Tendon Autograft in High-Activity Patients: Results From the New Zealand ACL Registry

Rahardja

Love²,

Clatworthy

et al. 2021

Am J Sports Med

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Background: In primary anterior cruciate ligament (ACL) reconstruction, a bone–patellar tendon–bone (BTB) autograft is associated with lower ipsilateral failure rates. BTB autografts are associated with a higher rate of contralateral ACL injuries, which some clinicians view as a marker of success of the BTB autograft. However, there is a lack of evidence on whether BTB autografts improve the rate of return to activity and sport. Purpose: To compare the rate of return to preinjury activity levels in high-activity patients after ACL reconstruction with BTB autograft or hamstring tendon autograft. Study Design: Cohort study; Level of evidence, 3. Methods: In a high-activity cohort of patients recorded between 2014 and 2018 in the New Zealand ACL Registry, prospectively collected data on preinjury and postoperative Marx activity scores were analyzed. The proportion of patients who returned to their preinjury activity levels at 1- and 2-year follow-up was compared between graft types. Results: Overall, 11.3% (208/1844) of patients returned to their preinjury activity levels at 1-year follow-up, and 15.5% (184/1190) returned at 2-year follow-up. At 1-year follow-up, 17.2% of patients with a BTB autograft returned to their preinjury activity levels compared with 9.3% of patients with a hamstring tendon autograft (adjusted odds ratio, 1.59 [95% CI, 1.16-2.17]; P = .004). At 2-year follow-up, 23.3% of patients with a BTB autograft had returned to their preinjury activity levels compared with 13.3% of patients with a hamstring tendon autograft (adjusted odds ratio, 1.63 [95% CI, 1.14-2.34]; P = .008). Male sex and younger age were associated with a higher rate of return to activity at both follow-up time points. Conclusion: The use of BTB autografts increased the odds of returning to preinjury activity levels at early follow-up. A higher rate of return to activity is a possible explanation for the higher rate of contralateral ACL injuries with the use of BTB autografts.

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Section: Discussionmentioning

confidence: 99%

Higher Rate of Return to Preinjury Activity Levels After Anterior Cruciate Ligament Reconstruction With a Bone–Patellar Tendon–Bone Versus Hamstring Tendon Autograft in High-Activity Patients: Results From the New Zealand ACL Registry

Rahardja

Love²,

Clatworthy

et al. 2021

Am J Sports Med

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“…When making rehabilitative decisions on return to sport, it is important for clinicians to consider the postoperative changes to the biomechanics of the knee and the association between high activity levels and repeat ACL injury. 7,28,50 Although the ''perfect'' graft would have the lowest risk of ipsilateral reinjury, it would also have the highest rate of return to activity, potentially increasing the risk of injury to the contralateral ACL. Injury prevention programs are known to be effective in reducing ACL injury; however, further studies are required to evaluate the efficacy of postoperative prevention measures in reducing contralateral ACL injury, especially in patients with a patellar tendon graft.…”

Section: Time (Years)mentioning

confidence: 99%

Effect of Graft Choice on Revision and Contralateral Anterior Cruciate Ligament Reconstruction: Results From the New Zealand ACL Registry

Rahardja

Zhu

Love³

et al. 2019

Am J Sports Med

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Background: The patellar tendon is often considered the “gold standard” graft for reducing the risk of graft rupture after anterior cruciate ligament (ACL) reconstruction. However, its use may also be associated with an increased risk of injury to the contralateral ACL. Purpose: To clarify the association between graft choice and the risk of revision and contralateral ACL reconstruction. Study Design: Cohort study; Level of evidence, 2. Methods: Prospective data captured by the New Zealand ACL Registry between April 2014 and December 2018 were reviewed. All primary ACL reconstructions performed using either a hamstring tendon or patellar tendon autograft were included. Cox regression survival analysis adjusting for patient factors was performed to compare the risk of revision and contralateral ACL reconstruction between the hamstring tendon graft and the patellar tendon graft. Results: A total of 7155 primary ACL reconstructions were reviewed, of which 5563 (77.7%) were performed using a hamstring tendon graft and 1592 (22.3%) were performed using a patellar tendon graft. Patients with a hamstring tendon graft had a revision rate of 2.7% compared with 1.3% in patients with a patellar tendon graft (adjusted hazard ratio [HR], 2.51; 95% CI, 1.55-4.06; P < .001). The patellar tendon graft was associated with an increased risk of contralateral ACL reconstruction compared with the hamstring tendon graft (adjusted HR, 1.91; 95% CI, 1.15-3.16; P = .012). The number needed to treat (NNT) with a patellar tendon graft to prevent 1 revision was 73.6. However, the NNT with a hamstring tendon graft to prevent 1 contralateral reconstruction was 116.3. Conclusion: Use of a patellar tendon graft reduced the risk of graft rupture but was associated with an increased risk of injury to the contralateral ACL. Adequate rehabilitation and informed decision making on return to activity and injury prevention measures may be important in preventing subsequent injury to the healthy knee.

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Interval Return to Play Programs for the Tennis Athlete

Félix

Dines

2021

Curr Rev Musculoskelet Med

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Purpose of Review General guidelines exist for return to sport after injury. The goal of these guidelines is to outline phases of recovery that will minimize the risk of reinjury and promote an optimal return to function for the athlete. This paper analyzes the current research pertaining to interval return to play programs with a special focus on the tennis athlete. The authors examine the different components of an interval tennis program and work to develop what they feel are the necessary elements of the optimal return to sport guidelines for tennis athletes. These criteria are based on the available literature, research, and preliminary data collection as well as the personal experiences and clinical observations of the authors. Recent Findings Interval sports programs are typically designed to guide the athlete back to competition after an injury. The current research reveals the obstacles present in implementing an appropriate interval sports program including a lack of consensus on which criteria is actually necessary and relevant. Limited research is present for interval tennis programs. Summary Return to sport competition and sports science is continuously evolving. The authors highlight the necessary components in rehabilitation and performance principles for establishing a comprehensive interval tennis program. In addition, the role of technology in sports rehabilitation is assessed as it pertains to return to play. The authors proposed that interval sports program can help guide and direct future clinicians in their rehabilitation of the tennis athlete.

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Return to play following anterior cruciate ligament reconstruction: incorporating fatigue into a return to play functional battery. Part A: treadmill running

Cited by 3 publications

References 41 publications

Higher Rate of Return to Preinjury Activity Levels After Anterior Cruciate Ligament Reconstruction With a Bone–Patellar Tendon–Bone Versus Hamstring Tendon Autograft in High-Activity Patients: Results From the New Zealand ACL Registry

Higher Rate of Return to Preinjury Activity Levels After Anterior Cruciate Ligament Reconstruction With a Bone–Patellar Tendon–Bone Versus Hamstring Tendon Autograft in High-Activity Patients: Results From the New Zealand ACL Registry

Effect of Graft Choice on Revision and Contralateral Anterior Cruciate Ligament Reconstruction: Results From the New Zealand ACL Registry

Interval Return to Play Programs for the Tennis Athlete

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