There Is Substantial Variation in Rehabilitation Protocols Following Anterior Cruciate Ligament Reconstruction: A Survey of 46 American Orthopaedic Surgeons

Glattke, Kaycee; Tummala, Sailesh V.; Goldberg, Boaz; Menzer, Heather; Chhabra, Anikar

doi:10.1016/j.arthro.2022.07.024

Cited by 16 publications

(13 citation statements)

References 44 publications

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“…Rehabilitation protocols after ACLR have been found to be considerably variable between rehabilitation specialists and orthopaedic surgeons. 14 Although post-ACLR rehabilitation clinical practice guidelines exist, 43 postoperative progression is often dictated by surgeon training and preference, rehabilitation specialist clinical reasoning, physiologic healing (which can vary among individuals), and clinic protocol. The association between these variable rehabilitative practices and objective return-to-sport criteria has yet to be examined.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Meniscal Tear Type and Surgical Treatment on Quadriceps Strength: A Study of Adolescent Patients Post Anterior Cruciate Ligament Reconstruction

et al. 2023

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Background: Treatment of meniscal injuries at the time of anterior cruciate ligament reconstruction (ACLR) can result in restrictions on weightbearing and range of motion in the early rehabilitative phases. What is unknown is the effect of (1) meniscal tear type and location at the time of anterior cruciate ligament injury and (2) meniscal treatment at the time of ACLR on quadriceps strength in adolescents during the late rehabilitative phase. Hypothesis: Meniscal tears involving the root and requiring repair would adversely affect quadriceps strength at 6 to 9 months postoperatively. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent ACLR at 1 of 2 research sites between 2013 and 2021 were identified. Adolescent participants were included if they were between the ages of 12 and 20 years at the time of assessment and had undergone primary unilateral ACLR in the previous 6 to 9 months. Participants were subgrouped by meniscal tear type (no tear, nonroot tear, root tear) and meniscal treatment at the time of ACLR (no treatment, meniscectomy, meniscal repair), which were confirmed via chart review. Isokinetic strength testing occurred at 60 deg/s, and quadriceps strength and quadriceps strength limb symmetry index were compared between the meniscal tear type and meniscal procedure subgroups using analysis of covariance while controlling for the effects of age, sex, and ACLR graft source. Results: An overall 236 patients were included in this analysis (109 male, 127 female; mean ± SD age, 16.0 ± 1.9 years). There were no significant differences in ACLR limb quadriceps strength based on meniscal tear type ( P = .61) or meniscal procedure at the time of ACLR ( P = .61), after controlling for age, biological sex, and ACLR graft source. Similarly, quadriceps strength limb symmetry index did not differ by meniscal tear type ( P = .38) or meniscal procedure at the time of ACLR ( P = .40). Conclusion: Meniscal tear type and treatment at the time of ACLR did not affect quadriceps strength or quadriceps strength symmetry in adolescents 6 to 9 months after ACLR.

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Section: Discussionmentioning

confidence: 99%

The Impact of Meniscal Tear Type and Surgical Treatment on Quadriceps Strength: A Study of Adolescent Patients Post Anterior Cruciate Ligament Reconstruction

et al. 2023

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“…[63] Previous evidence supports that patients who do not fully resume exercises until 9 months after surgery are associated with a significantly lower reinjury rate. [3,[64][65][66] In a study by Glattke et al, [52] half of the respondents waited for at least 9 months before allowing patients to resume unrestricted exercises, while 42.5% allowed patients to resume exercises after 6 to 8 months. In a Croatian survey, two-thirds of the surgeons (66.67%) required their patients to rest for 6 to 9 months after ACLR before fully resuming physical activity, 25.64% prescribed a rest of 3 to 6 months, and others prescribed a rest of more than 9 months.…”

Section: Postoperative Protocolmentioning

confidence: 99%

Preferences in anterior cruciate ligament reconstruction: A survey among orthopedic surgeons in China

Tang,

Xiao,

Liu

et al. 2024

Medicine

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The purpose of this study was to reveal the current trends and preferences of Chinese orthopedic surgeons regarding anterior cruciate ligament (ACL) reconstruction through a nationwide web-based survey conducted in China. The survey questionnaire was distributed via WeChat to the chairmen of provincial orthopedic and sports medicine organizing committees in China, who then shared it in their respective WeChat workgroups. The questionnaire consisted of 52 multiple-choice questions covering 8 sections. Data collection was implemented by Questionnaire Star. A total of 812 valid questionnaires were returned: 94.21% of the respondents preferred single-bundle reconstruction of ACL, while 61.70% preferred autogenous semitendinosus plus gracilis reconstruction; 76.35% of the respondents preferred establishing the femoral tunnel first, while 47.29% preferred establishing the femoral tunnel through a medial auxiliary approach; and 85.10% of the respondents recommended patients to undergo surgery within 3 months after ligament injury. Besides, the vast majority of respondents chose to retain the ligamentous remnant bundle (92.98%) and recommended routine use of knee braces postoperatively (94.09%). It is recommended to perform arthroscopic single-bundle ACL reconstruction with the remnant preserving technique using a hamstring autograft within 3 months of ACL rupture, with support of postoperative functional braces.

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“…A majority of providers interviewed by Betsch et al 7 in a qualitative study reported to not evaluate psychosocial status during the recovery process. Glattke et al 18 published a survey study in which only 23.3% of surgeons reported utilizing a psychological measurement when evaluating for RTS after ACLR. There is no standardized protocol for RTS, allowing providers to choose when, whether, and how patients are evaluated.…”

Section: Measuring Psychosocial Factorsmentioning

confidence: 99%

“…Furthermore, there is variability among clinicians in measuring and addressing such factors. 7,18,35 Whereas the use of these psychological readiness scales may be beneficial in directing the recovery process, identifying and addressing the underlying factors may lead to more personalized recommendations and improved outcomes. The current review article aims to evaluate the impact of psychosocial factors on patients undergoing ACLR.…”

mentioning

confidence: 99%

The Influence of Psychosocial Factors on Patients Undergoing Anterior Cruciate Ligament Reconstruction

Momaya,

Wood,

Benson

et al. 2024

Sports Health: A Multidisciplinary Approach

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Context: Anterior cruciate ligament (ACL) injuries greatly impact patients in terms of future performance, reduced physical activity and athletic participation, and overall economic burden. Decades of research have investigated how to improve ACL reconstruction (ACLR) outcomes. Recently, there has been growing interest to understand the effects of psychosocial factors on patient outcomes. Study Design: Clinical review. Evidence Acquisition: A search of the PubMed database was performed in March 2023. Articles were reviewed by at least 2 authors to determine relevance. We highlighted publications of the past 5 years while incorporating previous pertinent studies. Level of Evidence: Level 5. Results: There is no standardization of psychosocial factors regarding ACLR. As such, there is a lack of consensus regarding which psychosocial measures to use and when. There is a need for clarification of the complex relationship between psychosocial factors and physical function. Despite this, psychosocial factors have the potential to help predict patients who are more likely to return to sport: (1) desire/motivation to return; (2) lower levels of kinesiophobia; (3) higher levels of self-efficacy, confidence, and subjective knee function; (4) risk acceptance; and (5) social support. However, there are no standardized interventions to improve psychosocial factors after ACLR. Conclusion: Psychosocial factors affect outcomes after ACLR. However, the interplay between psychosocial factors and physical function is complex. There is emerging evidence that testing and interventions may improve ACLR outcomes. There is a lack of standardized interventions to determine or improve psychosocial factors after ACLR. Further research is needed to identify psychosocial factors and to develop standardized interventions for clinicians to implement to improve clinical outcomes.

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There Is Substantial Variation in Rehabilitation Protocols Following Anterior Cruciate Ligament Reconstruction: A Survey of 46 American Orthopaedic Surgeons

Cited by 16 publications

References 44 publications

The Impact of Meniscal Tear Type and Surgical Treatment on Quadriceps Strength: A Study of Adolescent Patients Post Anterior Cruciate Ligament Reconstruction

The Impact of Meniscal Tear Type and Surgical Treatment on Quadriceps Strength: A Study of Adolescent Patients Post Anterior Cruciate Ligament Reconstruction

Preferences in anterior cruciate ligament reconstruction: A survey among orthopedic surgeons in China

The Influence of Psychosocial Factors on Patients Undergoing Anterior Cruciate Ligament Reconstruction

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