ACL Rehabilitation: Re-injury and Return to Sport Tests: Difference between revisions

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'''Asymetry''' in the kinematics and differences in moment arm between involved side joints compared to the other side is another factor that continues to manifest years following surgery<ref>Castanharo R, Da Luz BS, Bitar AC, D’Elia CO, Castropil W, Duarte M. Males still have limb asymmetries in multijoint movement tasks more than 2 years following anterior cruciate ligament reconstruction. Journal of Orthopaedic Science. 2011 Sep 1;16(5):531.</ref>.     
'''Asymetry''' in the kinematics and differences in moment arm between involved side joints compared to the other side is another factor that continues to manifest years following surgery<ref>Castanharo R, Da Luz BS, Bitar AC, D’Elia CO, Castropil W, Duarte M. Males still have limb asymmetries in multijoint movement tasks more than 2 years following anterior cruciate ligament reconstruction. Journal of Orthopaedic Science. 2011 Sep 1;16(5):531.</ref>.     


'''Abnormal movement patterns''' are often present bilaterally. changes in kinetics and kinematics of both knees. Studies report higer peak knee angles, moments, and joint powers relative to controls<ref name=":1" />.   
'''Abnormal movement patterns''' are often present bilaterally. changes in kinetics and kinematics of both knees. Studies report higer peak knee angles, moments, and joint powers relative to controls<ref name=":1" />. 3-dimensional biomechanical analyses and postural stability testing reported hip rotation moment changes during landing in uninvolved side, frontal-plane knee motion during landing, sagittal-plane knee moment asymmetries at initial contact, and deficits in postural stability on the reconstructed limb<ref name=":2" />.   


The development of '''compensatory sttrategies of the uninvolved hip'''  is considered to be the primary predictor of risk in athletes who sustained a second ACL injury within the first year of return to play<ref>Paterno MV, Schmitt LC, Ford KR, Rauh MJ, Myer GD, Huang B, Hewett TE. Biomechanical measures during landing and postural stability predict second anterior cruciate ligament injury after anterior cruciate ligament reconstruction and return to sport. The American journal of sports medicine. 2010 Oct;38(10):1968-78.</ref>.   
The development of '''compensatory sttrategies of the uninvolved hip'''  is considered to be the primary predictor of risk in athletes who sustained a second ACL injury within the first year of return to play<ref name=":2">Paterno MV, Schmitt LC, Ford KR, Rauh MJ, Myer GD, Huang B, Hewett TE. Biomechanical measures during landing and postural stability predict second anterior cruciate ligament injury after anterior cruciate ligament reconstruction and return to sport. The American journal of sports medicine. 2010 Oct;38(10):1968-78.</ref>. Engaging both limbs in rehabilitaiton is a necceity<ref name=":1" />. 
 
'''Sex''' may be a contributing factor to secondary ACL injury. Graft rupture is more likely to occurin men, according to a 15 year cohort<ref>Leys T, Salmon L, Waller A, Linklater J, Pinczewski L. Clinical results and risk factors for reinjury 15 years after anterior cruciate ligament reconstruction: a prospective study of hamstring and patellar tendon grafts. The American journal of sports medicine. 2012 Mar;40(3):595-605.</ref>. Another study reported no difference between sexes in graft rupure, however, contralateral injury was higher in female athletes<ref>Shelbourne KD, Gray T, Haro M. Incidence of subsequent injury to either knee within 5 years after anterior cruciate ligament reconstruction with patellar tendon autograft. The American journal of sports medicine. 2009 Feb;37(2):246-51.</ref>. 
 
'''Young athletes''' are at a higher risk of re-injury and also to contralateral injury <ref name=":1" />.   
 
=== Prevention of Re-injury ===
Revision of ACL reconstruction has poor outcomes with regards to functional performance and knee OA. However, about 25% of athletes undergo a second revision within 6 years of the primary ACL revision<ref>Battaglia MJ, Cordasco FA, Hannafin JA, Rodeo SA, O'brien SJ, Altchek DW, Cavanaugh J, Wickiewicz TL, Warren RF. Results of revision anterior cruciate ligament surgery. The American journal of sports medicine. 2007 Dec;35(12):2057-66.</ref>. Efforts should be made to ensure the elimination of such process.     


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ACL Re-injury[edit | edit source]

Despite advancement in surgical procedures, outocmes following ACL-reconstruction continue to be poor. less than 50% of athletes is able to regain their pre-injury level of performance[1], and for thoses who returned successfully to sport re-injury remains a risk factor.

Athletes who suffered ACL injuries are at risk of recurrence in the first year, and often in the second year, upon returning to play. The incidence of re-injury in the first two years following reconstruction is estimated to be 6 times greater than thise who didn't suffer ACL injury, this incidence is much higher in female athlets[2]. A study reported 29.5% ACL re-injury in the second year with 20% sustaining a contralateral injury[2]. The risk of re-injury extends up to 5 years following injury[3].

Risk factors of primary and second ACL injury have been investigated widely in the literature. Biomechanical factors such as abnormal loading distribution patters around the knee, increased external knee abduction moment in females[4], side-to-side differences in lower extremities, frontal-plane displacement of the trunk[5] and reduced lower extremity aflexor activation in vertical jump[6] have been associated with ACL injury.

Re-injury Risk Factors[edit | edit source]

Quadriceps weakness is a common persisting issue after surgery[7] which is manifested through abnormal loading patterns in gait and sports activities.A deficit of about 20% of quadriceps strength compared to he opposite side is found in athletes after ACL recosntruction. However, even a 90% quadriceps index is not neccesarily associated with normal neuro-muscular control.

Asymetry in the kinematics and differences in moment arm between involved side joints compared to the other side is another factor that continues to manifest years following surgery[8].

Abnormal movement patterns are often present bilaterally. changes in kinetics and kinematics of both knees. Studies report higer peak knee angles, moments, and joint powers relative to controls[7]. 3-dimensional biomechanical analyses and postural stability testing reported hip rotation moment changes during landing in uninvolved side, frontal-plane knee motion during landing, sagittal-plane knee moment asymmetries at initial contact, and deficits in postural stability on the reconstructed limb[9].

The development of compensatory sttrategies of the uninvolved hip is considered to be the primary predictor of risk in athletes who sustained a second ACL injury within the first year of return to play[9]. Engaging both limbs in rehabilitaiton is a necceity[7].

Sex may be a contributing factor to secondary ACL injury. Graft rupture is more likely to occurin men, according to a 15 year cohort[10]. Another study reported no difference between sexes in graft rupure, however, contralateral injury was higher in female athletes[11].

Young athletes are at a higher risk of re-injury and also to contralateral injury [7].

Prevention of Re-injury[edit | edit source]

Revision of ACL reconstruction has poor outcomes with regards to functional performance and knee OA. However, about 25% of athletes undergo a second revision within 6 years of the primary ACL revision[12]. Efforts should be made to ensure the elimination of such process.

Sub Heading 3[edit | edit source]

References[edit | edit source]

  1. ↑ Dunn WR, Spindler KP, Moon Consortium. Predictors of Activity Level 2 Years After Anterior Cruciate Ligament Reconstruction (ACLR) A Multicenter Orthopaedic Outcomes Network (MOON) ACLR Cohort Study. The American journal of sports medicine. 2010 Oct;38(10):2040-50.
  2. ↑ 2.0 2.1 Paterno MV, Rauh MJ, Schmitt LC, Ford KR, Hewett TE. Incidence of second ACL injuries 2 years after primary ACL reconstruction and return to sport. The American journal of sports medicine. 2014 Jul;42(7):1567-73.
  3. ↑ Salmon L, Russell V, Musgrove T, Pinczewski L, Refshauge K. Incidence and risk factors for graft rupture and contralateral rupture after anterior cruciate ligament reconstruction. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2005 Aug 1;21(8):948-57.
  4. ↑ Hewett, T.E., Myer, G.D., Ford, K.R., Heidt Jr, R.S., Colosimo, A.J., McLean, S.G., Van den Bogert, A.J., Paterno, M.V. and Succop, P., 2005. Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: a prospective study. The American journal of sports medicine, 33(4), pp.492-501.
  5. ↑ Zazulak BT, Hewett TE, Reeves NP, Goldberg B, Cholewicki J. Deficits in neuromuscular control of the trunk predict knee injury risk: prospective biomechanical-epidemiologic study. The American journal of sports medicine. 2007 Jul;35(7):1123-30.
  6. ↑ Hewett TE, Myer GD, Ford KR, Heidt Jr RS, Colosimo AJ, McLean SG, Van den Bogert AJ, Paterno MV, Succop P. Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: a prospective study. The American journal of sports medicine. 2005 Apr;33(4):492-501.
  7. ↑ 7.0 7.1 7.2 7.3 Hewett TE, Di Stasi SL, Myer GD. Current concepts for injury prevention in athletes after anterior cruciate ligament reconstruction. The American journal of sports medicine. 2013 Jan;41(1):216-24.
  8. ↑ Castanharo R, Da Luz BS, Bitar AC, D’Elia CO, Castropil W, Duarte M. Males still have limb asymmetries in multijoint movement tasks more than 2 years following anterior cruciate ligament reconstruction. Journal of Orthopaedic Science. 2011 Sep 1;16(5):531.
  9. ↑ 9.0 9.1 Paterno MV, Schmitt LC, Ford KR, Rauh MJ, Myer GD, Huang B, Hewett TE. Biomechanical measures during landing and postural stability predict second anterior cruciate ligament injury after anterior cruciate ligament reconstruction and return to sport. The American journal of sports medicine. 2010 Oct;38(10):1968-78.
  10. ↑ Leys T, Salmon L, Waller A, Linklater J, Pinczewski L. Clinical results and risk factors for reinjury 15 years after anterior cruciate ligament reconstruction: a prospective study of hamstring and patellar tendon grafts. The American journal of sports medicine. 2012 Mar;40(3):595-605.
  11. ↑ Shelbourne KD, Gray T, Haro M. Incidence of subsequent injury to either knee within 5 years after anterior cruciate ligament reconstruction with patellar tendon autograft. The American journal of sports medicine. 2009 Feb;37(2):246-51.
  12. ↑ Battaglia MJ, Cordasco FA, Hannafin JA, Rodeo SA, O'brien SJ, Altchek DW, Cavanaugh J, Wickiewicz TL, Warren RF. Results of revision anterior cruciate ligament surgery. The American journal of sports medicine. 2007 Dec;35(12):2057-66.
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