Sports Health-A Multidisciplinary Approach最新文献

Background: The ability to identify patients with long-term poor outcomes using clinical and functional information is limited. Identifying prognostic factors to improve long-term outcomes after anterior cruciate ligament (ACL) injury can influence and inform targeted interventions for this population.

Hypothesis: Preoperative functional tests and patient-reported outcome measures are predictive of postoperative functional recovery and satisfaction in patients undergoing first-time ACL repair, second-time ACL repair on the same knee, and bilateral ACL repair.

Study design: Quasi-experimental prospective study.

Level of evidence: Level 3.

Methods: A total of 88 patients with ACL reconstruction were included. Subjective knee scoring systems and functional performance tests were used for evaluation and analyzed for correlation with results.

Results: The first time ACL injury group had lower scores in the various self-report scales: Knee injury and Osteoarthritis Outcome Score (KOOS), Lysholm Rating Scale, International Knee Documentation Committee (IKDC), and Lower Extremity Functional Scale (LEFS).

Conclusion: Reduction in self-reported knee function and Y balance test performance after ACL injury are predictive factors for recovery. Estimates exceeded clinically important thresholds. Those who had already undergone surgery had clinically better thresholds, highlighting the assessing these measures when designing presurgical rehabilitation programs.

Background: Undergoing anterior cruciate ligament (ACL) reconstruction (ACLR) does not normalize the asymmetric knee biomechanics during gait that are related to the later development of post-traumatic osteoarthritis. ACL rupture and reconstruction have negative neuromuscular implications, disrupting knee joint afferent inputs that may be essential for central nervous system adaptability and motor learning. Here, we examined the ability of patients after ACLR to adapt knee joint biomechanics using a split-belt treadmill locomotor learning paradigm compared with uninjured controls.

Hypothesis: Patients after ACLR will be able to adapt and retain their knee joint mechanics, but to a lesser extent than controls.

Study design: Cross-sectional study.

Level of evidence: Level III.

Methods: We examined neuromuscular adaptations (ie, motor learning) using an evidence-based split-belt treadmill adaptation paradigm in 15 patients (20.8 ± 3.5 years old, 9 female), 3 to 9 months after ACLR and 15 control patients. During adaptation, the 2 treadmill belts were split (ie, moving at different speeds) to induce motor learning of new knee joint kinematic patterns. Three-dimensional motion capture was used to record joint kinematics and assess adaptation of knee flexion and extension angles. We also measured quadriceps strength, knee joint proprioception, and other markers of ACLR recovery.

Results: After ACLR, patients showed flexibility in motor patterns for peak knee flexion and extension angles. Our data showed no difference between patients after ACLR and uninjured controls in the extent of adaptation of either kinematic variable.

Conclusion: These data suggest that knee kinematics are malleable during rehabilitation, and demonstrate adaptability in the nervous system for knee joint angles during gait.

Clinical relevance: Current clinical interventions and evidence-based rehabilitation programs have not been successful in restoring gait mechanics. The current work indicates motor learning-based approaches can modify knee joint kinematics and therefore may be worthy of consideration in future interventions to address poor gait mechanics after ACLR.

Background: Kinetic and kinematic side-to-side limb asymmetries can increase after anterior cruciate ligament reconstruction (ACLR). Limb stiffness asymmetry has not been previously explored.

Hypothesis: Athletes with ACLR will exhibit greater asymmetry in limb stiffness, peak eccentric joint power, and eccentric joint work compared with asymptomatic controls during landing.

Study design: Case-control study.

Level of evidence: Level 4.

Methods: Forty athletes with 5.9 ± 1.4 months removed from ACLR and 40 asymptomatic athletes completed 7 stop-jumps (SJs) during a single session. Three-dimensional motion capture and ground-reaction force data were collected during landing. Normalized symmetry index values for limb stiffness, peak eccentric joint power, and eccentric joint work of athletes with bone-patellar tendon-bone (BPTB) grafts, athletes with hamstring grafts, and control athletes were compared.

Results: Athletes with ACLR had greater knee power Athletes with ACLR had greater knee power (BPTB, 29.1 ± 17.6; hamstring, 27.3 ± 14.1; Control, 14.2 ± 10.7; P < 0.01) and knee work (BPTB, 35.2 ± 21.5; hamstring, 32.1 ± 18.4; Control, 14.9 ± 10.1; P < 0.01) asymmetries than control athletes. Athletes with BPTB grafts and hamstring grafts both displayed larger knee power and work asymmetries compared with control athletes (P < 0.01 for each comparison), with no differences between graft types (P = 0.90 and P = 0.80, respectively). No between-group differences were found in limb stiffness (BPTB, 16.2 ± 10.8; hamstring, 13.5 ± 9.83; Control, 13.9 ± 9.33; P = 0.63), ankle power (BPTB, 16.5 ± 11.4; hamstring, 14.4 ± 13.0; Control, 18.3 ± 14.0; P = 0.55), ankle work (BPTB, 20.9 ± 13.0; hamstring, 17.4 ± 14.9; Control, 18.4 ± 12.8; P = 0.69), hip power (BPTB, 17.6 ± 12.8; hamstring, 19.5 ± 11.3; Control, 13.3 ± 9.08; P = 0.09), or hip work (BPTB, 17.2 ± 13.9; hamstring, 24.6 ± 14.1; Control, 16.2 ± 11.7; P = 0.06) asymmetries.

Conclusion: Athletes with ACLR use asymmetric landing strategies that favor their nonsurgical limb, resulting in greater knee power and knee work asymmetries compared with controls. No between-group asymmetry differences in limb stiffness, ankle power and work, and hip power and work were found.

Clinical relevance: After 5.9 ± 1.4 months removed from ACLR surgery, athletes favor their nonsurgical limb at the knee, risking further injury. While limb stiffness asymmetry was not different between groups, the groups appeared to modulate limb stiffness differently between limbs to produce similar asymmetry values.

Background: Running biomechanics can influence injury risk, but whether the combined effect of different biomechanical factors can be identified by individual running profiles remains unclear. Here, we identified distinct biomechanical profiles among healthy runners, examined lower limb mechanical load characteristics, and evaluated potential implications for injury risk.

Hypothesis: Multiple factors would serve as a common denominator allowing identification of specific patterns.

Study design: Cross-sectional.

Level of evidence: Level 2.

Methods: Step cadence, stance time, vertical oscillation, duty factor, vertical stiffness, peak ground reaction force (GRF), and anteroposterior, lateral, and vertical smoothness were determined from 3-dimensional kinematic data from 79 healthy runners using a treadmill at 2.92 m/s. Principal component analysis, self-organizing maps, and K-means clustering techniques delineated distinct biomechanical running profiles. Mutual information analysis, Kruskal-Wallis, and Pearson's Chi-squared tests were conducted.

Results: Five biomechanical profiles (P1-P5) demonstrated different running mechanical characteristics: P1 exhibited low cumulative and peak mechanical load due to a combination of high duty factor, low step cadence, and longer stance time; P2 showed characteristics associated with the lowest peak mechanical load due to reduced peak GRF and greater smoothness; P3 and P5 showed contrasting running patterns, but maintained moderate smoothness and peak GRF; and P4 exhibited the highest peak mechanical load, driven by high GRF, low duty factor, and high vertical oscillation.

Conclusion: The 5 profiles appear to be associated with different lower limb load patterns, highlighting previously unrecognized connections between biomechanical variables during running. Some variables contribute to increased peak and cumulative load, whereas others help reduce it, underscoring the complex interplay of biomechanical factors in running.

Clinical relevance: Identifying distinct running profiles can help clinicians better understand individual variations in mechanical load and injury risk, thus informing targeted interventions, such as personalized training adjustments or rehabilitation programs, to prevent injuries and enhance performance in runners.

Background: The isokinetic dynamometer is the "gold standard" equipment for assessing muscle strength after anterior cruciate ligament reconstruction (ACLR); however, its high cost limits its use in clinical practice. The hand-held dynamometer (HHD) and performance-based tests are alternative methods.

Hypothesis: The single leg bridge test (SLBT) and HHD are reliable and valid for assessing knee flexor strength compared with isokinetic dynamometer and knee-specific patient-reported outcomes after ACLR.

Study design: Cross-sectional study.

Level of evidence: Level 4.

Methods: A total of 127 participants with ACLR ≥6 months previously were evaluated using the International Knee Documentation Committee (IKDC) Subjective Knee Form, the Anterior Cruciate Ligament - Return to Sport after Injury (ACL-RSI) questionnaire, the SLBT, the HHD, and the isokinetic dynamometer.

Results: The SLBT showed good test/retest reliability in both limbs (intraclass correlation coefficient [ICC]_2,1 = 0.85-0.87), moderate-to-good criterion validity with an isokinetic dynamometer (r = 0.53), and moderate-to-good construct validity with IKDC and ACL-RSI (r = 0.42 and 0.43). An HHD showed good test/retest reliability (ICC_2,1 = 0.85-0.89), moderate-to-good criterion validity with an isokinetic dynamometer (r = 0.42), and none-to-weak construct validity with IKDC and ACL-RSI (r = 0.07 and 0.23). The limb symmetry index (LSI) of the SLBT and HHD showed weak validity with the isokinetic dynamometer (r = 0.23 and 0.24).

Conclusion: Compared with the isokinetic dynamometer, the SLBT and HHD showed good reliability and moderate-to-good validity. However, the LSIs showed weak correlations with the gold standard.

Clinical relevance: When isokinetic testing is not possible, clinicians can use SLBT and HHD to assess knee flexor muscle strength in patients after ACLR. However, we do not recommend using the LSI of the SLBT and HHD for clinical decision making.

Background: Walkovers (WOs) and Defaults are significant occurrences in professional tennis, leading to uncompleted matches. WOs typically result from injuries, illnesses, or unforeseen circumstances, while Defaults stem from code of conduct violations. Understanding their epidemiology is essential for optimizing competition structure and injury prevention strategies.

Hypotheses: The incidence of WOs in Women's Tennis Association (WTA) tournaments increases over time. Both WOs and Defaults are associated with competition-related factors.

Study design: Retrospective cohort study.

Level of evidence: Level 3.

Methods: A total of 706,816 singles matches from WTA tournaments between 1975 and 2024 were analyzed. To assess the occurrence of WOs and Defaults, potential associated factors were analyzed using absolute and relative epidemiological measures.

Results: The overall incidence of WOs was 5.3 per 1000 matches (95% CI, 5.13-5.47), with a slight increase observed in recent years. The WTA Tour recorded the highest incidence (incidence proportion [IP], 5.62; 95% CI, 5.28-5.98). WOs were most frequent in qualifying rounds (IP, 8.09; 95% CI, 7.66-8.55), final rounds (IP, 7.22; 95% CI, 6.75-7.73), and on carpet courts (IP, 7.21; 95% CI, 6.39-8.11). Defaults were extremely rare, with an overall incidence of 0.15 per 1000 matches (95% CI, 0.12-0.18). The highest Default incidence was recorded in qualifying rounds (IP, 0.20; 95% CI, 0.14-0.28) and was most frequent on hard courts (IP, 0.17; 95% CI, 0.13-0.22).

Conclusion: Competitive structure and playing surface play a role in the occurrence of WOs and Defaults. These findings underscore the importance of injury prevention strategies, fair play policies, and player support systems to minimize disruptions in competition.

Clinical relevance: Understanding the epidemiology of WOs and Defaults can help inform injury prevention strategies, optimize tournament formats, and guide policy development to reduce uncompleted matches in the WTA.

Background: Considering limb dominance (LD) may be valuable when utilizing limb symmetry index (LSI) when assessing patients after anterior cruciate ligament reconstruction (ACLR).

Hypothesis: Patients will have better performance-based outcomes when index ACLR occurred on the dominant limb (DL) compared with the nondominant limb (NDL).

Study design: Observational cross-sectional study.

Level of evidence: Level 3.

Methods: A total of 279 patients (49.1% female, 20.83 ± 5.23 years; 48% DL surgery) completed a laboratory visit (7.65 ± 1.65 months post-ACLR) assessing LD influence on knee extension and flexion peak torque, center of pressure (COP) distance and velocity, and hop performance. LD was defined as the preferred limb to kick a soccer ball. LSI variables were converted to indicator variables and categorized as "Pass" or "Fail" based on LSI ≥ 90%.

Results: Patient LD and isometric knee extension LSI Pass status were significantly associated (χ² = 10.09; P = 0.001). No additional associations were found between LD and other LSI Pass status variables (P > 0.05). Patients with DL ACLR demonstrated more symmetric knee extension peak torque (P < 0.001, d = 0.42) and 6-meter hop (P = 0.02, d = 0.25) outcomes; NDL was more symmetric during COP distance tests (P = 0.03, d = 0.40). No differences were observed between LD and raw strength or balance measures (P > 0.05). Patients with ACLR on their NDL jumped farther on their contralateral limb for triple-hop (P = 0.03, d = 0.23) but not single-hop (P > 0.05) distance.

Conclusion: LD appears to influence isometric knee LSI in patients post-ACLR; patients with surgery on their DL achieved higher symmetry and a greater rate of LSI Pass success for knee extension strength.

Clinical relevance: Addressing differences in recovery patterns between DL and NDL may improve rehabilitation precision and guide return-to-activity timelines after ACLR.

Context: Interest in the relationship between psychology and the outcomes of anterior cruciate ligament (ACL) reconstruction (ACLR) continues to grow as variable rates of return to preinjury level of activity continue to be observed.

Evidence acquisition: Articles were collected from peer-reviewed sources available on PubMed using a combination of search terms, including psychology, resilience, mental health, recovery, and anterior cruciate ligament reconstruction. Further evaluation of the included bibliographies were used to expand the evidence.

Study design: Clinical review.

Level of evidence: Level 4.

Results: General mental health and wellbeing, in addition to a host of unique psychological traits (self-efficacy, resilience, psychological readiness and distress, pain catastrophizing, locus of control, and kinesiophobia) have been demonstrated convincingly to affect treatment outcomes. Moreover, compelling evidence suggests that a number of these traits may be modifiable. Although the effect of resilience on outcomes of orthopaedic surgical procedures has been studied extensively, there is very limited information linking this unique psychological trait to the outcomes of ACLR. Similarly, the available information related to other parameters, such as pain catastrophizing, is limited with respect to the existence of adequately sized cohorts capable of accommodating more rigorous and compelling analyses. A better understanding of the specific mechanisms through which psychological traits influence outcomes can inform future interventions intended to improve rates of return to preinjury level of activity after ACLR.

Conclusion: The impact of psychology on patients' responses to ACL injury and treatment represents a promising avenue for improving low rates of return to preinjury activity levels among certain cohorts. Future research into these areas should focus on specific effects of targeted interventions on known, modifiable risk factors that commonly contribute to suboptimal clinical outcomes.Strength-of-Recommendation Taxonomy (SORT):B.

Background: Anterior cruciate ligament (ACL) tears represent half of all knee injuries and are often treated surgically through ACL reconstruction. Recent attention has focused on mental health factors as potential modifiable risk factors in ACL reconstruction outcomes. However, no studies have looked at ACL reconstruction outcomes in patients with attention-deficit/hyperactivity disorder (ADHD). This study aimed to assess the effect of ADHD on 3-month, 6-month, and 3-year complications in patients undergoing ACL reconstruction.

Hypothesis: There will be increased rates of complications in ADHD patients, compared with non-ADHD patients, after ACL reconstruction.

Study design: Retrospective case-control study.

Level of evidence: Level 3.

Methods: We queried TriNetX, a global research database, to analyze patients who underwent an ACL reconstruction surgery and divided them into ADHD and non-ADHD cohorts. We examined outcomes from 1 day to 3 months, 1 day to 6 months, and 6 months to 3 years postoperatively. For the 1-day to 3-month and 6-month outcomes, we examined arthrofibrosis, infection, wound complications, revision surgery, emergency department visits, and readmission. We examined arthrofibrosis, chronic instability, and revision surgery between 6 months and 3 years. Cohorts were propensity score matched.

Results: In the 1-day to 3-month and 6-month cohorts, ADHD patients were found to have a significantly increased risk of requiring revision surgery, having wound complications, and experiencing hospital readmission compared with the non-ADHD group. ADHD patients were also more likely to return to the emergency department within 6 months. At 3 years follow-up, there were no differences between cohorts.

Conclusion: This study demonstrates that patients with ADHD who undergo ACL reconstruction are at increased risk of early revision surgery, wound complications, and hospital readmission.

Clinical relevance: These findings can be useful to healthcare professionals to help reduce the risk of complications in ADHD patients undergoing ACL reconstruction by tailoring postoperative rehabilitation protocols.