Sports Health-A Multidisciplinary Approach最新文献

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.

Background: Subjective patient-reported outcome measures (PROMs) and physical performance tests are important tools for assessing rehabilitation after anterior cruciate ligament reconstruction (ACLR). However, the associations and interrelationships between PROMs and dual-task jump performance, and sex-specific differences among patients with ACLR remain unclear.

Hypothesis: Associations exist between PROMs and dual-task jump performance, and do not differ between men and women with ACLR.

Study design: Controlled laboratory study.

Level of evidence: Level 3.

Methods: A total of 44 sports-active people with ACLR (50% men; mean [SD] 25.4 [16.0] months postsurgery) completed the International Knee Documentation Committee Subjective Knee Form (IKDC-SKF), the Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) scale, and a dual-task drop vertical jump test. The test incorporated cognitive challenges targeting short-term memory, attention, fast decision-making, and inhibitory control. Dual-task performance was quantified as the percentage of correctly completed memory and motor trials. Associations were analyzed using partial correlations, controlling for time post-ACLR.

Results: Across all participants, no significant correlations were observed between dual-task performance and ACL-RSI or IKDC-SKF scores (r = 0.02-0.14; P = 0.37-0.92). Women demonstrated positive correlations (r = 0.39-0.40; P = 0.07-0.08) with both PROMs, suggesting a potential association, although shallow linear slopes, whereas men showed negative, nonsignificant correlations (r = -0.10 to -0.36; P = 0.11-0.65). A high and significant correlation was found between ACL-RSI and IKDC-SKF scores among women (r = 0.76; P < 0.01) but not men (r = 0.36; P = 0.11).

Conclusion: After ACLR, ACL-RSI and IKDC-SKF scores were not significantly associated with dual-task jump performance. However, women showed greater consistency between the 2 PROMs than men.

Clinical relevance: The ACL-RSI, IKDC-SKF, and dual-task jump performance capture distinct aspects of recovery, potentially reflecting different biopsychosocial constructs, highlighting the importance of considering sex-specific factors in post-ACLR rehabilitation and assessment.

Background: Foot strike type affects running mechanics and may influence overuse injury occurrence. Measuring the interaction between cumulative load and foot strike type may provide additional information that could increase understanding of injury mechanisms.

Hypothesis: There will be no differences in cumulative loading between runners using rearfoot strike (RFS) and nonrearfoot strike (NRFS) patterns. NRFS runners will have a greater stride rate. There will be differences in per stride metrics of select lower extremity mechanics.

Study design: Observational laboratory study.

Level of evidence: Level 3.

Methods: Thirty male participants (age, 22.7 ± 2.9 years; height, 1.79 ± 0.07 m; mass, 70.7 ± 7.86 kg; mean ± SD) ran on an instrumented treadmill for 5 km at 3.15 m/s with their preferred foot strike type (14 RFS, 16 NRFS). Stride rate, foot strike angle, loading rate (LR), per stride and per kilometer (cumulative) vertical ground-reaction force (VGRF) impulse, impact peak, absolute peak, knee negative work, and ankle negative work were calculated and compared across time and between groups.

Results: Per stride differences were seen for stance time, foot strike angle, and LR (greater for RFS runners, P = 0.003). Per stride and cumulative ankle and knee negative work showed significant differences (greater ankle negative work for NRFS runners, P < 0.001 [per stride and cumulative], greater knee negative work for RFS runners, P = 0.01 per stride, P = 0.008 cumulative).

Conclusion: Ankle and knee loading metrics showed differences in per stride and cumulative metrics between foot strike groups. Individual variability in VGRF loading patterns was more apparent than group distinctions. The common perception that NRFS runners have a higher stride rate was not supported.

Clinical relevance: Individual loading patterns, not just foot strike type, and training session characteristics related to cumulative load should be considered when assessing injury risk.

Background: Arthroscopic hip surgery for femoroacetabular impingement syndrome (FAIS) has high rates of return to sport; however, patient return to long-distance running is unclear.

Hypotheses: (1) Long-distance runners undergoing arthroscopic hip surgery for FAIS are a distinctive subgroup in terms of demographics, hip injury characteristics, and running metrics. (2) Most patients will return to general running but a lower proportion return to long-distance running after arthroscopic hip surgery.

Study design: Case series.

Level of evidence: Level 4.

Methods: An institutional hip preservation registry was reviewed retrospectively for long-distance runners (half marathons, marathons) who underwent primary hip arthroscopies for FAIS between March 2008 and January 2018. Patient demographics, injury characteristics, and clinical and radiographic findings were recorded. Multivariable logistic regression analysis identified potential risk factors for not returning to long-distance running.

Results: Sixty-eight (78 hips) long-distance runners (mean patient age, 37.8 ± 8.9 years; 38 (56%) female; mean weekly running mileage before injury, 34.5 ± 16.9 miles) were included. Overall, 50 runners (74%) returned to any running, of which 25 (50%) returned to long-distance running, completing half/full marathons races after surgery. Most common reasons for not returning to running were pain or discomfort (50%) followed by fear of reinjury (22%), and additional different injuries (22%). Multivariable logistic regression analysis revealed female runners (odds ratio, 0.2; CI, 0.0-0.9; P = 0.03) were less likely to return to long-distance running.

Conclusion: Most (74%) long distance runners returned to running after hip arthroscopic treatment for FAIS; however, only 37% returned to long-distance running. Satisfaction from surgery was not necessarily associated with return to running. Female long-distance runners were less likely to return to long-distance running after surgery.

Clinical relevance: Study findings provide helpful context for clinicians counseling patients with symptomatic FAIS who are considering hip arthroscopy and are concerned about return to long-distance running.

Background: People suffering anterior cruciate ligament (ACL) injuries are at increased risk for development of osteoarthritis (OA). This study investigated associations between daily step count, cartilage degeneration and patient-reported outcomes 2 years after ACL reconstruction (ACLR).

Hypothesis: Daily step count is associated with cartilage health and patient-reported knee symptoms and function 2 years after ACLR.

Study design: Cross-sectional.

Level of evidence: Level 4.

Methods: We analyzed data from 34 patients (18 female), aged 33.4 ± 10.8 years with stable knees recruited from the community 2 years after primary ACLR. Mean daily step count was measured using an activity tracker (FitBit) over a 7-day collection period. Cartilage morphology on magnetic resonance imaging (MRI) was graded across multiple joint areas. Knee symptoms and function were assessed by the Knee injury and Osteoarthritis Outcome Score (KOOS) subscales pain, symptoms, activity of daily living (ADL), sport/recreation (sport/rec), and knee-related quality of life (QoL) using published thresholds for patient acceptable symptom state (PASS). Analyses were adjusted for age, sex, and body mass index.

Results: The mean (SD) daily step count was 9276 (3199). At least 1 cartilage abnormality was present on morphological MRI in 20% of ACLR knees. The mean (SD) KOOS values were: pain 94 (7), symptoms 92 (8), ADL 91 (10), function in sport/rec 85 (14), and knee-related QoL 56 (22). Failure to achieve PASS rates were 76% for ADL; 59% for QoL, 18% for pain, 35% for sport/rec, and 0% for symptoms.

Conclusion: Daily step count was not associated with cartilage health or knee symptoms and function 2 years after ACLR. However, a high proportion of participants with reported unacceptable ADL and QoL 2 years after ACLR.

Clinical relevance: The proportion with unacceptable PASS for ADL and QoL in participants with stable knees after ACLR indicates a need to optimize rehabilitation and improve post-ACLR recovery.

Context: Lateral extra-articular tenodesis (LET) and anterolateral ligament (ALL) reconstruction have been adopted by some surgeons as augmentations during anterior cruciate ligament reconstruction (ACLR) to improve anterolateral rotatory instability.

Objective: The objective of this study was to assess the statistical robustness of outcomes reported in randomized controlled trials (RCTs) assessing the clinical significance of LET and ALL reconstruction in ACLR.

Methods: PubMed, Embase, and MEDLINE were systematically searched. RCTs published January 1, 2010 to December 31, 2024 assessing LET and ALL reconstruction during ACLR were included. Fragility index (FI) or reverse FI (rFI) was calculated for each outcome, representing the number of event reversals required to alter statistical significance for significant and nonsignificant outcomes, respectively. The fragility quotient (FQ) was determined by dividing the FI or rFI by sample size.

Level of evidence: Level 1.

Results: Of 112 RCTs screened for inclusion, 17 were included for analysis, resulting in 51 total outcomes. The median FI across the 51 outcomes was 4 [interquartile range (IQR), 2-7] with an associated median FQ of 0.031 (IQR, 0.014-0.049). Statistically significant outcomes were more fragile (median FI, 3.5; median FQ, 0.015) than statistically nonsignificant outcomes (median rFI, 5; median FQ, 0.038). In 60.8% of all outcomes (31 of 51), the number of patients lost to follow-up was greater than the outcome's respective FI or rFI. In the 7 RCTs assessing LET, the median FQ was 0.015 (IQR, 0.012-0.042) across 23 outcomes. In the 10 RCTs assessing ALL, the median FQ was 0.035 (IQR, 0.019-0.051) across 28 outcomes. Graft failure, pivot shift, and Lachman/anterior laxity were the most common outcome categories reported, with median FQs of 0.017, 0.035, and 0.048, respectively.

Conclusion: Outcomes reported in RCTs for LET and ALL reconstruction as augments of ACLR are statistically fragile, emphasizing the need for additional robust and adequately powered RCTs to better understand the impact of anterolateral augmentation on ACLR outcomes.