ECSS Paris 2023: CP-MH27
INTRODUCTION: Female athletes face a 2-8 times higher likelihood of sustaining an ACL injury compared to their male counterparts. Reinjury rates following ACL reconstruction (ACLR) are notably high, ranging from 20-30%. Decisions on return to sports (RTS) are often based on time rather than objective measures. Current RTS testing for ACL injuries primarily assesses quadriceps strength and hop test symmetry, overlooking crucial performance gaps and asymmetries that are vital for athletic success. Rehabilitation and RTS protocols have predominantly been developed using male-centric models, which do not fully address the unique biomechanical and neuromuscular factors that influence recovery and performance in females. This study explored the differences between genders in ACL RTS testing, incorporating patient-reported outcomes (PROs), balance, strength, and single-leg (SL) jump performance metrics. METHODS: Athletes who were 8-12 months from ACLR surgery and aged 15-17 years (N= 55; female = 31, male = 24) performed an ACL RTS test battery that included PROs (GRIT, IKDC, ACL-RSI), y-balance, SL hop, SL triple hop, SL countermovement jump (CMJ) using force plates, and isokinetic dynamometry. RESULTS: A Principal Component Analysis (PCA) identified key variables that differentiate ACLR athletes. Principal component one (PC1) explained 25% of the variance that was primarily driven by the involved limb in SL hop (female = 110.6±26.83cm; male = 151.6±30.73cm), SL CMJ jump height Imp-Mom (female = 8.9±3.06cm; male = 14.2 ± 4.37cm), peak power (female = 22.2±3.85W/kg; male = 29.1±5.65W/kg), concentric impulse (female = 82.2±18.76Ns; male = 124.8±26.09Ns), and peak landing force (female = 29.7±4.69N/kg; male = 35.7±5.82N/kg). Uninvolved limbs, as well as isokinetic quad and hamstring strength (60 deg/s), and SL triple hop, contributed to a small proportion of the variance. There were no differences in PROs and y-balance. CONCLUSION: Significant gender differences in neuromuscular performance extend beyond the affected limb, reflecting both local and systemic adaptations that occur 8-12 months following ACLR. Force plate testing revealed critical neuromuscular deficits that are frequently overlooked in standard RTS protocols for ACL rehabilitation that do not incorporate force plate testing. These deficits involve gender-specific variations with asymmetry across the sequence of a CMJ (concentric impulse, peak power, and landing force), implying training gaps in force application, propulsion, and landing mechanics. This may be a result of a younger training age in which these athletes have less experience with strength training and plyometrics that would address neuromuscular control and proper biomechanics. Female athletes may require additional focused interventions during rehabilitation to address more aspects of neuromuscular performance due to their lower training ages and different levels of competition.
Read CV Lucy PhanECSS Paris 2023: CP-MH27
INTRODUCTION: Although the effectiveness of preoperative training before anterior cruciate ligament (ACL) reconstruction is well-established, there is ongoing debate regarding its optimal structure, including the specific components, degree of supervision (one-on-one guidance or self-administered training) and overall framework. This study evaluated the effectiveness of an individually tailored, adaptive, guided, structured, and criteria-based preoperative rehabilitation program in contrast to a non-guided, self-administered home training program in individuals with an ACL rupture. METHODS: Participants with an unilateral complete ACL rupture, scheduled to an arthroscopic ACL-reconstruction with a hamstrings or quadriceps autograft in >3 weeks after inclusion were included. They were investigator-blinded block-randomised using an 1:1 allocation to one of the following groups: intervention group (structured, criteria-based, guided prehabilitation training) and comparator group (non-guided, self-administered home training). After ACL reconstruction, patients of both groups participated in a standard, postoperative rehabilitation program. Self-reported knee function (KOOS sum score) was the primary outcome and assessed at six specified time points: during the initial anamnesis in the hospital (t1), 1-7 days prior to ACL reconstruction (t2), and at 30 (t3), 60 (t4), 90 (t5), and 180 (t6) days postoperatively. The analyses were conducted based on an intention-to-treat basis, linear mixed models for the change scores to t1 were calculated. RESULTS: In the 114 enrolled participants (mean age M = 31.03 years, SD = 10.30 years; 47% males, 53% females), the ACL rupture injuries occurred while playing football (37%), while skiing (26%), others (37%). After study commencement, 59 participants discontinued intervention or withdrew consent during the course of the study. The intervention group (KOOS score M1: mean = 46.04, 95% confidence interval = [45.07 to 47.02]; M2: 58.52, [57.51 to 59.54]) demonstrated a more pronounced preoperative improvement from t1 to t2 in the KOOS score compared to the comparator group (KOOS score M1: 51.01, [50.10 to 51.92]; M2: 59.18, [58.40 to 59.96]). The interaction (group*time) of the KOOS score reached significance for the change score from t1 to t3 (p = 0.039) and to t5 (p = 0.039). CONCLUSION: An individually tailored, adaptive, guided, structured, and criteria-based preoperative rehabilitation program improved perceived knee function more than self-guided training. However, the evidence is limited as the effects are small. Self-administered training presents the challenge of maintaining self-motivation due to the absence of structured scheduling and personal guidance while guided training is more structured and more accountable.
Read CV Rebecca AbelECSS Paris 2023: CP-MH27
INTRODUCTION: While medial meniscus extrusion (MME) is one of the potential contributors to developing knee joint complications, the relative degree of MME and its response to running in individuals with a history of knee joint surgery remain unclear. This study evaluated whether the MME in individuals with meniscus surgery, anterior cruciate ligament reconstruction (ACLR), and healthy individuals differ before and after 30-min of treadmill running. METHODS: A total of 63 subjects (21 individuals each in meniscus surgery: 30.0 years, 172.5 cm, 74.4 kg, time since surgery: 47.9 months; ACLR: 27.0 years, 174.2 cm, 76.2 kg, time since surgery: 44.4 months; and healthy control: 24.9 years, 171.3 cm, 68.7 kg). Ultrasonographic images using a 12 MHz linear probe (gain: 20 Db; dynamic range: 50 dB; frame rates: 30 fps; depth: 3 cm) of the MME in the supine and standing positions [1] were obtained before and after 30-min of treadmill running at a self-selected moderate intensity (running speed to correspond to the Borg’s Perceived Rate of Exertion of the 5-6 /10 scale) [2]. Running speed, heart rate, and step count were compared between groups to assess running intensity. Data were analyzed using analysis of variance and Tukey-adjusted post hoc tests (p<0.05) with effect sizes (d). RESULTS: MME in the supine position was different (group by time: F2,60=8.00, p=0.0008) that individuals with meniscus surgery showed a 13% increase in MME after running (p=0.01, d=0.57). MME in the standing position was different (group by time: F2,60=3.42, p=0.04), but Tukey-adjusted pairwise comparisons did not identify any statistical differences (p>0.16 for all tests). Statistical trends were observed that individuals with ACLR showed greater MME than those with meniscus surgery (supine: −16%, p=0.09, d=0.68; standing: −11%, p=0.19, d=0.56) and control group (supine: −12%, p=0.10, d=0.68; standing: −14%, p=0.16, d=0.69) group before running. The running speed (F2,60=1.16, p=0.32), heart rate (F2,60=0.70, p=0.50) and step count (F2,60=1.92, p=0.16) during 30-min treadmill running did not differ between groups. CONCLUSION: While limited data are available on change in MME in response to functional movements, our results provide meaningful clinical insights into MME morphology, suggesting that (1) running activity may immediately induce further extrusion of the medial meniscus in individuals who have undergone meniscus surgery and (2) individuals with ACLR may have greater MME than those with meniscus surgery healthy controls. References: 1. Seo, D., and Park, J. Ultrasonography assessments of talar cartilage and ATFL after running in chronically unstable, coper, and healthy ankles: a case-control study. Physiother Theory Pract, 2024. In Press. 2. Savage, N.J., Bell-Linnear K., Heston, D., et al. Ultrasonographic evaluation of medial meniscal extrusion during common orthopedic physical therapy examination procedures: An observational study. JOSPT Open, 2024. 2(2): p.134-140.
Read CV Eunkyu KangECSS Paris 2023: CP-MH27