ECSS Paris 2023: OP-MH16
INTRODUCTION: In elite football, injury risk is considerable, especially in the weeks after return-to-play (RTP) from a previous injury. Consequently, optimal rehabilitation and well-informed decisions regarding the timepoint of RTP are crucial. Arguably, experiential knowledge as well as data-driven analyses may provide meaningful insights. This work aims to leverage their synergies to identify options for improving the rehab process and reduce injury risk after RTP. METHODS: Following a mixed-methods approach, semi-structured interviews were conducted with 14 practitioners in elite European football (2 orthopaedic surgeons, 5 physiotherapists, 7 rehab and / or strength-and-conditioning (S&C) coaches). Areas of overlap in the interview data were identified by thematic analysis. Subsequently, media-based injury data from European top leagues were used to investigate novel themes where possible. Specifically, we used methods of causal inference and classifier development to assess the expert opinion that a reduction in injury risk may be expected when RTP is delayed. RESULTS: 4 themes and 6 subthemes were identified. With the highest consistency and attributed importance, theme 1 posits that injury risk after RTP would be lower with longer rehab. Data analytics confirmed the previously reported negative association between rehab time and injury risk. However, this association is entirely accounted for by higher exposure after early return (“They return early for a reason.”). Importantly, the virtual absence of high exposures after long rehab (for the respective diagnosis) impedes on predicting the effect of actively prolonging rehab time. CONCLUSION: Taken together, our results point to surprisingly clear and simple options for improving rehab outcome in elite football. While data analytics did not provide evidence in favour of reduced injury risk with prolonged rehab, the massive increase in risk with high exposures after early return entails two important messages: (1) If an early return must be attempted exposure should be limited to the strict minimum. (2) If no injury occurred during initial match exposure(-s), luck should not be mistaken for evidence of low injury risk.
Read CV Anne HeckstedenECSS Paris 2023: OP-MH16
INTRODUCTION: Return to sport (RTS) after an anterior cruciate ligament (ACL) rupture and reconstruction is successfully reached when one returns to the pre-injury level of sports participation. A multitude of individual and spatiotemporal factors interact during the rehabilitation and RTS process. Only if these potential factors are known, they can be considered and, where possible, modified to improve the RTS process. The objective of this study was to find contributors to RTS success or time until RTS in patients after an an ACL reconstruction aiming to RTS. METHODS: We performed a cohort study and secondary analysis of the data of two intervention studies. We included adults <36 years of age with a tendon autograft ACL reconstruction who were active in any type of sport prior to the injury and aiming to RTS. All participants were prospectively monitored for 24 months. At the end of the individual post-surgery rehabilitation and re-injury prevention programs, self-report- and objective functional outcomes were quantified. Main outcome measures were the potential RTS success (return to the same type of sports, frequency, intensity, and quality of performance as pre-injury), secondary injuries, and all rehabilitation and training measures were prospectively monitored. To determine the contributing factors, Cox regressions for traits and baseline factors and a logistic mixed model, which also included prospective time-dependent factors, were calculated. RESULTS: Overall, 203 participants were included; 104 (51% of the total sample and 68% of the full cases) successfully returned to their sporting activity. The median duration until RTS was 302 days (interquartile range was 114 days). Contributing factors were the type of working (blue- vs. white collar: odds ratio (OR) for RTS = 0.51 [95% CI = 0.29 to 0.90]) and the athletic status (elite vs. non-elite: OR = 2.28 [1.03 to 5.03]). Prospectively, higher rehabilitation volumes until the end of the rehabilitation were predictive for RTS success: the OR per additional hour of rehabilitation was 1.004 [1.001 to 1.006]. Functional abilities such as the normalized knee separation distance during drop jump landing (OR = 0.961 [0.924 to 0.999]) were predictive at a later stage, at the end of the re-injury prevention. Psychological readiness for RTS was predictive at most of the timepoints: those who were confident to RTS were more successful to RTS at the end of the rehabilitation (OR = 1.029 [1.004 to 1.056]) and at the end of the re-injury prevention (OR = 1.038 [1.004 to 1.073]). CONCLUSION: The most important factors for a successful pre-injury-level return to sport after anterior cruciate ligament reconstruction were the exercise volume, psychological readiness and functional hop/jump abilities. Whilst the impact of these modifiable factors were robust against multilevel modeling, the impact of athletic and working status vanishes when the prospective factors are included.
Read CV Daniel NiedererECSS Paris 2023: OP-MH16
INTRODUCTION: Lateral ankle sprain (LAS) is the most common sports-related injury, with a re-injury rate exceeding 50% (1). Despite conservative management being the standard approach for grade II injuries (excluding recurrent cases), the timeline for the resolution of anterior displacement remains unclear. This study aimed to quantify temporal changes in talofibular distance using an ultrasound-guided anterior drawer test to determine the critical period for restoring ankle joint stabilization in patients with acute grade II LAS. METHODS: This prospective observational study included 94 patients with acute grade II LAS who visited a single clinic between April 2021, and December 2023. All patients underwent splint fixation for 1–2 weeks without weight-bearing restrictions, followed by functional ankle brace until 6 weeks. Rehabilitation began at 3 weeks to facilitate functional recovery and return to sports. The ultrasound-guided anterior drawer test was conducted at initial consultation and follow-ups at 1, 3, and 5–6 weeks by a single examiner, assessing changes in talofibular distance (difference between maximum and minimum distances). Statistical analysis was performed using a mixed-model repeated-measures one-way analysis of variance, followed by Tukey’s post-hoc test, with significance set at p < 0.05. RESULTS: The mean change in talofibular distance on the affected side was 3.2±1.8 mm at the initial consultation and 3.1±1.7, 1.6±0.9, and 1.6±1.0 mm at 1, 3, and 5–6 weeks, respectively. A significant reduction was observed at 3 weeks (p < 0.01), with no further significant changes thereafter. The mean change in talofibular distance on the unaffected side was 1.3±0.8 mm. The mean time to return to sports practice (excluding dropouts) was 41.2±14.3 days from the initial consultation. CONCLUSION: These findings identified mean change in talofibular distance on the affected side significantly decreased at 3 weeks post-injury and remained unchanged at 5–6 weeks. Previous studies reported that unrestricted activity from the initial consultation failed to restore joint stability, even at 3 and 6 weeks (2). Conversely, our results suggest that restricting activity to walking until 3 weeks facilitated ligament healing, thereby optimizing rehabilitation outcomes and preventing residual joint instability upon return to play at 5–6 weeks . The critical recovery period for change in talofibular distance occurred between 1 and 3 weeks post-injury. These findings highlight the importance of managed activity limitation in the early phase in promoting ligamentous recovery and reducing re-injury risk in acute grade II LAS. Reference 1. Kobayashi T, et al. Lateral ankle sprain and chronic ankle instability: a critical review. Foot Ankle Spec. 2014;7:298–326. doi: 10.1177/1938640014539813. 2. Croy T, Saliba S, Saliba E, Anderson MW, Hertel J. Talofibular interval changes after acute ankle sprain: a stress ultrasonography study of ankle laxity. J Sport Rehabil. 2013;22:257–263. doi: 10.1123/jsr.22.4.257.
Read CV Uchida YutoECSS Paris 2023: OP-MH16