Purpose: The aim of this study was to assess physiotherapists’ clinical use and acceptance of a novel telemonitoring platform to facilitate the recording of measurements during rehabilitation of patients following anterior cruciate ligament reconstruction. Additionally, suggestions for platform improvement were explored. Methods: Physiotherapists from seven Dutch private physiotherapy practices participated in the study. Data were collected through log files, a technology acceptance questionnaire and focus group meetings using the “buy a feature” method. Data regarding platform use and acceptance (7-point/11-point numeric rating scale) were descriptively analysed. Total scores were calculated for the features suggested to improve the platform, based on the priority rating (1 = nice to have, 2 = should have, 3 = must have). Results: Participating physiotherapists (N = 15, mean [SD] age 33.1 [9.1] years) together treated 52 patients during the study period. Platform use by the therapists was generally limited, with the number of log-ins per patient varying from 3 to 73. Overall, therapists’ acceptance of the platform was low to moderate, with average (SD) scores ranging from 2.5 (1.1) to 4.9 (1.5) on the 7-point Likert scale. The three most important suggestions for platform improvement were: (1) development of a native app, (2) system interoperability, and (3) flexibility regarding type and frequency of measurements. Conclusions: Even though health care professionals were involved in the design of the telemonitoring platform, use in routine care was limited. Physiotherapists recognized the relevance of using health technology, but there are still barriers to overcome in order to successfully implement eHealth in routine care.
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Individuals after anterior cruciate ligament reconstruction (ACLR) have a high rate of reinjury upon return to competitive sports. Deficits in motor control may influence reinjury risk and can be addressed during rehabilitation with motor learning strategies. When instructing patients in performing motor tasks after ACLR, an external focus of attention directed to the intended movement effect has been shown to be more effective in reducing reinjury risk than an internal focus of attention on body movements. While this concept is mostly agreed upon, recent literature has made it clear that the interpretation and implementation of an external focus of attention within ACLR rehabilitation needs to be better described. The purpose of this commentary is to provide a clinical framework for the application of attentional focus strategies and guide clinicians towards effectively utilizing an external focus of attention in rehabilitation after ACLR.
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Hop tests are frequently used to determine return to sports (RTS) after anterior cruciate ligament reconstruction (ACLR). Given that bilateral deficits are present after ACLR, this may result in a falsely high limb symmetry index (LSI), since LSI is calculated as a ratio between the values of the limbs.HypothesisAthletes after ACLR would achieve LSI > 90% for the hop test. Secondly, athletes after ACLR demonstrate decreased jump distance on the single hop for distance (SLH) and triple leg hop for distance (TLH) and decreased number of hops for the side hop (SH) for both involved and uninvolved limbs compared to normative data of sex, age and type of sports matched healthy athletes.Materials and MethodsFifty-two patients (38 males mean age 23.9 ±3.5 yrs; 14 females mean age 21.7±3.5 years) who had undergone an ACLR participated in this study. Patients performed the 3 hop tests at a mean time of 7.0 months after ACLR. Hop distance, number of side hops and LSI were compared with normative data of 188 healthy athletes.ResultsThe differences between the involved limb and the uninvolved limb were significant in all hop tests (SLH p=0.003, TLH p=0.003 , SH p=0.018). For females, only significant between limb differences were found in the SLH (p=0.049). For both the SLH and the TLH, significant differences were found between the involved limb and the normative data (males; SLH p<0.001, TLH p<0.001; females; SLH p<0.001, TLH p=0.006) and between the uninvolved limb and the normative data for both males and females (males; SLH p<0.001, TLH p<0.001; females; SLH p=0.003, TLH p=0.038). For the SH, only significant differences were found between the involved limb and the normative values in males (p=0.033).ConclusionAthletes who have undergone an ACLR demonstrate bilateral deficits on hop tests in comparison to age and sex matched normative data of healthy controls. Using the LSI may underestimate performance deficits and should therefore be analyzed with caution when used as a criterion for RTS after ACLR.
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The seventh ACL Research Retreat was held March 19–21, 2015, in Greensboro, North Carolina. The retreat brought together clinicians and researchers to present and discuss the most recent advances in anterior cruciate ligament (ACL) injury epidemiology, risk factor identification, and injury risk screening and prevention strategies. Subsequently, our goal was to identify important unknowns and future research directions. The ACL Research Retreat VII was attended by 64 clinicians and researchers from Australia, Canada, India, Ireland, the Netherlands, South Africa, the United States, and the United Kingdom. The meeting featured 3 keynote and 29 podium presentations highlighting recent research. Keynotes were delivered by Bruce Beynnon, PhD (Univer- sity of Vermont), Charles ‘‘Buz’’ Swanik, PhD, ATC (University of Delaware), and Mark Paterno, PhD, PT, ATC, SCS (Cincinnati Children’s Hospital Medical Cen- ter), addressing their ongoing work related to sex-specific multivariate risk factor models for ACL injury,1 the role of the brain in noncontact ACL injury,2 and the incidence and predictors of a second ACL injury after primary ACL reconstruction and return to sport,3 respectively. Podium and poster presentations were organized into thematic sessions of prospective and case-control risk factor studies, anatomical and hormonal risk factors, neuromuscular and biomechanical risk factors, injury risk assessment after ACL injury, and injury-prevention strategies. Time was provided for group discussion throughout the conference. At the end of the meeting, attendees participated in 1 of 3 breakout sessions on the topics of genetic, hormonal, and anatomical risk factors; neuromechanical contributions to ACL injury; and risk factor screening and prevention. From these discussions, we updated the 2012 consensus state- ment4 to reflect the most recent advances in the field and to revise the important unknowns and future directions necessary to enhance our understanding of ACL injury. Following are the updated consensus statement, keynote presentation summaries, and free communication abstracts organized by topic and presentation order.
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The aim of the present study was to investigate if the presence of anterior cruciate ligament (ACL) injury risk factors depicted in the laboratory would reflect at-risk patterns in football-specific field data. Twenty-four female footballers (14.9 ± 0.9 year) performed unanticipated cutting maneuvers in a laboratory setting and on the football pitch during football-specific exercises (F-EX) and games (F-GAME). Knee joint moments were collected in the laboratory and grouped using hierarchical agglomerative clustering. The clusters were used to investigate the kinematics collected on field through wearable sensors. Three clusters emerged: Cluster 1 presented the lowest knee moments; Cluster 2 presented high knee extension but low knee abduction and rotation moments; Cluster 3 presented the highest knee abduction, extension, and external rotation moments. In F-EX, greater knee abduction angles were found in Cluster 2 and 3 compared to Cluster 1 (p = 0.007). Cluster 2 showed the lowest knee and hip flexion angles (p < 0.013). Cluster 3 showed the greatest hip external rotation angles (p = 0.006). In F-GAME, Cluster 3 presented the greatest knee external rotation and lowest knee flexion angles (p = 0.003). Clinically relevant differences towards ACL injury identified in the laboratory reflected at-risk patterns only in part when cutting on the field: in the field, low-risk players exhibited similar kinematic patterns as the high-risk players. Therefore, in-lab injury risk screening may lack ecological validity.
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Background: Limited information is available on the experiences of patients during rehabilitation after anterior cruciate ligament reconstruction (ACLR). Aim: The current study aimed to identify factors that differentiated positive and negative patient experiences during rehabilitation after ACLR. Method and Design: A survey-based study with an online platform was used to identify factors that differentiated positive and negative patient experiences during rehabilitation after ACLR. Seventy-two patients (age 27.8 [8.8] y) after ACLR participated. Data were analyzed and themes were identified by comparing categories and subcategories on similarity. Main Findings: Positive patient experiences were room for own input, supervision, attention, knowledge, honesty, and professionalism of the physiotherapist. Additionally, a varied and structured rehabilitation program, adequate facilities, and contact with other patients were identified as positive patient experiences. Negative experiences were a lack of attention, lack of professionalism of the physiotherapists, a lack of sport-specific field training, a lack of goal setting, a lack of adequate facilities, and health insurance costs. Conclusions: The current study identified factors that differentiated positive and negative patient experiences during rehabilitation after ACLR. These findings can help physiotherapists in understanding the patient experiences during rehabilitation after ACLR.
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OBJECTIVES:The purpose of the current study was to compare the results of a progressive strength training protocol for soccer players after anterior cruciate ligament reconstruction (ACLR) with healthy controls, and to investigate the effects of the strength training protocol on peak quadriceps and hamstring muscle strength. DESIGN:Between subjects design. SETTING:Outpatient physical therapy facility. PARTICIPANTS:Thirty-eight amateur male soccer players after ACLR were included. Thirty age-matched amateur male soccer players served as control group. MAIN OUTCOME MEASURES:Quadriceps and hamstring muscle strength was measured at three time points during the rehabilitation. Limb symmetry index (LSI) > 90% was used as cut-off criteria. RESULTS:Soccer players after ACLR had no significant differences in peak quadriceps and hamstring muscle strength in the injured leg at 7 months after ACLR compared to the dominant leg of the control group. Furthermore, 65.8% of soccer players after ACLR passed LSI >90% at 10 months for quadriceps muscle strength. CONCLUSION:Amateur male soccer players after ACLR can achieve similar quadriceps and hamstring muscle strength at 7 months compared to healthy controls. These findings highlight the potential of progressive strength training in rehabilitation after ACLR that may mitigate commonly reported strength deficits.
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BACKGROUND: A limited number of patients return to sport (RTS) after an anterior cruciate ligament reconstruction (ACLR) and patients who RTS have a relatively high risk for second ACL injury. The purpose of the current study was to compare the results of a test battery between patients who returned to the pre-injury level of sport (RTS group) and patients who did not (NO-RTS group). It was hypothesized that the RTS group showed better test results.METHODS: Sixty-four patients (age 27.8 ± 8.8 years) were included. The results of a multicomponent test battery (jump-landing task assessed with the Landing Error Scoring System (LESS), three hop tests, isokinetic strength test for quadriceps and hamstring) were compared between groups with a 2 × 2 ANOVA.RESULTS: The RTS group showed a significantly lower LESS score (p = 0.010), significantly higher absolute scores on hop tests with both legs (injured leg: single leg hop test p = 0.013, triple leg hop test p = 0.024, side hop test p = 0.021; non-injured leg: single leg hop test p = 0.011, triple leg hop test p = 0.023, side hop test p = 0.032) and significantly greater hamstring strength in the injured leg (p = 0.009 at 60°/s, p = 0.012 at 180°/s and p = 0.013 at 300°/s). No differences in test results were identified between patients who sustained a second ACL injury and patients who did not.CONCLUSION: Patients after ACLR with better jump-landing patterns, hop performance and greater hamstring strength have greater likelihood for RTS. However, our findings show that RTS criteria fail to identify patients who are at risk for a second ACL injury.
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PURPOSE: To compare the responses in knee joint muscle activation patterns to different perturbations during gait in healthy subjects.SCOPE: Nine healthy participants were subjected to perturbed walking on a split-belt treadmill. Four perturbation types were applied, each at five intensities. The activations of seven muscles surrounding the knee were measured using surface EMG. The responses in muscle activation were expressed by calculating mean, peak, co-contraction (CCI) and perturbation responses (PR) values. PR captures the responses relative to unperturbed gait. Statistical parametric mapping analysis was used to compare the muscle activation patterns between conditions.RESULTS: Perturbations evoked only small responses in muscle activation, though higher perturbation intensities yielded a higher mean activation in five muscles, as well as higher PR. Different types of perturbation led to different responses in the rectus femoris, medial gastrocnemius and lateral gastrocnemius. The participants had lower CCI just before perturbation compared to the same phase of unperturbed gait.CONCLUSIONS: Healthy participants respond to different perturbations during gait with small adaptations in their knee joint muscle activation patterns. This study provides insights in how the muscles are activated to stabilize the knee when challenged. Furthermore it could guide future studies in determining aberrant muscle activation in patients with knee disorders.
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