The Journal of orthopaedic and sports physical therapy, 2017
A 13-year-old adolescent girl presented to the emergency department with low back pain of acute o... more A 13-year-old adolescent girl presented to the emergency department with low back pain of acute onset after bending forward. Lumbar spine radiographs were taken and found to be unremarkable, and the patient was referred to physical therapy. Following examination, the patient was referred to her physician for a suspected nonmechanical cause. Magnetic resonance imaging assessment revealed L3-4 discitis, with osteomyelitis extending into the adjacent right iliopsoas muscle. Further testing and bone biopsy confirmed osteomyelitis. J Orthop Sports Phys Ther 2017;47(10):814. doi:10.2519/jospt.2017.6883.
Journal of Orthopaedic & Sports Physical Therapy, Sep 1, 2012
STUDY DESIGN-Cross-sectional study. OBJECTIVES-To investigate the impact of quadriceps femoris (Q... more STUDY DESIGN-Cross-sectional study. OBJECTIVES-To investigate the impact of quadriceps femoris (QF) muscle strength asymmetry at the time of return to sport on self-reported function and functional performance of individuals following anterior cruciate ligament reconstruction (ACLR). BACKGROUND-Evidence-based QF strength guidelines for return-to-sport decision making are lacking. Objective guidelines necessitate understanding the impact of QF strength deficits at the time of return to sport on function and performance. METHODS-Fifty-five individuals (mean age, 17.3 years) who were cleared for return to sport following primary ACLR (ACLR group) and 35 uninjured individuals (mean age, 17.0 years) in a control group participated in the study. QF strength (maximum voluntary isometric contraction) was assessed, and the quadriceps index (QI) was calculated [(involved strength/uninvolved strength) × 100%]. The ACLR group was further subdivided into 2 groups, based on the QI: high quadriceps (QI of 90% or greater) and low quadriceps (QI of less than 85%).
Background: Lower extremity landing asymmetries are common and associated with strength deficits ... more Background: Lower extremity landing asymmetries are common and associated with strength deficits after anterior cruciate ligament reconstruction (ACLR). However, less is known regarding
Background:The association between quadriceps strength and functional outcomes after anterior cru... more Background:The association between quadriceps strength and functional outcomes after anterior cruciate ligament reconstruction (ACLR) is a focus of current research, while evaluations of hamstring strength are limited, despite the frequent use of hamstring autografts.Purpose/Hypothesis:The purpose of this study was to determine the relationship between changes in quadriceps and hamstring strength symmetry and self-reported outcomes before ACLR and at 12 and 24 weeks after surgery. We hypothesized that improvements in quadriceps and hamstring strength symmetry would be correlated with improvements in self-reported outcome measures within the first 6 months after ACLR.Study Design:Cohort study; Level of evidence, 2.Methods:Thirty patients who underwent ACLR with a hamstring autograft were enrolled. Quadriceps and hamstring strength and Knee injury and Osteoarthritis Outcome Score (KOOS) values were assessed before and at 12 and 24 weeks after ACLR; limb symmetry indexes for strength w...
Biomechanical predictors of a second anterior cruciate ligament (ACL) injury after ACL reconstruc... more Biomechanical predictors of a second anterior cruciate ligament (ACL) injury after ACL reconstruction (ACLR) and return to sport (RTS) have been identified; however, these measures may not be feasible in a standard clinical environment. The purpose of this study was to evaluate whether standard clinical measures predicted the risk of second ACL injuries. The hypothesis tested was that a combination of strength, function, and patient-reported measures at the time of RTS would predict the risk of second ACL injuries with high sensitivity and specificity. Case-control study; Level of evidence, 3 and Cohort study (prognosis); Level of evidence, 1. A total of 163 participants (mean age, 16.7 ± 3.0 years) who underwent primary ACLR and were able to RTS were evaluated. All participants completed an assessment of isokinetic strength, hop testing, balance, and the Knee Injury and Osteoarthritis Outcome Score (KOOS). Participants were tracked for a minimum of 24 months to identify occurrences...
Context:As high school female athletes demonstrate a rate of noncontact anterior cruciate ligamen... more Context:As high school female athletes demonstrate a rate of noncontact anterior cruciate ligament (ACL) injury 3–6 times higher than their male counterparts, research suggests that sagittal-plane hip strength plays a role in factors associated with ACL injuries.Objective:To determine if gender or age affect hip-abductor strength in a functional standing position in young female and male athletes.Design:Prospective cohort design.Setting:Biomechanical laboratory.Participants:Over a 3-y time period, 852 isokinetic hip-abduction evaluations were conducted on 351 (272 female, 79 male) adolescent soccer and basketball players.Intervention:Before testing, athletes were secured in a standing position, facing the dynamometer head, with a strap secured from the uninvolved side and extending around the waist just above the iliac crest. The dynamometer head was positioned in line with the body in the coronal plane by aligning the axis of rotation of the dynamometer with the center of hip rotat...
Background and Purpose. The purpose of this case report is to describe a novel multidisciplinary ... more Background and Purpose. The purpose of this case report is to describe a novel multidisciplinary approach for evaluating and preparing a patient with quiescent juvenile rheumatoid arthritis (JRA) for safe sports participation. Case Description. The patient was a 10-year-old girl with a history of bilateral knee arthritis who desired to participate in soccer and basketball. Range of motion and manual muscle testing of the lower extremity were within normal limits. Neuromuscular testing included kinematic and kinetic testing, isokinetic assessment, and postural stability testing. The patient's gait was near normal; however, she had narrowed step width and increased knee flexion at heel-strike. Landing analysis during a box drop vertical jump task showed increased and imbalanced (right versus left lower extremity) peak impact forces. The testing was followed by specialized neuromuscular training (SNT). Outcomes. Following SNT, heel-strike and step width were within normal limits, p...
Anterior cruciate ligament (ACL) injuries in female athletes lead to a variety of short- and long... more Anterior cruciate ligament (ACL) injuries in female athletes lead to a variety of short- and long-term physical, financial, and psychosocial ramifications. While dedicated injury prevention training programs have shown promise, ACL injury rates remain high as implementation has not become widespread. Conventional prevention programs use a combination of resistance, plyometric, balance and agility training to improve high-risk biomechanics and reduce the risk of injury. While many of these programs focus on reducing knee abduction load and posture during dynamic activity, targeting hip extensor strength and utilization may be more efficacious, as it is theorized to be an underlying mechanism of injury in adolescent female athletes. Biofeedback training may complement traditional preventive training, but has not been widely studied in connection with ACL injuries. We hypothesize that biofeedback may be needed to maximize the effectiveness of neuromuscular prophylactic interventions, a...
ABSTRACTEconomic and societal pressures influence modern medical practice to develop and implemen... more ABSTRACTEconomic and societal pressures influence modern medical practice to develop and implement prevention strategies. Anterior cruciate ligament (ACL) injury devastates the knee joint leading to short term disability and long term sequelae. Due to the high risk of long term osteoarthritis in all treatment populations following ACL injury, prevention is the only effective intervention for this life‐altering disruption in knee health. The “Sequence of Prevention” Model provides a framework to monitor progress towards the ultimate goal of preventing ACL injuries. Utilizing this model, our multidisciplinary collaborative research team has spent the last decade working to delineate injury mechanisms, identify injury risk factors, predict which athletes are at‐risk for injury, and develop ACL injury prevention programs. Within this model of injury prevention, modifiable factors (biomechanical and neuromuscular) related to injury mechanisms likely provide the best opportunity for inter...
Femoral Nerve Block after Anterior Cruciate Ligament Reconstruction
The Journal of Knee Surgery, 2016
Femoral nerve block (FNB) has been proposed for pain control following anterior cruciate ligament... more Femoral nerve block (FNB) has been proposed for pain control following anterior cruciate ligament (ACL) reconstruction. Although numerous studies have assessed the efficacy of FNBs, there has been little to no research into the effect of such blocks on postoperative strength and patient-reported outcomes. We hypothesized that performance of an FNB would result in decreased quadriceps strength and poorer patient-reported outcome scores within the first 6 months following ACL reconstruction. A total of 30 patients scheduled to undergo hamstring autograft ACL reconstruction following an acute ACL injury were randomized to a single-shot FNB group or a control group. Preoperatively, patients completed a Knee Injury and Osteoarthritis Outcome Score (KOOS) and isokinetic quadriceps strength testing at 60 degrees/second. At 6 weeks postoperative, 29 of 30 patients completed a KOOS and isometric quadriceps strength testing at 90 degrees. At 6 months postoperative, 23 of 30 patients completed a KOOS and isokinetic strength testing. Quadriceps femoris strength limb symmetry indices (QF-LSI) were calculated at all time points. Repeated measures analysis of variance (ANOVA) models were then utilized to model the effect of FNB and time on QF-LSI as well as KOOS subscales for activities of daily living, pain, and symptoms. QF-LSI and all KOOS subscales demonstrated improvement with time following ACL reconstruction. Repeated measures ANOVA demonstrated that patients who underwent FNB had a mean QF-LSI that was 13.4% lower than the control group (p = 0.005) and poorer KOOS symptoms subscale scores (10.4 point difference, p = 0.032) at 6 weeks postoperative compared with controls. At 6 months postoperative, no differences were noted in QF-LSI or any of the KOOS subscales based on block status. FNB resulted in decreased strength and poorer KOOS symptom subscale score at 6 weeks following ACL reconstruction compared with controls. These differences resolved by 6 months postoperative. The long-term effect of delayed quadriceps recovery on movement patterns and functional outcome remains unknown and requires further study. The study is a randomized controlled trial with level of evidence 1.
Objectives: Femoral nerve block (FNB) has been proposed for pain control following anterior cruci... more Objectives: Femoral nerve block (FNB) has been proposed for pain control following anterior cruciate ligament (ACL) reconstruction. Although numerous high level studies have assessed the efficacy of FNB’s, there has been little to no research into the effect of such blocks on post-operative strength and patient-reported outcomes. Exacerbation of post-operative quadriceps weakness by a FNB could negatively impact recovery, particularly in the early post-operative period. We hypothesized that performance of a FNB would result in decreased quadriceps strength and poorer patient-reported outcome score in the first three months following ACL reconstruction. Methods: Thirty patients scheduled to undergo hamstring autograft ACL reconstruction following an acute ACL injury were randomized to a single shot FNB group or a control group. The surgical procedure and post-operative rehabilitation were performed identically in both groups. Pre-operatively, all patients completed a KOOS and isokine...
Medicine & Science in Sports & Exercise, 2015
Purpose-Evidence-based quadriceps femoris muscle (QF) strength guidelines for return to sport fol... more Purpose-Evidence-based quadriceps femoris muscle (QF) strength guidelines for return to sport following anterior cruciate ligament (ACL) reconstruction are lacking. This study
Anterior-posterior (AP) knee laxity after anterior cruciate ligament (ACL) reconstruction may dif... more Anterior-posterior (AP) knee laxity after anterior cruciate ligament (ACL) reconstruction may differ between sexes for different graft types. Females may experience an increase in AP knee laxity following an ACL reconstruction with a hamstrings graft, which is not seen in males with a hamstrings graft or in males or females with a bone-patellar tendon-bone (BTB) graft. The hypothesis of this review is sex differences in AP knee laxity and this will be identified in patients who undergo an ACL reconstruction with a hamstrings graft, while no sex differences will be observed in patients who have an ACL reconstruction with a BTB graft. A systematic search was performed in PubMed, CINAHL ® and SPORTDiscus ™. Inclusion criteria were articles published in the English language that studied human subjects who underwent an ACL reconstruction with a BTB or hamstrings autograft, and the presence of a sex comparison on outcome measures including side-to-side difference in AP knee laxity. Methodological quality was assessed using a Modified Coleman Methodology Score. Eleven cohort studies met the inclusion criteria. Six investigated sex differences in both hamstrings and
Journal of Strength and Conditioning Research, 2008
Surgical intervention and early-phase rehabilitation after anterior cruciate ligament (ACL) recon... more Surgical intervention and early-phase rehabilitation after anterior cruciate ligament (ACL) reconstruction have undergone a relatively rapid and global evolution over the past 25 years. Despite the advances that have significantly improved outcomes, decreases in healthcare coverage (limited visits allowed for physical therapy) have increased the role of the strength and conditioning specialist in the rehabilitation of athletes returning to sport after ACL reconstruction. In addition, there is an absence of standardized, objective criteria to accurately assess an athlete's ability to progress through the end stages of rehabilitation and safely return to sport. The purpose of this Scientific Commentary is to present an example of a progressive, end-stage return to sport protocol that is targeted to measured deficits of neuromuscular control, strength, power, and functional symmetry that are rehabilitative landmarks after ACL reconstruction. The proposed return to sport training protocol incorporates quantitative measurement tools that will provide the athlete with objective feedback and targeted goal setting. Objective feedback and targeted goal setting may aid the strength and conditioning specialist with exercise selection and progression. In addition, a rationale for exercise selection is outlined to provide the strength and conditioning specialist with a flexible decision-making approach that will aid in the modification of return to sport training to meet the individual athlete's abilities and to target objectively measured deficits. This algorithmic approach may improve the potential for athletes to return to sport after ACL reconstruction at the optimal performance level and with minimized risk of reinjury.
Our purpose was to examine the effects of pubertal status on generalized joint laxity in a popula... more Our purpose was to examine the effects of pubertal status on generalized joint laxity in a population of male and female athletes. We hypothesized that females would show higher generalized joint laxity after the onset of puberty while males would not. This cross-sectional cohort study included 275 female and 143 male middle school and high school basketball and soccer athletes. Joint laxity was assessed using the Beighton and Horan Joint Mobility Index. BHJMI scores were averaged and female and male athletes were compared by pubertal stage. Females demonstrated increased joint laxity scores between pre-pubertal and post-pubertal groups (P=0.042), while males did not. Prepubertal male and female athletes were not different in cumulative joint laxity scores (female prepuberty Mean=2.00; male pre-pubertal Mean=1.66). However, following the onset of puberty females (pubertal Mean=2.96; post-pubertal Mean= 3.03) demonstrated a greater joint laxity score compared to males (pubertal Mean=1.24; post-pubertal Mean=1.30). Gender differences in BHJMI score was found at puberty and post-puberty (P<0.001). In contrast to males, females may have greater generalized joint laxity following the onset of puberty. Structural and physiological changes that occur during puberty such as alterations in passive joint restraints, may affect the type, severity and incidence of injuries in the maturing adolescent population.
Journal of Orthopaedic & Sports Physical Therapy, 2010
I n the United States more than 3.1 million females participate in high school sports annually. 2... more I n the United States more than 3.1 million females participate in high school sports annually. 22 Soccer is ranked fifth in popularity, with over 346 000 female athletes having participated in the sport during the 2007-2008 school year. 22 As the popularity of women's soccer grows, the incidence of injury in high school sports has become more apparent.
The Journal of orthopaedic and sports physical therapy, 2017
A 13-year-old adolescent girl presented to the emergency department with low back pain of acute o... more A 13-year-old adolescent girl presented to the emergency department with low back pain of acute onset after bending forward. Lumbar spine radiographs were taken and found to be unremarkable, and the patient was referred to physical therapy. Following examination, the patient was referred to her physician for a suspected nonmechanical cause. Magnetic resonance imaging assessment revealed L3-4 discitis, with osteomyelitis extending into the adjacent right iliopsoas muscle. Further testing and bone biopsy confirmed osteomyelitis. J Orthop Sports Phys Ther 2017;47(10):814. doi:10.2519/jospt.2017.6883.
Journal of Orthopaedic & Sports Physical Therapy, Sep 1, 2012
STUDY DESIGN-Cross-sectional study. OBJECTIVES-To investigate the impact of quadriceps femoris (Q... more STUDY DESIGN-Cross-sectional study. OBJECTIVES-To investigate the impact of quadriceps femoris (QF) muscle strength asymmetry at the time of return to sport on self-reported function and functional performance of individuals following anterior cruciate ligament reconstruction (ACLR). BACKGROUND-Evidence-based QF strength guidelines for return-to-sport decision making are lacking. Objective guidelines necessitate understanding the impact of QF strength deficits at the time of return to sport on function and performance. METHODS-Fifty-five individuals (mean age, 17.3 years) who were cleared for return to sport following primary ACLR (ACLR group) and 35 uninjured individuals (mean age, 17.0 years) in a control group participated in the study. QF strength (maximum voluntary isometric contraction) was assessed, and the quadriceps index (QI) was calculated [(involved strength/uninvolved strength) × 100%]. The ACLR group was further subdivided into 2 groups, based on the QI: high quadriceps (QI of 90% or greater) and low quadriceps (QI of less than 85%).
Background: Lower extremity landing asymmetries are common and associated with strength deficits ... more Background: Lower extremity landing asymmetries are common and associated with strength deficits after anterior cruciate ligament reconstruction (ACLR). However, less is known regarding
Background:The association between quadriceps strength and functional outcomes after anterior cru... more Background:The association between quadriceps strength and functional outcomes after anterior cruciate ligament reconstruction (ACLR) is a focus of current research, while evaluations of hamstring strength are limited, despite the frequent use of hamstring autografts.Purpose/Hypothesis:The purpose of this study was to determine the relationship between changes in quadriceps and hamstring strength symmetry and self-reported outcomes before ACLR and at 12 and 24 weeks after surgery. We hypothesized that improvements in quadriceps and hamstring strength symmetry would be correlated with improvements in self-reported outcome measures within the first 6 months after ACLR.Study Design:Cohort study; Level of evidence, 2.Methods:Thirty patients who underwent ACLR with a hamstring autograft were enrolled. Quadriceps and hamstring strength and Knee injury and Osteoarthritis Outcome Score (KOOS) values were assessed before and at 12 and 24 weeks after ACLR; limb symmetry indexes for strength w...
Biomechanical predictors of a second anterior cruciate ligament (ACL) injury after ACL reconstruc... more Biomechanical predictors of a second anterior cruciate ligament (ACL) injury after ACL reconstruction (ACLR) and return to sport (RTS) have been identified; however, these measures may not be feasible in a standard clinical environment. The purpose of this study was to evaluate whether standard clinical measures predicted the risk of second ACL injuries. The hypothesis tested was that a combination of strength, function, and patient-reported measures at the time of RTS would predict the risk of second ACL injuries with high sensitivity and specificity. Case-control study; Level of evidence, 3 and Cohort study (prognosis); Level of evidence, 1. A total of 163 participants (mean age, 16.7 ± 3.0 years) who underwent primary ACLR and were able to RTS were evaluated. All participants completed an assessment of isokinetic strength, hop testing, balance, and the Knee Injury and Osteoarthritis Outcome Score (KOOS). Participants were tracked for a minimum of 24 months to identify occurrences...
Context:As high school female athletes demonstrate a rate of noncontact anterior cruciate ligamen... more Context:As high school female athletes demonstrate a rate of noncontact anterior cruciate ligament (ACL) injury 3–6 times higher than their male counterparts, research suggests that sagittal-plane hip strength plays a role in factors associated with ACL injuries.Objective:To determine if gender or age affect hip-abductor strength in a functional standing position in young female and male athletes.Design:Prospective cohort design.Setting:Biomechanical laboratory.Participants:Over a 3-y time period, 852 isokinetic hip-abduction evaluations were conducted on 351 (272 female, 79 male) adolescent soccer and basketball players.Intervention:Before testing, athletes were secured in a standing position, facing the dynamometer head, with a strap secured from the uninvolved side and extending around the waist just above the iliac crest. The dynamometer head was positioned in line with the body in the coronal plane by aligning the axis of rotation of the dynamometer with the center of hip rotat...
Background and Purpose. The purpose of this case report is to describe a novel multidisciplinary ... more Background and Purpose. The purpose of this case report is to describe a novel multidisciplinary approach for evaluating and preparing a patient with quiescent juvenile rheumatoid arthritis (JRA) for safe sports participation. Case Description. The patient was a 10-year-old girl with a history of bilateral knee arthritis who desired to participate in soccer and basketball. Range of motion and manual muscle testing of the lower extremity were within normal limits. Neuromuscular testing included kinematic and kinetic testing, isokinetic assessment, and postural stability testing. The patient's gait was near normal; however, she had narrowed step width and increased knee flexion at heel-strike. Landing analysis during a box drop vertical jump task showed increased and imbalanced (right versus left lower extremity) peak impact forces. The testing was followed by specialized neuromuscular training (SNT). Outcomes. Following SNT, heel-strike and step width were within normal limits, p...
Anterior cruciate ligament (ACL) injuries in female athletes lead to a variety of short- and long... more Anterior cruciate ligament (ACL) injuries in female athletes lead to a variety of short- and long-term physical, financial, and psychosocial ramifications. While dedicated injury prevention training programs have shown promise, ACL injury rates remain high as implementation has not become widespread. Conventional prevention programs use a combination of resistance, plyometric, balance and agility training to improve high-risk biomechanics and reduce the risk of injury. While many of these programs focus on reducing knee abduction load and posture during dynamic activity, targeting hip extensor strength and utilization may be more efficacious, as it is theorized to be an underlying mechanism of injury in adolescent female athletes. Biofeedback training may complement traditional preventive training, but has not been widely studied in connection with ACL injuries. We hypothesize that biofeedback may be needed to maximize the effectiveness of neuromuscular prophylactic interventions, a...
ABSTRACTEconomic and societal pressures influence modern medical practice to develop and implemen... more ABSTRACTEconomic and societal pressures influence modern medical practice to develop and implement prevention strategies. Anterior cruciate ligament (ACL) injury devastates the knee joint leading to short term disability and long term sequelae. Due to the high risk of long term osteoarthritis in all treatment populations following ACL injury, prevention is the only effective intervention for this life‐altering disruption in knee health. The “Sequence of Prevention” Model provides a framework to monitor progress towards the ultimate goal of preventing ACL injuries. Utilizing this model, our multidisciplinary collaborative research team has spent the last decade working to delineate injury mechanisms, identify injury risk factors, predict which athletes are at‐risk for injury, and develop ACL injury prevention programs. Within this model of injury prevention, modifiable factors (biomechanical and neuromuscular) related to injury mechanisms likely provide the best opportunity for inter...
Femoral Nerve Block after Anterior Cruciate Ligament Reconstruction
The Journal of Knee Surgery, 2016
Femoral nerve block (FNB) has been proposed for pain control following anterior cruciate ligament... more Femoral nerve block (FNB) has been proposed for pain control following anterior cruciate ligament (ACL) reconstruction. Although numerous studies have assessed the efficacy of FNBs, there has been little to no research into the effect of such blocks on postoperative strength and patient-reported outcomes. We hypothesized that performance of an FNB would result in decreased quadriceps strength and poorer patient-reported outcome scores within the first 6 months following ACL reconstruction. A total of 30 patients scheduled to undergo hamstring autograft ACL reconstruction following an acute ACL injury were randomized to a single-shot FNB group or a control group. Preoperatively, patients completed a Knee Injury and Osteoarthritis Outcome Score (KOOS) and isokinetic quadriceps strength testing at 60 degrees/second. At 6 weeks postoperative, 29 of 30 patients completed a KOOS and isometric quadriceps strength testing at 90 degrees. At 6 months postoperative, 23 of 30 patients completed a KOOS and isokinetic strength testing. Quadriceps femoris strength limb symmetry indices (QF-LSI) were calculated at all time points. Repeated measures analysis of variance (ANOVA) models were then utilized to model the effect of FNB and time on QF-LSI as well as KOOS subscales for activities of daily living, pain, and symptoms. QF-LSI and all KOOS subscales demonstrated improvement with time following ACL reconstruction. Repeated measures ANOVA demonstrated that patients who underwent FNB had a mean QF-LSI that was 13.4% lower than the control group (p = 0.005) and poorer KOOS symptoms subscale scores (10.4 point difference, p = 0.032) at 6 weeks postoperative compared with controls. At 6 months postoperative, no differences were noted in QF-LSI or any of the KOOS subscales based on block status. FNB resulted in decreased strength and poorer KOOS symptom subscale score at 6 weeks following ACL reconstruction compared with controls. These differences resolved by 6 months postoperative. The long-term effect of delayed quadriceps recovery on movement patterns and functional outcome remains unknown and requires further study. The study is a randomized controlled trial with level of evidence 1.
Objectives: Femoral nerve block (FNB) has been proposed for pain control following anterior cruci... more Objectives: Femoral nerve block (FNB) has been proposed for pain control following anterior cruciate ligament (ACL) reconstruction. Although numerous high level studies have assessed the efficacy of FNB’s, there has been little to no research into the effect of such blocks on post-operative strength and patient-reported outcomes. Exacerbation of post-operative quadriceps weakness by a FNB could negatively impact recovery, particularly in the early post-operative period. We hypothesized that performance of a FNB would result in decreased quadriceps strength and poorer patient-reported outcome score in the first three months following ACL reconstruction. Methods: Thirty patients scheduled to undergo hamstring autograft ACL reconstruction following an acute ACL injury were randomized to a single shot FNB group or a control group. The surgical procedure and post-operative rehabilitation were performed identically in both groups. Pre-operatively, all patients completed a KOOS and isokine...
Medicine & Science in Sports & Exercise, 2015
Purpose-Evidence-based quadriceps femoris muscle (QF) strength guidelines for return to sport fol... more Purpose-Evidence-based quadriceps femoris muscle (QF) strength guidelines for return to sport following anterior cruciate ligament (ACL) reconstruction are lacking. This study
Anterior-posterior (AP) knee laxity after anterior cruciate ligament (ACL) reconstruction may dif... more Anterior-posterior (AP) knee laxity after anterior cruciate ligament (ACL) reconstruction may differ between sexes for different graft types. Females may experience an increase in AP knee laxity following an ACL reconstruction with a hamstrings graft, which is not seen in males with a hamstrings graft or in males or females with a bone-patellar tendon-bone (BTB) graft. The hypothesis of this review is sex differences in AP knee laxity and this will be identified in patients who undergo an ACL reconstruction with a hamstrings graft, while no sex differences will be observed in patients who have an ACL reconstruction with a BTB graft. A systematic search was performed in PubMed, CINAHL ® and SPORTDiscus ™. Inclusion criteria were articles published in the English language that studied human subjects who underwent an ACL reconstruction with a BTB or hamstrings autograft, and the presence of a sex comparison on outcome measures including side-to-side difference in AP knee laxity. Methodological quality was assessed using a Modified Coleman Methodology Score. Eleven cohort studies met the inclusion criteria. Six investigated sex differences in both hamstrings and
Journal of Strength and Conditioning Research, 2008
Surgical intervention and early-phase rehabilitation after anterior cruciate ligament (ACL) recon... more Surgical intervention and early-phase rehabilitation after anterior cruciate ligament (ACL) reconstruction have undergone a relatively rapid and global evolution over the past 25 years. Despite the advances that have significantly improved outcomes, decreases in healthcare coverage (limited visits allowed for physical therapy) have increased the role of the strength and conditioning specialist in the rehabilitation of athletes returning to sport after ACL reconstruction. In addition, there is an absence of standardized, objective criteria to accurately assess an athlete's ability to progress through the end stages of rehabilitation and safely return to sport. The purpose of this Scientific Commentary is to present an example of a progressive, end-stage return to sport protocol that is targeted to measured deficits of neuromuscular control, strength, power, and functional symmetry that are rehabilitative landmarks after ACL reconstruction. The proposed return to sport training protocol incorporates quantitative measurement tools that will provide the athlete with objective feedback and targeted goal setting. Objective feedback and targeted goal setting may aid the strength and conditioning specialist with exercise selection and progression. In addition, a rationale for exercise selection is outlined to provide the strength and conditioning specialist with a flexible decision-making approach that will aid in the modification of return to sport training to meet the individual athlete's abilities and to target objectively measured deficits. This algorithmic approach may improve the potential for athletes to return to sport after ACL reconstruction at the optimal performance level and with minimized risk of reinjury.
Our purpose was to examine the effects of pubertal status on generalized joint laxity in a popula... more Our purpose was to examine the effects of pubertal status on generalized joint laxity in a population of male and female athletes. We hypothesized that females would show higher generalized joint laxity after the onset of puberty while males would not. This cross-sectional cohort study included 275 female and 143 male middle school and high school basketball and soccer athletes. Joint laxity was assessed using the Beighton and Horan Joint Mobility Index. BHJMI scores were averaged and female and male athletes were compared by pubertal stage. Females demonstrated increased joint laxity scores between pre-pubertal and post-pubertal groups (P=0.042), while males did not. Prepubertal male and female athletes were not different in cumulative joint laxity scores (female prepuberty Mean=2.00; male pre-pubertal Mean=1.66). However, following the onset of puberty females (pubertal Mean=2.96; post-pubertal Mean= 3.03) demonstrated a greater joint laxity score compared to males (pubertal Mean=1.24; post-pubertal Mean=1.30). Gender differences in BHJMI score was found at puberty and post-puberty (P<0.001). In contrast to males, females may have greater generalized joint laxity following the onset of puberty. Structural and physiological changes that occur during puberty such as alterations in passive joint restraints, may affect the type, severity and incidence of injuries in the maturing adolescent population.
Journal of Orthopaedic & Sports Physical Therapy, 2010
I n the United States more than 3.1 million females participate in high school sports annually. 2... more I n the United States more than 3.1 million females participate in high school sports annually. 22 Soccer is ranked fifth in popularity, with over 346 000 female athletes having participated in the sport during the 2007-2008 school year. 22 As the popularity of women's soccer grows, the incidence of injury in high school sports has become more apparent.
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Papers by Mark Paterno