Initial treatment of trapeziometacarpal osteoarthritis (TMO) often consists of intra-articular in... more Initial treatment of trapeziometacarpal osteoarthritis (TMO) often consists of intra-articular injection of corticosteroids or hyaluronic acid. Several studies have shown that ultrasound (US)-guided injections demonstrate greater precision and effectiveness when compared to blind techniques. The aim of our study was to describe a simple and reliable procedure of US-guided intra-articular injection of hyaluronic acid solution in patients with TMO.
Patellofemoral pain syndrome (PFPS) is a common source of anterior knee pain. While treatment for... more Patellofemoral pain syndrome (PFPS) is a common source of anterior knee pain. While treatment for PFPS may be successful in the short term, long-term results are less promising. The purpose of this study was to record longterm pain and functionality outcomes following rehabilitation in patients affected by PFPS. A prospective cohort study of 44 patients with a diagnosis of PFPS and an activation imbalance between the vastus medialis obliquus (VMO) and vastus lateralis (VL) muscles were enrolled. Patients underwent patellar taping (2 weeks) followed by a rehabilitation program lasting until the end of the third month. Primary outcome measures were pain and the functional level of the patellofemoral joint. Secondary outcome measures were surface electromyographic (sEMG) onset timing of the VMO/VL during seated knee extension and squat and isometric knee extensor muscle strength. Significant differences in all the outcome measures were observed between the affected and unaffected sides before treatment. The pain score significantly decreased both posttreatment (Δ=−4.7; 95% CI=−5.4 to −3.9) and at the 12-month follow-up (Δ=−5.5; 95% CI=−6.1 to −4.8), while the functional level significantly increased both posttreatment (Δ=24; 95% CI=18.3 to 30.2) and at the 12-month follow-up (Δ=26; 95% CI=21.4 to 30.6). Posttreatment, 35/44 patients (79.5%) and 31/44 patients (70.5%) achieved normal sEMG onset timing of the VMO and VL in the seated knee extension exercise and in the squat exercise, respectively. A short period of patellar taping followed by an exercise program results in long-lasting pain control in PFPS associated with muscular dysfunction.
Aim of our work was to evaluate the diagnostic role and potentials of Magnetic Resonance Imaging ... more Aim of our work was to evaluate the diagnostic role and potentials of Magnetic Resonance Imaging (MRI) in the study of groin pain in athletes and in the differential diagnosis among the pathological conditions that cause this syndrome. MRI examinations were performed with a 1.5 T superconductive magnet, and a 0.2 T permanent magnet. Spin-Echo (SE) T1-w, PD, SE T2-w, Gradient-Echo (GE) T2-w and fat saturation sequences were used, on axial, sagittal and coronal scan planes. We performed MRI on twenty-five athletes (22 men and 3 women; age range 17 to 32 years) with chronic groin pain of questionable origin who had been complaining of it for at least 6 months. In 22 cases, radiographs were available; Computed Tomography (CT) had been performed in 3 cases and Ultrasound (US) in 7 cases. Nine patients were submitted to MRI after the symptoms had disappeared. In all patients, MRI provided an accurate depiction of pubic bone alterations and of adjacent myotendinous structures. In 14 cases, osteitis pubis was diagnosed, which was bilateral in 2 cases only (muscular asymmetry of the rectus abdominis was found in 4 of these patients); 4 patients had myotendinous posttraumatic changes (1 hematoma of the psoas muscle and 3 injuries of the abductor muscles of the thigh); 4 patients presented isolated dysmetria of rectus abdominis muscles, with unilateral involvement of the sacroiliac joint in 1 patient; 3 patients had inguinal hernia, surgically confirmed in all cases. Osteitis pubis, intended as reactive intraspongiuos edema of the pubic bones, is the most frequent cause of groin pain in athletes. In the early diagnostic phases, both plain films and CT may be negative or not specific. On the other hand, MRI has always proved to be a valuable diagnostic technique in detecting the osteitic change as an area of low signal intensity on T1-w images and of high and homogeneous signal intensity on T2-w scans without fat suppression. Dysmetria of the straight muscles of the abdomen, which may be associated, is always well depicted by MRI on axial planes. Both posttraumatic and dysmetric changes of the muscular structures adjacent to the pubis are well documented by US and MRI. The latter, however, thanks to its multiplanar capabilities, allows better spatial assessment of the alteration, especially if located at peri-insertional level. Possible associated diseases such as the involvement of the sacroiliac joints are also well shown by MRI. Inguinal hernias are easily demonstrated by MRI, which allows the direct visualization of the hernial sac within the inguinal canal. In our experience, only MRI can permit an accurate and early diagnosis of the different sport-related pubic conditions. MRI is also a valuable tool in monitoring the alterations with reference to their response to treatment, which may also help bring the athletes back to their activities.
Background. Extracorporeal shock-wave therapy (ESWT) represents a valid intervention in the treat... more Background. Extracorporeal shock-wave therapy (ESWT) represents a valid intervention in the treatment of people with supraspinatus calcifying tendinitis (SCT), but there is limited evidence for the useful range of ESWT doses.
The Journal of orthopaedic and sports physical therapy, 2012
P atellar tendinopathy is an injury related to structural damage in the distal and proximal regio... more P atellar tendinopathy is an injury related to structural damage in the distal and proximal regions of the patellar tendon. This injury generally occurs in individuals who engage in sports and recreational activities that require sudden acceleration and deceleration, and in athletes who perform repetitive movements such as jumping, climbing, and kicking. These activities are known to have the potential to overload the extensor apparatus of the knee. Lian et al, 13 in a study that included 612 athletes from different sports, reported a prevalence of patellar tendinopathy of 14.2%. This injury is twice as prevalent in men as it is in women 11 and keeps 33% of athletes away from their sports activities for more than 6 months, forcing 50% of these athletes into early retirement. 2 Furthermore, it affects approximately 45% of volleyball athletes, as this is a sport with actions that involve several risk factors for patellar tendinopathy. Due to the high prevalence of patellar tendinopathy in athletes, early diagnosis and treatment are essential to avoid extended periods away from sports activities. Clinical instruments to determine the severity and the level of disability resulting from patellar tendinopathy are highly useful because they can assess the evolution of the condition and serve as T T STUDY DESIGN: Clinical measurement. T T OBJECTIVES: To translate, adapt, and test the measurement properties of the Brazilian Portuguese version of the Victorian Institute of Sport Assessment-Patella (VISA-P) questionnaire.
ObjectiveTo evaluate the effectiveness of disodium EDTA administration in the treatment of calcif... more ObjectiveTo evaluate the effectiveness of disodium EDTA administration in the treatment of calcific tendinitis of the shoulder.To evaluate the effectiveness of disodium EDTA administration in the treatment of calcific tendinitis of the shoulder.MethodsEighty patients with radiographically verified calcific tendinitis of the shoulder were enrolled between September 2001 and October 2003. Patients were randomly assigned to either a study group (n = 40) or a control group (n = 40). Pain and functional level were evaluated before and after treatment and at 1-year followup. Radiographic modifications in calcifications were evaluated before and after treatment. Disodium EDTA was administered through single needle mesotherapy and 15 minutes of pulsed-mode 1 MHz-ultrasound.Eighty patients with radiographically verified calcific tendinitis of the shoulder were enrolled between September 2001 and October 2003. Patients were randomly assigned to either a study group (n = 40) or a control group (n = 40). Pain and functional level were evaluated before and after treatment and at 1-year followup. Radiographic modifications in calcifications were evaluated before and after treatment. Disodium EDTA was administered through single needle mesotherapy and 15 minutes of pulsed-mode 1 MHz-ultrasound.ResultsThe study group displayed improvement in all of the parameters analyzed after treatment and at the 1-year followup. Calcifications disappeared completely in 62.5% of the patients in the study group and partially in 22.5%; calcifications partially disappeared in only 15% of the patients in the control group, and none displayed a complete disappearance.The study group displayed improvement in all of the parameters analyzed after treatment and at the 1-year followup. Calcifications disappeared completely in 62.5% of the patients in the study group and partially in 22.5%; calcifications partially disappeared in only 15% of the patients in the control group, and none displayed a complete disappearance.ConclusionOur results suggest that the use of disodium EDTA for the management of calcific tendinitis of the shoulder is safe and effective, leading to a significant reduction in pain, improvement in shoulder function, and disappearance of calcifications after 4 weeks, without adverse effects.Our results suggest that the use of disodium EDTA for the management of calcific tendinitis of the shoulder is safe and effective, leading to a significant reduction in pain, improvement in shoulder function, and disappearance of calcifications after 4 weeks, without adverse effects.
Kinematic and kinetic methods (sacral marker, reconstructed pelvis, segmental analysis, and force... more Kinematic and kinetic methods (sacral marker, reconstructed pelvis, segmental analysis, and force platform methods) have been used to calculate the vertical excursion of the center of mass (COM) during movement. In this study we compared the measurement of vertical COM displacement yielded by different methods during able-bodied subjects' hopping at different frequencies (varying between 1.2 and 3.2 Hz). ANOVA revealed a significant interaction between hopping frequency and method (p < 0.001), showing that increasing hopping frequency reduced the differences between methods. A post hoc analysis revealed a significant difference between all methods at the lowest hopping frequency and between the force platform and both the sacral marker and reconstructed pelvis methods at the intermediate hopping frequencies, with differences ranging from 16 to 67 millimeters (all p < 0.05). Results are discussed in view of each methods' limits. We conclude that the segmental analysis and force platform methods can be considered to provide the most accurate results for COM vertical excursion during human hopping in a large range of hopping frequency.
There are no controlled studies testing the efficacy of various nonoperative strategies for treat... more There are no controlled studies testing the efficacy of various nonoperative strategies for treatment of greater trochanter pain syndrome.
In the present study we investigated the probability, latency and duration of the inhibitory comp... more In the present study we investigated the probability, latency and duration of the inhibitory component of the withdrawal reflex elicited by painful electrical stimulation of the index finger in humans. The stimulus consisted of a train of high-intensity pulses. The investigation was carried out in several upper limb muscles during isometric contractions of different strengths and during a motor sequence consisting of reaching, picking up and transporting an object. We used a new algorithm to detect and characterize the inhibitory reflex. The reflex was found in all muscles except the brachioradialis at all the isometric contraction strengths, and showed a distal-to-proximal gradient of latency and duration. Conversely, during movement the reflex probability was high (> 80%) in the anterior deltoid and triceps muscles during reaching, in the extensor carpi radialis muscle during transporting of the object, and in the first interosseous muscle during both picking up and transporting of the object. This modulation of inhibitory reflex transmission in the upper limb muscles suggests that the motor response is organized in such a way as to inhibit the overall ongoing motor task by interrupting motion during reaching and by releasing the object during transporting. This pattern of modulation appears to differ markedly from that previously reported for the excitatory component of the withdrawal reflex. Study of the nociceptive inhibitory reflexes during movement offers new and more profound insights into the functional anatomical organization of the spinal interneuronal network mediating sensory–motor integration.
Study Design. Multicenter randomized, double-blind, simulated therapy-controlled trial in a cohor... more Study Design. Multicenter randomized, double-blind, simulated therapy-controlled trial in a cohort of patients with acute low back pain (LBP) due to lumbar disc herniation (LDH).
Background. The relationship between ankle plantar flexor biomechanical properties and gait patte... more Background. The relationship between ankle plantar flexor biomechanical properties and gait pattern following surgery for acute rupture of the Achilles tendon has not yet been fully investigated.
The Journal of orthopaedic and sports physical therapy, 2012
T he anterior cruciate ligament (ACL) is the most frequently injured ligament in the knee and is ... more T he anterior cruciate ligament (ACL) is the most frequently injured ligament in the knee and is typically managed, especially in the athletic population, with arthroscopic reconstruction followed by rehabilitation treatment. Generally, rehabilitation programs after arthroscopic ACL reconstruction include progression through the acute, subacute, functional, and returnto-activity phases of rehabilitation. The ultimate goal of ACL reconstruction and subsequent rehabilitation procedures is the restoring of the patient's functional knee stability to prevent reinjury and allow safe return to previous activity levels. Despite the obvious progress in ACL reconstruction techniques and rehabilitation procedures after ACL injury, two-thirds of athletes who undergo ACL reconstruction do not return to preinjury sport levels. 4,18 Moreover, among the athletes who return to their preinjury sport levels, ACL reinjury occurs in 3% to 19% of ACL-reconstructed knees, and 5% to 24% of athletes sustain a contralateral ACL injury. The authors of a recent review reported that, although the great majority (nearly 90%) of athletes obtained what was considered normal or near-normal strength values (greater than or equal to 85% to 90% of muscle strength capacity in their injured leg compared to their noninjured leg), the rate of return to sport was low. 5 This suggests that muscle strength tests commonly used as criteria T T STUDY DESIGN: Descriptive, prospective, longitudinal single-cohort study.
Initial treatment of trapeziometacarpal osteoarthritis (TMO) often consists of intra-articular in... more Initial treatment of trapeziometacarpal osteoarthritis (TMO) often consists of intra-articular injection of corticosteroids or hyaluronic acid. Several studies have shown that ultrasound (US)-guided injections demonstrate greater precision and effectiveness when compared to blind techniques. The aim of our study was to describe a simple and reliable procedure of US-guided intra-articular injection of hyaluronic acid solution in patients with TMO.
Patellofemoral pain syndrome (PFPS) is a common source of anterior knee pain. While treatment for... more Patellofemoral pain syndrome (PFPS) is a common source of anterior knee pain. While treatment for PFPS may be successful in the short term, long-term results are less promising. The purpose of this study was to record longterm pain and functionality outcomes following rehabilitation in patients affected by PFPS. A prospective cohort study of 44 patients with a diagnosis of PFPS and an activation imbalance between the vastus medialis obliquus (VMO) and vastus lateralis (VL) muscles were enrolled. Patients underwent patellar taping (2 weeks) followed by a rehabilitation program lasting until the end of the third month. Primary outcome measures were pain and the functional level of the patellofemoral joint. Secondary outcome measures were surface electromyographic (sEMG) onset timing of the VMO/VL during seated knee extension and squat and isometric knee extensor muscle strength. Significant differences in all the outcome measures were observed between the affected and unaffected sides before treatment. The pain score significantly decreased both posttreatment (Δ=−4.7; 95% CI=−5.4 to −3.9) and at the 12-month follow-up (Δ=−5.5; 95% CI=−6.1 to −4.8), while the functional level significantly increased both posttreatment (Δ=24; 95% CI=18.3 to 30.2) and at the 12-month follow-up (Δ=26; 95% CI=21.4 to 30.6). Posttreatment, 35/44 patients (79.5%) and 31/44 patients (70.5%) achieved normal sEMG onset timing of the VMO and VL in the seated knee extension exercise and in the squat exercise, respectively. A short period of patellar taping followed by an exercise program results in long-lasting pain control in PFPS associated with muscular dysfunction.
Aim of our work was to evaluate the diagnostic role and potentials of Magnetic Resonance Imaging ... more Aim of our work was to evaluate the diagnostic role and potentials of Magnetic Resonance Imaging (MRI) in the study of groin pain in athletes and in the differential diagnosis among the pathological conditions that cause this syndrome. MRI examinations were performed with a 1.5 T superconductive magnet, and a 0.2 T permanent magnet. Spin-Echo (SE) T1-w, PD, SE T2-w, Gradient-Echo (GE) T2-w and fat saturation sequences were used, on axial, sagittal and coronal scan planes. We performed MRI on twenty-five athletes (22 men and 3 women; age range 17 to 32 years) with chronic groin pain of questionable origin who had been complaining of it for at least 6 months. In 22 cases, radiographs were available; Computed Tomography (CT) had been performed in 3 cases and Ultrasound (US) in 7 cases. Nine patients were submitted to MRI after the symptoms had disappeared. In all patients, MRI provided an accurate depiction of pubic bone alterations and of adjacent myotendinous structures. In 14 cases, osteitis pubis was diagnosed, which was bilateral in 2 cases only (muscular asymmetry of the rectus abdominis was found in 4 of these patients); 4 patients had myotendinous posttraumatic changes (1 hematoma of the psoas muscle and 3 injuries of the abductor muscles of the thigh); 4 patients presented isolated dysmetria of rectus abdominis muscles, with unilateral involvement of the sacroiliac joint in 1 patient; 3 patients had inguinal hernia, surgically confirmed in all cases. Osteitis pubis, intended as reactive intraspongiuos edema of the pubic bones, is the most frequent cause of groin pain in athletes. In the early diagnostic phases, both plain films and CT may be negative or not specific. On the other hand, MRI has always proved to be a valuable diagnostic technique in detecting the osteitic change as an area of low signal intensity on T1-w images and of high and homogeneous signal intensity on T2-w scans without fat suppression. Dysmetria of the straight muscles of the abdomen, which may be associated, is always well depicted by MRI on axial planes. Both posttraumatic and dysmetric changes of the muscular structures adjacent to the pubis are well documented by US and MRI. The latter, however, thanks to its multiplanar capabilities, allows better spatial assessment of the alteration, especially if located at peri-insertional level. Possible associated diseases such as the involvement of the sacroiliac joints are also well shown by MRI. Inguinal hernias are easily demonstrated by MRI, which allows the direct visualization of the hernial sac within the inguinal canal. In our experience, only MRI can permit an accurate and early diagnosis of the different sport-related pubic conditions. MRI is also a valuable tool in monitoring the alterations with reference to their response to treatment, which may also help bring the athletes back to their activities.
Background. Extracorporeal shock-wave therapy (ESWT) represents a valid intervention in the treat... more Background. Extracorporeal shock-wave therapy (ESWT) represents a valid intervention in the treatment of people with supraspinatus calcifying tendinitis (SCT), but there is limited evidence for the useful range of ESWT doses.
The Journal of orthopaedic and sports physical therapy, 2012
P atellar tendinopathy is an injury related to structural damage in the distal and proximal regio... more P atellar tendinopathy is an injury related to structural damage in the distal and proximal regions of the patellar tendon. This injury generally occurs in individuals who engage in sports and recreational activities that require sudden acceleration and deceleration, and in athletes who perform repetitive movements such as jumping, climbing, and kicking. These activities are known to have the potential to overload the extensor apparatus of the knee. Lian et al, 13 in a study that included 612 athletes from different sports, reported a prevalence of patellar tendinopathy of 14.2%. This injury is twice as prevalent in men as it is in women 11 and keeps 33% of athletes away from their sports activities for more than 6 months, forcing 50% of these athletes into early retirement. 2 Furthermore, it affects approximately 45% of volleyball athletes, as this is a sport with actions that involve several risk factors for patellar tendinopathy. Due to the high prevalence of patellar tendinopathy in athletes, early diagnosis and treatment are essential to avoid extended periods away from sports activities. Clinical instruments to determine the severity and the level of disability resulting from patellar tendinopathy are highly useful because they can assess the evolution of the condition and serve as T T STUDY DESIGN: Clinical measurement. T T OBJECTIVES: To translate, adapt, and test the measurement properties of the Brazilian Portuguese version of the Victorian Institute of Sport Assessment-Patella (VISA-P) questionnaire.
ObjectiveTo evaluate the effectiveness of disodium EDTA administration in the treatment of calcif... more ObjectiveTo evaluate the effectiveness of disodium EDTA administration in the treatment of calcific tendinitis of the shoulder.To evaluate the effectiveness of disodium EDTA administration in the treatment of calcific tendinitis of the shoulder.MethodsEighty patients with radiographically verified calcific tendinitis of the shoulder were enrolled between September 2001 and October 2003. Patients were randomly assigned to either a study group (n = 40) or a control group (n = 40). Pain and functional level were evaluated before and after treatment and at 1-year followup. Radiographic modifications in calcifications were evaluated before and after treatment. Disodium EDTA was administered through single needle mesotherapy and 15 minutes of pulsed-mode 1 MHz-ultrasound.Eighty patients with radiographically verified calcific tendinitis of the shoulder were enrolled between September 2001 and October 2003. Patients were randomly assigned to either a study group (n = 40) or a control group (n = 40). Pain and functional level were evaluated before and after treatment and at 1-year followup. Radiographic modifications in calcifications were evaluated before and after treatment. Disodium EDTA was administered through single needle mesotherapy and 15 minutes of pulsed-mode 1 MHz-ultrasound.ResultsThe study group displayed improvement in all of the parameters analyzed after treatment and at the 1-year followup. Calcifications disappeared completely in 62.5% of the patients in the study group and partially in 22.5%; calcifications partially disappeared in only 15% of the patients in the control group, and none displayed a complete disappearance.The study group displayed improvement in all of the parameters analyzed after treatment and at the 1-year followup. Calcifications disappeared completely in 62.5% of the patients in the study group and partially in 22.5%; calcifications partially disappeared in only 15% of the patients in the control group, and none displayed a complete disappearance.ConclusionOur results suggest that the use of disodium EDTA for the management of calcific tendinitis of the shoulder is safe and effective, leading to a significant reduction in pain, improvement in shoulder function, and disappearance of calcifications after 4 weeks, without adverse effects.Our results suggest that the use of disodium EDTA for the management of calcific tendinitis of the shoulder is safe and effective, leading to a significant reduction in pain, improvement in shoulder function, and disappearance of calcifications after 4 weeks, without adverse effects.
Kinematic and kinetic methods (sacral marker, reconstructed pelvis, segmental analysis, and force... more Kinematic and kinetic methods (sacral marker, reconstructed pelvis, segmental analysis, and force platform methods) have been used to calculate the vertical excursion of the center of mass (COM) during movement. In this study we compared the measurement of vertical COM displacement yielded by different methods during able-bodied subjects' hopping at different frequencies (varying between 1.2 and 3.2 Hz). ANOVA revealed a significant interaction between hopping frequency and method (p < 0.001), showing that increasing hopping frequency reduced the differences between methods. A post hoc analysis revealed a significant difference between all methods at the lowest hopping frequency and between the force platform and both the sacral marker and reconstructed pelvis methods at the intermediate hopping frequencies, with differences ranging from 16 to 67 millimeters (all p < 0.05). Results are discussed in view of each methods' limits. We conclude that the segmental analysis and force platform methods can be considered to provide the most accurate results for COM vertical excursion during human hopping in a large range of hopping frequency.
There are no controlled studies testing the efficacy of various nonoperative strategies for treat... more There are no controlled studies testing the efficacy of various nonoperative strategies for treatment of greater trochanter pain syndrome.
In the present study we investigated the probability, latency and duration of the inhibitory comp... more In the present study we investigated the probability, latency and duration of the inhibitory component of the withdrawal reflex elicited by painful electrical stimulation of the index finger in humans. The stimulus consisted of a train of high-intensity pulses. The investigation was carried out in several upper limb muscles during isometric contractions of different strengths and during a motor sequence consisting of reaching, picking up and transporting an object. We used a new algorithm to detect and characterize the inhibitory reflex. The reflex was found in all muscles except the brachioradialis at all the isometric contraction strengths, and showed a distal-to-proximal gradient of latency and duration. Conversely, during movement the reflex probability was high (> 80%) in the anterior deltoid and triceps muscles during reaching, in the extensor carpi radialis muscle during transporting of the object, and in the first interosseous muscle during both picking up and transporting of the object. This modulation of inhibitory reflex transmission in the upper limb muscles suggests that the motor response is organized in such a way as to inhibit the overall ongoing motor task by interrupting motion during reaching and by releasing the object during transporting. This pattern of modulation appears to differ markedly from that previously reported for the excitatory component of the withdrawal reflex. Study of the nociceptive inhibitory reflexes during movement offers new and more profound insights into the functional anatomical organization of the spinal interneuronal network mediating sensory–motor integration.
Study Design. Multicenter randomized, double-blind, simulated therapy-controlled trial in a cohor... more Study Design. Multicenter randomized, double-blind, simulated therapy-controlled trial in a cohort of patients with acute low back pain (LBP) due to lumbar disc herniation (LDH).
Background. The relationship between ankle plantar flexor biomechanical properties and gait patte... more Background. The relationship between ankle plantar flexor biomechanical properties and gait pattern following surgery for acute rupture of the Achilles tendon has not yet been fully investigated.
The Journal of orthopaedic and sports physical therapy, 2012
T he anterior cruciate ligament (ACL) is the most frequently injured ligament in the knee and is ... more T he anterior cruciate ligament (ACL) is the most frequently injured ligament in the knee and is typically managed, especially in the athletic population, with arthroscopic reconstruction followed by rehabilitation treatment. Generally, rehabilitation programs after arthroscopic ACL reconstruction include progression through the acute, subacute, functional, and returnto-activity phases of rehabilitation. The ultimate goal of ACL reconstruction and subsequent rehabilitation procedures is the restoring of the patient's functional knee stability to prevent reinjury and allow safe return to previous activity levels. Despite the obvious progress in ACL reconstruction techniques and rehabilitation procedures after ACL injury, two-thirds of athletes who undergo ACL reconstruction do not return to preinjury sport levels. 4,18 Moreover, among the athletes who return to their preinjury sport levels, ACL reinjury occurs in 3% to 19% of ACL-reconstructed knees, and 5% to 24% of athletes sustain a contralateral ACL injury. The authors of a recent review reported that, although the great majority (nearly 90%) of athletes obtained what was considered normal or near-normal strength values (greater than or equal to 85% to 90% of muscle strength capacity in their injured leg compared to their noninjured leg), the rate of return to sport was low. 5 This suggests that muscle strength tests commonly used as criteria T T STUDY DESIGN: Descriptive, prospective, longitudinal single-cohort study.
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Papers by Angelo Cacchio