Functional progression milestones following anterior cruciate ligament reconstruction are more appropriate than time-based criteria:a survey among the ESSKA

Purpose The aim of this study was to report current rehabilitation recommendations after ACL reconstruction in ESSKA community, with a particular focus on the specific criteria utilized to guide activity progression Methods A web-based survey was developed to investigate preferences between time-based and functional ACL reconstruction rehabilitation progression milestones of ESSKA community. Results Eight hundred and twenty completed questionnaires were received. Responders were from 86 different countries worldwide, 63% of them from European countries. Functional criteria were considered more appropriate to decide if a patient can start specific activities/exercises by 67% of the responders. Good core and lower extremity neuromuscular control were the most often used functional criteria for decision-making regarding readiness for sport-specific rehabilitation (66%), sport-specific drills without (65%) and with contact (66%). Strength assessed with an isokinetic dynamometer was considered by about half of the responders a determinant to initiate sport-specific drills without (51%-isokinetic strength, LSI > 80%) and with contact (58%-isokinetic strength, LSI > 85-90%). To determine readiness for sport-specific drills, hop tests were used by 40% of respondents for drills without contact and 48% of respondents for drills with contact. Conclusion The results of this survey involving mainly orthopaedic surgeons indicate that functional measures are considered more appropriate than milestones based on time from surgery to guide progression through the postoperative rehabilitation process after ACLR. The main clinical relevance of this study is that updated information on collective agreement could be useful for clinicians and physiotherapists to delineate their postoperative treatments after ACLR. These results should be interpreted with caution, as this sample represents only a small portion of ESSKA community involved in knee surgery and treating patients following ACLR

Return to sport after ACL reconstruction: a survey between the Italian Society of Knee, Arthroscopy, Sport, Cartilage and Orthopaedic Technologies (SIGASCOT) members

Background: A worldwide consensus for timing and criteria for return to sport after anterior cruciate ligament (ACL) reconstruction is lacking. The aim of the study was to survey among the Italian Society of Knee, Arthroscopy, Sport, Cartilage and Orthopaedic Technologies (SIGASCOT) members in order to evaluate their approaches to the return to sport after ACL reconstruction regarding timing and criteria. Methods: A web survey among the SIGASCOT members was performed, including 14 questions regarding technical and graft preferences, timing for return to training and competitive activity for contact and non-contact sports and criteria to allow return to sport. Results: Totally, 123 members completed the questionnaire. Return to training sports was allowed within 6\ua0month by 87\ua0% for non-contact sports and by 53\ua0% for contact sports. Return to competitive activity was allowed within 6\ua0months by 48\ua0% for non-contact sports and by 13\ua0% for contact sports. Full ROM (77\ua0%), Lachman test (65\ua0%) and Pivot-Shift test (65\ua0%) were the most used criteria to allow return to sport. The 90\ua0% used at least one clinical score. Conclusion: The SIGASCOT members showed various approaches in the return to sport after ACL reconstruction, with differences between return to training or competitive activity, and between contact and non-contact sports. Six months was generally considered adequate by most of the members for the most demanding activities. The most used criteria to allow return to sport were manual testing. A clear definition of sport activities and more objective criteria for the return to sport are needed. Level of evidence: Level V, expert opinion

Hamstrings substitution via anteromedial portal with optional anterolateral ligament reconstruction is the preferred surgical technique for anterior cruciate ligament reconstruction: a survey among ESSKA members

Purpose The objective of this study was to report on a worldwide web-based survey among the ESSKA community developed to investigate current recommendations regarding ACL reconstruction surgical procedures. Methods All contacts in the official mailing list of the ESSKA were contacted to investigate preferences regarding graft type, anterolateral ligament reconstruction, femoral tunnel drilling technique, single-bundle vs double-bundle technique, femoral and tibial fixation methods. Results Eight-hundred and twenty responses were analyzed. Hamstrings autograft was the graft of choice in male patients for 634 (79%) and in female patients for 674 (84%) responders, while its preference for ACL reconstruction in professional athletes was for 401 (50%). 480 (63%) surgeons surveyed would include anterolateral ligament reconstruction only if diagnosed and remaining instability after ACL surgery or revision. 598 (75%) respondents were in favor of anteromedial portal for femoral tunnel drilling. The most popular femoral fixation technique was found to be cortical suspension (500-66%), while a compression system was preferred on the tibial side by 537 (71% of the sample). Conclusions This survey study found that HT autograft, single-bundle reconstruction, anteromedial portal for femoral tunnel drilling, cortical suspension systems for femoral fixation and compression systems for tibial fixation represent the current standard of ACLR in a large community of orthopedic surgeons. The present study performed with surgeons who are members of the ESSKA community will help to comprehend the actual ACLR worldwide practice patterns. Due to low response rate, these results should be interpreted with caution and not to be intended to represent the state of the art of ESSKA community

Cross-cultural adaptation and multi-centric validation of the Italian version of the Achilles tendon Total Rupture Score (ATRS)

Purpose: The purpose of this study was to translate the Achilles tendon Total Rupture Score (ATRS) into Italian and establish its cultural adaptiveness and validity. Methods: The original version of the ATRS was translated into Italian in accordance with the stages recommended by Guillemin. A web-based survey was developed to test the construct validity of the Italian ATRS. Eighty patients with an average age of 45.5 years (SD 11) were included in the study. The ATRS was completed twice at 5 days intervals for test–retest reliability. The intraclass correlation coefficient was used to calculate the test–retest reliability, and Cronbach’s α coefficient was used for internal consistency. Validity was evaluated by external correlation (Spearman’s rank correlation coefficient, r) of the ATRS with the Italian versions of the Victorian Institute of Sports Assessment-Achilles questionnaire (VISA-A), the 17-Italian Foot Function Index (17-FFI), the Lower Extremity Functional Scale (LEFS), and the Short-Form 36 (SF-36). Results: The internal consistency (α = 0.97) and the test–retest reliability (ICC = 0.96) were excellent. The correlation coefficient showed strong correlation of the Italian ATRS with the VISA-A and the LEFS (r = 0.72 and r = 0.70, respectively, p < 0.0001), a weak correlation with the 17-FFI (r = −0.30, p = 0.007), and high-to-moderate correlation with the physical functioning, bodily pain, physical role functioning, social functioning, role emotional, and vitality of the SF-36 (r = 0.75, r = 0.61, r = 0.52, r = 0.49, r = 0.40 and r = 0.34, respectively, p < 0.0001). Conclusion: The Italian version of the ATRS is a valid instrumentation to assess the functional limitations of Italian patients after Achilles tendon rupture. Level of evidence: III

Cross cultural adaptation and multi centric validation of the italian version of the Tegner Activity Scale

Background. This study aims to adapt the Tegner Activity Scale (TAS) to Italian language and establish its reliability and validity in patients after anterior cruciate ligament reconstruction. It was hypnotized the Italian version of the TAS have acceptable psychometric properties for use with the Italian population. Methods. This is an observational multicenter study. The Tegner Activity Scale was translated and culturally adapted according to the Beaton guidelines. A web-based survey was conducted to evaluate the construct validity: 62 patients were included in the study. Spearman’s rank correlation coefficient (r) between the TAS and the Short Form 36 (SF-36) subscales and the International Knee Documentation Committee (IKDC) was used to evaluate construct validity. The patients completed the TAS again one week after their first submission, and the intraclass correlation coefficient was used to calculate the test-retest reliability. Results. The correlation coefficient showed moderate correlation with the SF-36 Physical Function domain (r = 0.41; p = 0.001) and weak correlation with the IKDC (r = 0.3; p = 0.02). Correlations with the other SF-36 subscales were very weak and not statistically significant. Test-retest reliability (0.68, 95%CI 0.43-0.83) ranged from good to excellent. Conclusions. The Italian version of the Tegner Activity Scale is a valid instrument to assess a patient’s level of sporting activity after anterior cruciate ligament reconstruction. Cultural adaptation of this scale is fundamental to make this instrument comparable throughout scientific literature. © 2023, EDRA S.p.A. All rights reserved

Orthobiologics Injection Therapies in the Treatment of Muscle and Tendon Disorders in Athletes: Fact or Fake?

Muscle and tendon injuries encompass a wide range of conditions, including both acute and chronic ailments, and are common among athletes, representing a significant cause of injuries in various sports. Frequently affected areas include the hamstrings, quadriceps, gastrocnemius, and hip flexors. Concurrently, tendinopathy presents a complex clinical challenge, affecting a majority of athletes due to high load demands and repetitive movements, with its incidence in sports practice increasing over the last decades to account for up to 30% of all injuries. The substantial costs, both in terms of time away from competition and financial loss, have spurred growing scientific interest in therapies that can enhance the healing process of these injuries. In this context, innovative orthobiologic approaches, particularly platelet-rich plasma (PRP) and mesenchymal stem cells (MSCs), have been explored for their potential to facilitate the return-to-play phase and reduce the risk of reinjury by modulating inflammation and promoting tissue regeneration. This narrative review aims to summarize the current evidence regarding the role of orthobiologics in the management of sports-related muscle and tendon injuries