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

An update on the grading of muscle injuries: A narrative review from clinical to comprehensive systems

Muscle injuries are recognized to be among the most frequent injuries occurring in the sporting and athletic population, and they account for more than 30% of all injuries in professional soccer players. Despite their considerable frequency and impact, there is still a lack of uniformity in the categorization, description and grading of muscle injuries. Dozens of systems based on clinical signs, ultrasound imaging (Us) appearance or magnetic resonance imaging (MRi) findings have been proposed over the years. Most of them are three-grade systems that take into account pain, RoM limitation, swelling and hematoma, hypoechoic or hyperintense areas on Us or MRi, and muscle gap or tendon involvement; however, they still lack evidence-based prognostic value. Recently, new comprehensive classification systems have been proposed, with the aim of developing uniform muscle injury terminology and giving each severity grade prognostic value. The systems that combine detailed MRi and Us features with the clinical presentation, such as the Munich Muscle injury Classification, the isMuLt classification, and the British Athletic Classification, if used extensively, could improve the diagnosis, prognosis and management of muscle injuries

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

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

Osteochondral Lesions of the Ankle: An Evidence-Based Approach for Track and Field Athletes

Osteochondral lesions (OCL) of the ankle present a problematic injury for the track and field athlete. As no superior treatment exists to date, an evidence-based personalized approach is advised for the treatment of ankle OCLs. Treatment is guided by patient- and lesion-characteristics, and consists of conservative treatment and surgery. After-treatment of track and field athletes is based on rehabilitation phases and should be a personalized process. This chapter serves as a practical guideline for the diagnosis, management, and rehabilitation of OCLs in the ankle in the track and field athlete

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