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Clinicians’ Attitudes, Perspectives, and Clinical Practices on Gait Retraining After Anterior Cruciate Ligament Reconstruction

Kyle Southall, Laura Vogtle, Harshvardhan Singh, Matthew P. Ithurburn, C. Scott Bickel, and Christopher P. Hurt

Introduction: It has been shown that 45%–85% of patients with anterior cruciate ligament reconstruction (ACLR) will have early-onset arthritis within 10–12 years following surgery. Over the past two decades, the amount of literature regarding ACLR, gait maladaptations after ACLR and their potential link to early-onset arthritis, and rehabilitation techniques has grown exponentially; however, long-term patient outcomes remain modest. Methods: To evaluate current clinicians’ attitudes, perspectives, and clinical practice approach for rehabilitation of patients following ACLR, a survey questionnaire was designed using the Delphi technique. Results: Of the 263 respondents, 84.4% (n = 226) reported that they believed gait training to be “Very” or “Extremely Important.” However, only 35.7% (n = 94) reported objectively measuring gait during ACLR rehabilitation. Of the total respondents, only 6.8% (n = 18) assessed gait during rehabilitation using two-dimensional or three-dimensional motion capture technologies. Discussion: Our results suggest that while gait evaluation was perceived as important, most respondents did not objectively measure gait metrics as a clinical outcome during ACLR rehabilitation. These findings provide a prospective rehabilitation target to potentially mitigate a known risk factor of early-onset arthritis (gait maladaptations) in individuals following ACLR.

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The Effect of Insurance Type on Time to Anterior Cruciate Ligament Reconstruction in Pediatric Patients: A Critically Appraised Topic

Alexis P. Tucker, Marc F. Norcross, Kimberly S. Hannigan, and Samuel T. Johnson

Clinical Scenario: Delay in surgery for anterior cruciate ligament (ACL) injuries increases the risk of complications including secondary injuries. Previous research has shown individuals with public insurance have greater delays in care for a variety of health conditions. Clinical Question: In pediatric patients with ACL injuries, is the time from injury to surgery longer for patients with public insurance than patients with private insurance? Summary of Key Findings: Four studies met the inclusion criteria. All studies reported a greater wait time for surgery in pediatric patients with public insurance. Clinical Bottom Line: There is moderate evidence indicating that there is a delay in ACL surgery for pediatric patients with public insurance compared to those with private insurance. Strength of Recommendation: Grade B evidence exists that there is a delay in surgery for ACL injuries in pediatric patients with public insurance compared to those with private insurance.

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Extracondylar Patellar Dislocation Inverted on the Vertical Axis in a Collegiate Football Athlete: A Case Report and Literature Review

John C. Roberts Jr., Alexis M. Zegan, Alivia D. Fink, and Jane M. Kubala

A male, Division II collegiate football player presented with an extracondylar lateral patellar dislocation with inversion of the patella on its vertical axis following impact with the ground on the medial side. The patient was sedated for closed patellar reduction. He returned to full participation after 6 weeks of a progressive strength program. Extracondylar patellar inversion is not often associated with severe force or a direct blow, but the case described occurred after a high-impact tackle to the ground. This is also the only published case of a collegiate athlete returning to collision sport after sustaining an inverted extracondylar patellar dislocation. Despite the deformity and emergent nature of an inverted patellar dislocation, having patients complete early mobilization activities, including range of motion, and aggressive strengthening and functional progressions may facilitate a quick and safe return to highly intensive and competitive physical activity.

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In Physicians and Athletic Trainers, Is Burnout Associated With Self-Reported Medical Errors: A Critically Appraised Topic

Mark S. Myers, Jamie L. Mansell, Ryan T. Tierney, and Anne C. Russ

Clinical Question: In physicians and athletic trainers, is burnout associated with self-reported medical errors (MEs)? Clinical Bottom Line: Burnout directly increased the odds of self-reported ME. Physicians and surgeons with burnout had a higher risk of an self-reported ME than athletic trainers with burnout. This disparity may reflect the different definitions, oversight, and opportunities to commit MEs in the respective fields. Emotional exhaustion and personnel accomplishment appear to drive MEs within clinically practicing athletic trainers, whereas emotional exhaustion and depersonalization are indicative of MEs within practicing physicians. Understanding the mechanism behind burnout within practice settings may provide insights into mitigation strategies to reduce MEs and improve patient outcomes. Strength of Recommendation Taxonomy B.

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Surgical Intervention of a Fibular Stress Fracture in a Male Basketball Player: A Case Report

Randall G. Meador, Travis L. Randolph, Brenden J. Balcik, David F. Hubbard, and Barry McDonough

This is a case of a 21-year-old male, African American Division I basketball player with a fibula stress fracture. The athlete initially reported pain, without distinct injury and was diagnosed with a stress fracture. After a short period of immobilization in a walking boot, this individual opted to undergo surgical intervention consisting of an intramedullary screw inserted in his left fibula. This was in consultation with the orthopedic team physician and orthopedic trauma surgeon. After a brief period of rest and continued immobilization in a walking boot, weight bearing as tolerated, the patient was able to start rehabilitation. He continued rehabilitation and progressive return to activity and was able to return to limited practice approximately 4 weeks. He played 13 min of a game in under 5 weeks (31 days). Stress fractures are not uncommon in basketball players, but a fibula stress fracture is one not often seen, and there is a paucity of data in the literature regarding this injury. A nonoperative approach to treatment of a fibula stress fracture typically yields good results but may lead to longer return than a surgical intervention. Providing athletes options for treatment may result in a quicker recovery. This case demonstrates a novel treatment option resulting in a quicker return to play.

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Female Collegiate Gymnasts’ Perceptions and Beliefs on Preventative Training Programs

Jessica C. Martinez, Ja’Naya M. Alexander, and Kelly D. Pagnotta

Gymnastics has the highest injury rate of all women’s collegiate sports, most occurring to the lower extremity. Preventative training programs (PTPs) effectively reduce lower-extremity injury rates. This study aimed to determine the perceptions and beliefs of female collegiate gymnasts regarding PTPs. Participants reported that they would be more likely to participate in a PTP if it resulted in fewer injury risk factors (p < .001), less likely to suffer an anterior cruciate ligament injury (p < .001), and fewer leg injuries (p < .001). Marketing and education of PTPs should be targeted and focus on what is most important to stakeholders to increase compliance.

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Lower-Extremity Visuomotor Reaction Time Is Not Different Between Males and Females Following Anterior Cruciate Ligament Reconstruction

Francesca M. Genoese, Michelle C. Walaszek, Katherine Collins, Elaine Reiche, Ashley Triplett, Matthew S. Harkey, Christopher Kuenze, and Shelby E. Baez

Visuomotor reaction time (VMRT) is predictive of lower-extremity musculoskeletal injury and may be a modifiable anterior cruciate ligament (ACL) injury risk factor that affects the incidence of primary and secondary ACL injuries in females. However, it is unknown if females with ACL reconstruction (ACLR) experience diminished VMRT compared with their male counterparts. The purpose of this study was to compare lower-extremity VMRT (LEVMRT) between males and females with ACLR. Female (n = 40) and male (n = 20) participants who were between 4 and 12 months after primary, unilateral ACLR completed a LEVMRT task with each limb using a series of wireless light discs. Mann–Whitney U tests were used to compare between-group differences for LEVMRT (in milliseconds). No statistically significant sex differences were observed for LEVMRT when the ACLR limb deactivated the light discs (females = 509.5 [132.5], males = 507.0 [79.8]; p = .77) or when the ACLR limb was stabilizing while the nonsurgical limb deactivated the light discs (females = 528.5 [105.3], males = 546.0 [92.5]; p = .77). Both males and females may benefit from visual motor training to improve VMRT after ACLR.

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Disagreement of Rehabilitation Adherence Perceptions Among Athletic Trainers and Injured Collegiate Athletes

Luis Torres, Shala E. Davis, Colleen A. Shotwell, and Fredrick A. Gardin

Collegiate athletic trainers continue to report adherence to physical rehabilitation programs to be a problem in collegiate athletics, as rehabilitation adherence among collegiate athletes can range between 40% and 90%. Inconsistent appropriate adherence to these programs may limit patients’ ability to successfully recover from their sports injuries. This study sought to understand if differences in perception of rehabilitation adherence existed between athletic trainers and collegiate athletes. A nonsignificant fair inverse correlation was found between the athletic trainer perceptions and patient self-perceptions of rehabilitation adherence after an examination of 19 separate physical rehabilitation programs led by 5 collegiate athletic trainers (R = −.48, p = .06). Given the found practitioner–patient disconnect, collegiate athletic trainers should consider further encouraging patient involvement within their rehabilitation programs through various tactics such as the use of patient-rated outcomes or conversations that minimize patient distress.

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Professional Identity in Irish Certified Athletic Therapists

Siobhán O’Connor, Oran Lavelle Hayes, and Kate Sheridan

Professional identity is an important construct that considers an individual’s own values, beliefs, attitudes, and motives surrounding their own role in their profession. No research has examined this concept in athletic training/therapy beyond the U.S. context. We examined professional identity in Irish certified athletic therapists (n = 81) using the Professional Identity and Values Scale. Participants presented with a total Professional Identity and Values Scale score of 92.0 ± 9.9. Age (r = .26, p = .02; r = .27, p = .02) and years of experience (r = .29, p = .01; r = .32, p = .0004) were positively correlated with total Professional Identity and Values Scale score and professional development subscale score, respectively. No gender differences were observed (p > .05). Despite being a new emerging profession, Irish athletic therapists presented with a strong professional identity.

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Optimizing Health-Related Outcomes Following Musculoskeletal Injury Through the Integration of Self-Efficacy Theory and the Fear Avoidance Model

Bridget M. Walsh, Ke’La H. Porter, and Matthew C. Hoch

A primary goal of rehabilitation is to produce optimal health-related quality of life outcomes, which includes returning patients to their desired level of activity. Injury-related fear, kinesiophobia, and fear-avoidance beliefs are psychological factors that negatively impact health-related quality of life and are associated with decreased levels of physical activity. Conversely, increased levels of self-efficacy have been linked to favorable rehabilitation outcomes. To promote full recovery and optimal health-related quality of life, the rehabilitation process should consider addressing self-efficacy and injury-related fear (e.g., kinesiophobia, fear-avoidance beliefs). Therefore, the purpose of this paper is to introduce a theoretical framework which integrates self-efficacy theory and the Fear-Avoidance Model to mitigate injury-related fear and optimize patient outcomes following musculoskeletal injury. The intention of this theoretical framework is to provide clinicians with psychosocial interventions to improve self-efficacy and prevent the progression of injury-related fear at varying times throughout the rehabilitation process.