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Liam Anderson, Graeme L. Close, Matt Konopinski, David Rydings, Jordan Milsom, Catherine Hambly, John Roger Speakman, Barry Drust and James P. Morton

Anterior cruciate ligament (ACL) injury is a troublesome and potentially serious injury in soccer that often requires surgical reconstruction ( Brophy et al., 2012 ). After ACL reconstruction, an athlete’s return-to-play time is reported to range from 16 to 52 weeks ( Zaffagnini et al., 2014

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Selvin Balki and Hanım Eda Göktas¸

Nowadays, the number of anterior cruciate ligament (ACL) injuries has increased as a result of a positive attitude developing toward exercise and sports. 1 Annual incidence rate of an ACL injury is 3.5% among amateur athletes. 1 The incidence rate of an ACL injury in females is higher than males

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Takuma Hoshiba, Hiroki Nakata, Yasuaki Saho, Kazuyuki Kanosue and Toru Fukubayashi

Anterior cruciate ligament (ACL) injury and/or reconstruction may alter knee proprioception. 1 – 3 Previous studies have provided evidence of the presence of mechanoreceptors within the ACL, including Ruffini and Pacinian corpuscles, Golgi tendon organs, and free nerve endings, and of the

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Kelly R. Holcomb, Cheryl A. Skaggs, Teddy W. Worrell, Mark DeCarlo and K. Donald Shelbourne

A paucity of information exists concerning reliability of the KT-1000 knee arthrometer (MEDmetric Corp., San Diego, CA) when used by different clinicians to assess the same anterior cruciate ligament-deficient patient. The purpose of this study was to determine the reliability and standard error of measurement of four clinicians who routinely report KT-1000 arthrometer values to referring orthopedic surgeons. Two physical therapists and two athletic trainers performed anterior laxity tests using the KT-1000 on 19 subjects. Intraclass correlation coefficients (ICC) and standard error of measurement (SEM) were used to determine reliability. Intratester ICC ranged from .98 to 1.0 and intratester SEM ranged from 0.0 to .28 mm. Intertester ICC and SEM for all four testers were .53 and 1.2 mm, respectively. A 95% confidence interval (M ± 1.96 × SEM) of the intertester variability ranged from −0.18 to 4.52 mm. Therefore, large intertester variation existed in KT-1000 values. Each facility should standardize testing procedures and establish intratester and intertester reliability for all clinicians reporting KT-1000 values.

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Arika L. Cozzi, Kristina L. Dunn, Josie L. Harding, Tamara C. Valovich McLeod and Cailee E. Welch Bacon

Clinical Scenario:

There are approximately 200,000 anterior cruciate ligament (ACL) tears reported annually in the United States. Patients who undergo ACL reconstruction followed by an aggressive rehabilitation protocol can often structurally and functionally progress to a preinjury level. Despite physical improvements with ACL-rehabilitation protocols, however, there are still a substantial number of individuals who do not return to preinjury level, particularly physically active individuals, of whom only 63% return to their full potential preinjury level. This may be due to continued pain, swelling, stiffness, and weakness in the knee. In addition, research concerning the topic of kinesiophobia (ie, fear of reinjury), which may prevent individuals from returning to their activities, has increased over the past several years. Kinesiophobia is defined as the irrational or debilitating movement of physical activity resulting in the feeling of vulnerability to painful injury or reinjury. Kinesiophobia may have a significant impact on physically active individuals, considering the proportion of patients who do not return to their sport. However, it is unknown whether kinesiophobia is associated with patients’ perceived physical-impairment levels after ACL reconstruction.

Focused Clinical Question:

Is kinesiophobia associated with self-perceived levels of knee function after ACL reconstruction?

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Yoshiko Hasebe, Yoshie Tanabe and Kazunori Yasuda

Context:

Anterior cruciate ligament (ACL) reconstruction with doubled hamstring autograft might not sufficiently improve fundamental sports abilities of patients with ACL-deficient knees.

Objective:

To clarify whether ACL reconstruction using the hamstring graft can improve fundamental sports abilities.

Design:

Patients were examined twice, preoperatively and 2 years postoperatively, using the conventional evaluation scales and performance tests.

Participants:

15 athletic patients with ACL reconstruction using hamstring autograft.

Measurements:

A stairs-run test and figure-8 one-leg hop test. Muscle strength and knee stability were measured with Cybex® II and KT-2000® arthrometers, respectively.

Results:

There were no significant differences between the preoperative and postoperative results in the performance tests. The degree of postoperative recovery in the subjective score, the anterior translation of the tibia, and the isokinetic muscle strength was not significantly correlated with the degree of restoration in each performance test.

Conclusions:

Postoperative restoration as measured by conventional evaluation scales is not correlated with restoration of sports abilities in patients with ACL insufficiency.

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Aaron Derouin and Jim R. Potvin

Injuries to the knee account for up to 60% of all sports injuries. 1 Almost half of all reported knee injuries involve disruption to the anterior cruciate ligament (ACL). 1 , 2 Functional knee braces are designed to provide support to unstable knees by reducing anterior tibial translation and

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Christopher Kuenze, Jay Hertel, Susan Saliba, David R. Diduch, Arthur Weltman and Joseph M. Hart

Context:

Normal, symmetrical quadriceps strength is a common clinical goal after anterior cruciate ligament reconstruction (ACLR). Currently, the clinical thresholds for acceptable unilateral quadriceps function and symmetry associated with positive outcomes after return to activity are unclear.

Objective:

To establish quadriceps-activation and knee-extension-torque cutoffs for clinical assessment after return to activity after ACLR.

Design:

Descriptive laboratory study.

Setting:

Laboratory.

Patients:

22 (10 female, 12 male; age = 22.5 ± 5.0 y, height = 172.9 ± 7.1 cm, mass = 74.1 ± 15.5 kg, months since surgery = 31.5 ± 23.5) recreationally active persons with a history of unilateral, primary ACLR at least 6 months prior and 24 (12 female/12 male, age = 21.7 ± 3.6 y, height = 168.0 ± 8.8 cm, mass = 69.3 ± 13.6 kg) recreationally active healthy participants.

Main Outcome Measures:

Patient-reported measures of pain, knee-related function, and physical activity level were recorded for all participants. Normalized knee-extension maximum-voluntary-isometric-contraction (MVIC) torque (Nm/kg) and quadriceps central-activation ratio (CAR, %) were measured bilaterally in all participants. Receiver-operator-characteristic (ROC) curves were used to establish thresholds for unilateral measures of normalized knee-extension MVIC torque and quadriceps CAR, as well as limb-symmetry indices (LSI). ROC curves then established clinical thresholds for normalized knee-extension MVIC torque and quadriceps CAR LSIs associated with healthy knee-related function.

Results:

Involved-quadriceps CAR above 89.3% was the strongest unilateral indicator of healthy-group membership, while quadriceps CAR LSI above 0.996 and knee-extension MVIC torque above 0.940 were the strongest overall indicators. Unilateral normalized knee-extension MVIC torque above 3.00 Nm/kg and quadriceps CAR LSI above 0.992 were the best indicators of good patient-reported knee-related outcomes.

Conclusions:

Threshold values established in this study may provide a guide for clinicians when making return-to-activity decisions after ACLR. Normalized knee-extension MVIC torque (>3.00 Nm/kg) and quadriceps CAR symmetry (>99.6%) are both strong indicators of good patient-reported outcomes after ACLR.

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George A. Arangio and Edward W. Cohen

The records of 141 consecutive patients with confirmed complete anterior cruciate ligament injuries were reviewed retrospectively. One hundred and sixty-two associated injuries were divided into 25 injury complexes. Isolated injuries to the anterior cruciate ligament occurred in 40 cases (28.4%). Injuries of the medial meniscus occurred in 62 cases (38.2%), while injuries of the lateral meniscus occurred in 37 cases (22.8%). Injuries to the medial collateral ligament complex occurred in 42 cases (25.9%). Injuries to the lateral collateral ligament, posterior deep popliteus-arcuate ligament complex, and posterior cruciate ligament were found to be positively correlated (rho = .81, p = .001, and rho = .77, p = .001, N = 141, respectively). Injuries to the medial collateral ligament and the posterior oblique ligament were likewise positively correlated (rho = .45, p = .001, N = 141).

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Britton W. Brewer, Allen E. Cornelius, Judy Van Raalte, John C. Brickner, Howard Tennen, Joseph H. Sklar, John R. Corsetti and Mark H. Pohlman

The accuracy of retrospective ratings of pain intensity was examined in a sample of 72 men and 36 women undergoing rehabilitation following anterior cruciate ligament (ACL) reconstructive surgery. Participants completed daily ratings of current, worst, and average pain intensity for the first 42 days of rehabilitation. Participants provided retrospective ratings of worst and average pain intensity twice for a 7-day period (on Days 7 and 21) and once for a 30-day period (on Day 30). Correlations between concurrent and retrospective pain ranged from .74 to .88. Retrospective pain ratings consistently overestimated concurrent pain ratings, but were generally not biased by current pain. The results suggest that retrospective pain ratings can substitute for concurrent pain ratings if the tendency toward overestimation is taken into account.