| 51. |
- Fältström, Anne, et al.
(författare)
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High Risk of New Knee Injuries in Female Soccer Players After Primary Anterior Cruciate Ligament Reconstruction at 5-to 10-Year Follow-up
- 2021
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Ingår i: American Journal of Sports Medicine. - : SAGE PUBLICATIONS INC. - 0363-5465 .- 1552-3365. ; 49:13, s. 3479-3487
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Tidskriftsartikel (refereegranskat)abstract
- Background: A new anterior cruciate ligament (ACL) injury after ACL reconstruction is a feared outcome. Purpose: To study the risk of new knee injuries in female soccer players 5 to 10 years after primary unilateral ACL reconstruction and to compare players who returned to soccer with (1) players who did not return and (2) knee-healthy soccer players (controls). Study Design: Cohort study; Level of evidence, 2. Methods: Demographic, soccer-specific, and surgical data were recorded at baseline for 317 female soccer players (mean +/- SD age, 20.1 +/- 2.7 years) 1.6 +/- 0.7 years after ACL reconstruction and for 119 matched controls (mean age, 19.5 +/- 2.5 years). Data on new knee injuries and soccer-playing status were collected 5 to 10 years after ACL reconstruction via a questionnaire. Results: Among players with ACL reconstruction, 222 (70%) responded at a mean 6.5 +/- 1.0 years after primary ACL reconstruction. We compared 3 cohorts: (1) among 163 players with ACL reconstruction who returned to soccer, 68 (42%) sustained 44 reruptures and 29 contralateral ruptures; (2) among 59 players with ACL reconstruction who did not return to soccer, 11 (19%) sustained 9 reruptures and 2 contralateral ruptures; and (3) among 113 knee-healthy controls, 12 (11%) sustained 13 ACL injuries. Players who returned had a >2-fold higher risk of a new ACL injury than players who did not return (risk ratio, 2.24; 95% CI, 1.27-3.93; P = .005) and a 4-fold higher risk than controls (risk ratio, 3.93; 95% CI, 2.23-6.91; P <.001). A new ACL, meniscal, or cartilage injury was the most frequent new knee injury. Among players who returned to soccer, 68% reported a new knee injury, and they had a 2- to 5-times higher risk of any new knee injury and knee surgery than players who did not return and controls. Conclusion: Two-thirds of female soccer players with ACL reconstruction who returned to soccer sustained a new knee injury within 5 to 10 years; 42% had a new ACL injury. Their risk of a new knee injury and knee surgery was 2 to 5 times greater than that for players who did not return and for knee-healthy controls. New injury may have negative consequences for long-term knee health and should be a critical consideration in the decision to return to play.
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| 52. |
- Fältström, Anne, 1970-
(författare)
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One Anterior Cruciate Ligament injury is enough! : Focus on female football players
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Anterior cruciate ligament (ACL) injury is a severe and common injury, and females have 2-4 times higher injury risk compared to men. Return to sport (RTS) is a common goal after an ACL reconstruction (ACLR), but only about two thirds of patients RTS. Young patients who RTS may have a 30-40 times increased risk of sustaining an additional ACL injury to the ipsi- or contralateral knee compared with an uninjured person.Aims: The overall aim of this thesis was to increase the knowledge about female football players with ACLR, and patients with bilateral ACL injuries, and to identify predictors for additional ipsi- and/or contralateral ACLR.Methods: This thesis comprises four studies. Study I and II were cross-sectional, including females who sustained a primary ACL rupture while playing football and underwent ACLR 6–36 months prior to study inclusion. In study I, 182 females were included at a median of 18 months (IQR 13) after ACLR. All players completed a battery of questionnaires. Ninety-four players (52%) returned to football and were playing at the time of completing the questionnaires, and 88 (48%) had not returned. In study II, 77 of the 94 active female football players (from study I) with an ACLR and 77 kneehealthy female football players were included. A battery of tests was used to assess postural control (the Star excursion balance test) and hop performance (the one-leg hop for distance, the five jump test and the side hop). Movement asymmetries in the lower limbs and trunk were assessed with the drop vertical jump and the tuck jump using two-dimensional analyses. Study III, was a cohort study including all patients with a primary ACLR (n=22,429) registered in the Swedish national ACL register between January 2005 and February 2013. Data extracted from the register to identify predictors for additional ACLR were: patient age at primary ACLR, sex, activity performed at the time of ACL injury, primary injury to the right- or left knee, time between injury and primary ACLR, presence of any concomitant injuries, graft type, Knee injury and Osteoarthritis Outcome Score and Euroqol Index Five Dimensions measured pre-operatively. Study IV was cross-sectional. In this study, patient-reported knee function, quality of life and activity level in 66 patients with bilateral ACL injuries was investigated and outcomes were compared with 182 patients with unilateral ACLR.Results: Factors associated with returning to football in females were; short time between injury and ACLR (0–3 months, OR 5.6; 3–12 months OR 4.7 vs. reference group >12 months) and high motivation (study I). In all functional tests, the reconstructed and uninvolved limbs did not differ, and players with ACLR and controls differed only minimally. Nine to 49% of the players with ACLR and controls had side-to-side differences and movement asymmetries and only one fifth had results that met the recommended guidelines for successful outcome on all the different tests (study II). Main predictors for revision and contralateral ACLR were younger age (fourfold increased rate for <16 vs. >35-year-old patients), having ACLR early after the primary injury (two to threefold increased rate for ACLR within 3 months vs. >12 months), and incurring the primary injury while playing football (study III). Patients with bilateral ACL injuries reported poorer knee function and quality of life compared to those who had undergone unilateral ACLR. They had a high activity level before their first and second ACL injuries but an impaired activity level at follow-up after their second injury (study IV).Conclusions: Female football players who returned to football after an ACLR had high motivation and had undergone ACLR within one year after injury. Players with ACLR had similar functional performance to healthy controls. Movement asymmetries, which in previous studies have been associated with increased risk for primary and secondary ACL injury, occurred to a high degree in both groups. The rate of additional ACLR seemed to be increased in a selected group of young patients who desire to return to strenuous sports like football quickly after primary ACLR. Sustaining a contralateral ACL injury led to impaired knee function and activity level.
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| 53. |
- Fältström, Anne, et al.
(författare)
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Patient-Reported Knee Function, Quality of Life, and Activity Level After Bilateral Anterior Cruciate Ligament Injuries
- 2013
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Ingår i: American Journal of Sports Medicine. - : SAGE Publications (UK and US): No SAGE Choice. - 0363-5465 .- 1552-3365. ; 41:12, s. 2805-2813
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Tidskriftsartikel (refereegranskat)abstract
- Background: About 12% of patients who have undergone primary anterior cruciate ligament (ACL) reconstruction sustain a contralateral ACL injury within 5 years. less thanbrgreater than less thanbrgreater thanPurpose: To investigate patient-reported knee function, quality of life, and activity level in patients with bilateral ACL injuries. less thanbrgreater than less thanbrgreater thanStudy Design: Cohort study; Level of evidence, 3. less thanbrgreater than less thanbrgreater thanMethods: A search of hospital records identified 147 patients, aged 18 to 45 years, with bilateral ACL injuries. Of these, 83 met the inclusion criteria, having had their first ACL injury up to 12 years ago with no other major injuries to the knee joint. Sixty-six of these patients (80% of total; 47% female; mean age, 29.1 7.2 years) answered a questionnaire packet. Patients who had undergone unilateral ACL reconstruction (n = 182) were used for comparison. less thanbrgreater than less thanbrgreater thanResults: Patients with bilateral ACL injuries had a median Lysholm knee score of 82 (range, 34-100). The mean EuroQol index (EQ-5D) score of the overall health status was 0.77 +/- 0.22, and the mean EQ-5D visual analog scale score was 75.5 +/- 17.6. The median Tegner activity level was 9 (range, 1-9) before any injuries, 7 (range, 1-9) before the second ACL injury, and 4 (range, 1-9) at the time of follow-up. The activity level before the second injury was higher compared with the follow-up for patients who had undergone unilateral ACL reconstruction. At follow-up, 23% of the patients with bilateral ACL injuries returned to their previous activity, and 12% of patients returned to the same level as before their injuries compared with 43% (P = .004) and 28% (P = .01) in patients who had undergone unilateral ACL reconstruction, respectively. Patients with bilateral ACL injuries had significantly lower values in the Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales for pain, function in sports and recreation, and knee-related quality of life as well as the ACL Deficiency Quality of Life (ACL-QOL) score compared with patients who had undergone unilateral ACL reconstruction. less thanbrgreater than less thanbrgreater thanConclusion: Patients with bilateral ACL injuries reported poorer knee function and quality of life compared with those who had undergone unilateral ACL reconstruction. Their activities had changed, and they were dissatisfied with their current activity level. They had a high activity level before their first and second ACL injuries but an impaired activity level after their contralateral injury at follow-up.
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| 54. |
- Fältström, Anne, et al.
(författare)
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Poor Validity of Functional Performance Tests to Predict Knee Injury in Female Soccer Players With or Without Anterior Cruciate Ligament Reconstruction
- 2021
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Ingår i: American Journal of Sports Medicine. - : SAGE PUBLICATIONS INC. - 0363-5465 .- 1552-3365. ; 49:6, s. 1441-1450
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Tidskriftsartikel (refereegranskat)abstract
- Background: Various tests have been developed to evaluate athletes functional performance and for use as screening tools for injury prediction. Further validation of their accuracy to predict injury is needed. Purpose: To investigate the validity of predetermined cutoffs used to differentiate between high- and low-risk players in different functional performance tests to predict (1) anterior cruciate ligament (ACL) injury or (2) severe traumatic knee injury in a cohort of female soccer players with a primary unilateral ACL reconstruction and a cohort of knee-healthy players. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 117 active female soccer players (mean age +/- SD, 20 +/- 2 years) an average of 19 +/- 9 months after ACL reconstruction and 119 knee-healthy players (age, 19 +/- 3 years) were prospectively followed up for 2 years for new knee injuries. At baseline, all players underwent tests to assess postural control (Star Excursion Balance Test), hop performance (single-leg hop for distance, side hop), and movement asymmetries in the lower limbs and trunk (drop vertical jump [DVJ], tuck jump). The predictive validity of the test cutoffs to identify players who would sustain an ACL injury or a severe traumatic knee injury (absence from soccer play, >28 days) was assessed. The risk ratio (RR), area under the receiver operating characteristic curve (AUC), sensitivity, and specificity were calculated. Results: A total of 46 players (39%) with ACL reconstruction sustained 48 severe knee injuries, including 28 ACL ruptures. Of the knee-healthy players, 13 (11%) sustained 14 severe knee injuries, including 8 ACL ruptures. No association was found between the predetermined functional performance test cutoffs and the risk of a new ACL injury or severe knee injury in players with ACL reconstruction. In knee-healthy players, the only variable associated with future ACL injury was >= 6.5 cm knee valgus in the frontal plane (any knee) in the DVJ (RR, 4.93; 95% CI, 1.04-23.40; P = .045), but with only fair predictive validity (AUC, 0.7; sensitivity, 0.75; specificity, 0.65). Conclusion: In our cohorts of female soccer players, the validity of commonly used functional performance tests to predict new knee injuries was poor. Only knee valgus during the DVJ was associated with new ACL injuries in knee-healthy players, but with only fair predictive validity.
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| 55. |
- Fältström, Anne, et al.
(författare)
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Predictors for additional anterior cruciate ligament reconstruction : data from the Swedish national ACL register.
- 2016
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Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 24:3, s. 885-894
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To identify predictors for additional anterior cruciate ligament (ACL) reconstruction.METHODS: Patients from the Swedish national ACL register who underwent ACL reconstruction between January 2005 and February 2013 (follow-up duration 6-104 months) were included. Cox regression analyses included the following independent variables regarding primary injury: age, sex, time between injury and primary ACL reconstruction, activity at primary injury, concomitant injuries, injury side, graft type, and pre-surgery KOOS and EQ-5D scores.RESULTS: Among ACL reconstruction procedures, 93 % involved hamstring tendon (HT) autografts. Graft type did not predict additional ACL reconstruction. Final regression models only included patients with HT autograft (n = 20,824). Of these, 702 had revision and 591 contralateral ACL reconstructions. The 5-year post-operative rates of revision and contralateral ACL reconstruction were 4.3 and 3.8 %, respectively. Significant predictors for additional ACL reconstruction were age (fourfold increased rate for <16-year-old patients vs. >35-year-old patients), time between injury and primary surgery (two to threefold increased rate for ACL reconstruction within 0-90 days vs. >365 days), and playing football at primary injury.CONCLUSION: This study identified younger age, having ACL reconstruction early after the primary injury, and incurring the primary injury while playing football as the main predictors for revision and contralateral ACL reconstruction. This suggests that the rate of additional ACL reconstruction is increased in a selected group of young patients aiming to return to strenuous sports after primary surgery and should be taken into consideration when discussing primary ACL reconstruction, return to sports, and during post-surgery rehabilitation. LEVEL OF EVIDENCE: II.
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| 56. |
- Fältström, Anne, et al.
(författare)
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Risk Factors for Sustaining a Second ACL Injury after Primary ACL Reconstruction in Female Football Players: A Study Investigating the Effects of Follow-Up Time and the Statistical Approach
- 2023
-
Ingår i: SPORTS MEDICINE-OPEN. - : SPRINGER. - 2199-1170. ; 9:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundStudies evaluating risk factors for sustaining an anterior cruciate ligament (ACL) injury have different, sometimes contrasting, results. Different follow-up times and statistical approaches may be a reason for these differences. The aim of this study was to explore if different follow-up times and statistical approaches, classification and regression tree (CART) analysis and Cox regression, would impact on the association between various candidate risk factors and ACL injury in female football players. In total, 112 active female football players, 18 +/- 8 months after ACL reconstruction (mean age +/- SD, 20 +/- 2 years), were included and followed for at least 36 months. At baseline, all players underwent assessment of range of motion of knee and ankle joints, functional tests, and answered questionnaires regarding knee function, psychological and personality traits. Nineteen independent variables were included for the CART analysis and for univariable Cox regression and compared using four different follow-up times: 0-12, 0-24, 0-36, and 0->36 months.ResultsForty-three (38%) players sustained a second ACL injury. The identified risk factors varied depending on follow-up time both with CART analysis and with Cox regression. CART identified 12 of the 19 independent variables and selected between 5 and 6 of the variables in the four different follow-up times associated with second ACL injury. The accuracy of the different follow-up times for the CART varied between 86 and 93% with 77-96% sensitivity and 70-81% specificity. Cox regression identified two risk factors: knee extension at 0-36 months and 0->36 months, and time between primary injury and surgery at 0->36 months. The accuracy varied between 54 and 64% with 44-88% sensitivity and 32-71% specificity.ConclusionsThe identified risk factors associated with a second ACL injury varied depending on the follow-up time and statistical approach used. Thus, in future research on risk factors, the time athletes are followed up and the type of statistical methods used are important to discuss.
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| 57. |
- Fältström, Anne, et al.
(författare)
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Self-reported knee function and activity level are reduced after primary or additional anterior cruciate ligament injury in female football players: a five-year follow-up study
- 2023
-
Ingår i: Revista Brasileira de Fisioterapia. - : ASSOCIACAO BRASILEIRA PESQUISA POS-GRADUACAO FISIOTERAPIA-ABRAPG-FT. - 1413-3555 .- 1809-9246. ; 27:6
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Tidskriftsartikel (refereegranskat)abstract
- Background: Playing football involves a high risk of anterior cruciate ligament (ACL) injuries and these may affect knee function and activity level. Objectives: To measure changes in self-reported knee function, activity level, and satisfaction with knee function and activity level in female football players with or without an ACL-recon-structed knee. Methods: Female football players, age 19.9 (SD 2.6) years, with either a primary ACL-recon-struction 1.6 (SD 0.7) years after ACL-reconstruction (n = 186) or no ACL injury (n = 113) were fol-lowed prospectively for five years. Self-reported data collected at baseline and follow-up included knee function (International Knee Documentation Committee Subjective Knee Form [IKDC-SKF]), activity level (Tegner Activity Scale), and satisfaction with knee function (Likert scale 1=happy; 7=unhappy) and activity level (1-10 scale). Information on any new ACL injury during the follow-up period was collected. Results: Players with ACL-reconstruction at baseline who either did (n = 56) or did not (n = 130) sustain an additional ACL injury, and players with no injury at baseline who remained injury free (n = 101) had a lower Tegner score at follow-up. Players with additional ACL injury had lower IKDC-SKF score (mean difference:-11.4, 95% CI:-16.0,-6.7), and satisfaction with activity level (mean difference:-1.5, 95% CI:-2.3,-0.7) at follow-up. Players with no additional ACL injury had higher satisfaction with knee function (mean difference: 0.6, 95% CI: 0.3, 0.9) at fol-low-up. Players with no ACL injury had lower satisfaction with activity level (mean difference:-0.7, 95% CI:-1.1,-0.3) at follow-up. Players with additional ACL injury had larger decreases in all variables measured compared to the two other groups. Conclusion: Primary, and even more so additional, ACL injuries decreased self-reported knee function, activity level, and satisfaction with knee function and activity level in female football players. (c) 2023 The Author(s). Published by Elsevier Espana, S.L.U. on behalf of Associacao Brasileira de Pesquisa e Pos-Graduacao em Fisioterapia. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
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| 58. |
- Fältström, Anne, et al.
(författare)
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The side hop test: Validity, reliability, and quality aspects in relation to sex, age and anterior cruciate ligament reconstruction, in soccer players
- 2023
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Ingår i: Physical Therapy in Sport. - : CHURCHILL LIVINGSTONE. - 1466-853X .- 1873-1600. ; 62, s. 39-45
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To study the side hop test regarding validity, reliability, and quality in relation to sex, age and ACL-reconstruction in soccer players.Design: Cohort study. Participants: 117 females with a primary ACL-reconstruction, and 119 females, 46 males (age 16-26 years), 49 girls and 66 boys (age 13-16 years) without injury.Main outcome measures: For convergent validity, one physiotherapist analysed side hops live and later on video. One physiotherapist and two physiotherapy students analysed side hops from 92 players for interrater reliability (video). For intrarater reliability, side hops from 35 players were analysed twice (video). Quality aspects (flaws), i.e. number of times the hopping limb touched the strips, the nonhopping limb touched the floor, and double hops/foot turns with the hopping limb, were registered (video).Results: Convergent validity was excellent; the intraclass correlation coefficient (ICC) was 0.93-1.0. All reliability measures were excellent (ICC 0.92-1.0). Adult male players had fewest and girls had most flaws, especially double hops/foot turns with the hopping limb, compared with all other players (mean, 11-12 vs 1-6, h2 = 0.18, large effect size). No differences were reported between knee-healthy and ACLreconstructed females.Conclusion: The side hop test is valid and reliable. Quality aspects differ between sexes and ages.& COPY; 2023 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
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| 59. |
- Gomez-Piqueras, Pedro, et al.
(författare)
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Are we making SMART decisions regarding return to training of injured football players? Preliminary results from a pilot study
- 2018
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Ingår i: Isokinetics and exercise science. - : IOS PRESS. - 0959-3020 .- 1878-5913. ; 26:2, s. 115-123
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: "When will I be able to play again?" is the most frequent question asked by injured athletes. Due to the complex nature of sports injury, deciding when an injured athlete may safely return to training is a critical and difficult decision. OBJECTIVE: To study if the Safe Multidimensional Algorithm for Return to Training (SMART) scores, applied before the release to full return to training after injury differs between football players who suffer a subsequent re-injury and football players who do not. METHOD: Seventy one male professional football players were prospectively monitored for injuries during two seasons. The SMART tool was applied in injured players with an absence amp;gt; 10 days. The injured player had to carry out 17 multidimensional tests included in the algorithm in his final days of the planned rehabilitation. The results of the SMART were compared between players who sustained re-injuries and those who did not. RESULTS: Fifty-five injuries with absence amp;gt; 10 days were recorded and re-injuries occurred in 12 of these cases (22%). There was a lower re-injury rate in players who presented a better recovery in pain (p amp;lt; 0.001), agility (RR 21.0, 95% CI: 2.0 to 213.2), advanced agility (RR 26.7, 95% CI: 4.9 to 142.8), anxiety (RR 8.6, 95% CI: 2.0 to 36.2), depression (RR 10.3, 95% CI: 1.5 to 65.7), self-perception (p amp;lt; 0.001), advanced skills mode (RR 20.5, 95% CI: 3.3 to 125.9) and group skills mode (p amp;lt; 0.001). CONCLUSIONS: A multidimensional approach of Return to Training that includes objective measures may indicate potential deficiencies in the recovery of injured players.
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| 60. |
- Hallén, Anna, et al.
(författare)
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UEFA Women's Elite Club Injury Study: a prospective study on 1527 injuries over four consecutive seasons 2018/2019 to 2021/2022 reveals thigh muscle injuries to be most common and ACL injuries most burdensome
- 2024
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Ingår i: British Journal of Sports Medicine. - : BMJ PUBLISHING GROUP. - 0306-3674 .- 1473-0480.
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveInjuries in women's football (soccer) have scarcely been investigated, and no study has been conducted in the highest competitive level involving club teams from different countries. Our aim was to investigate the time-loss injury epidemiology and characteristics among women's elite football players over four seasons.Methods596 players from 15 elite women's teams in Europe were studied prospectively during the 2018/2019 to 2021/2022 seasons (44 team seasons). Medical staff recorded individual player exposure and time-loss injuries. Injury incidence was calculated as the number of injuries per 1000 playing hours and injury burden as the number of days lost per 1000 hours.Results1527 injuries were recorded in 463 players with an injury incidence of 6.7 (95% CI 6.4 to 7.0) injuries per 1000 hours and a nearly fourfold higher incidence during match play compared with training (18.4, 95% CI 16.9 to 19.9 vs 4.8, 95% CI 4.5 to 5.1; rate ratio 3.8, 95% CI 3.5 to 4.2). Thigh muscle injuries (hamstrings 12%, 188/1527, and quadriceps 11%, 171/1527) were the most frequent injury, while anterior cruciate ligament (ACL) injury had the highest burden (38.0 days lost per 1000 hours, IQR 29.2-52.1) with median days lost of 292 (IQR 246-334) days. Concussions constituted 3% (47/1527) of all injuries, with more than half of them (55%, 26/47) due to ball-related impact.ConclusionAn elite women's football team can expect approximately 35 time-loss injuries per season. Thigh muscle injury was the most common injury and ACL injury had the highest injury burden.
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