| 1. |
- Broman, D., et al.
(författare)
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A clinician-friendly test battery with a passing rate similar to a ‘gold standard’ return-to-sport test battery 1 year after ACL reconstruction: Results from a rehabilitation outcome registry
- 2023
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Ingår i: Physical Therapy in Sport. - : Elsevier BV. - 1466-853X. ; 59, s. 144-150
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To 1) present passing rates for different clinician-friendly (CF) test batteries and 2) determine the relationship between passing CF test batteries and passing gold standard (GS) return-to-sport (RTS) muscle function testing, 1 year after ACL reconstruction. Study design: Cross-sectional registry study, level of evidence: 3. Setting: Primary care. Participants: Data from 588 patients (52% women, mean age 29.3 ± 9.8 years) were extracted from the Project ACL registry. Main outcome measures: The passing rates for the different test batteries. Results: The passing rate for GS test battery was 28% (95% CI, 24–32%) and the passing rate for the CF test battery with the lowest passing rate was 27% (95% CI 24–31%). The two CF test batteries with the strongest relationships with passing GS test battery showed that 51% (95% CI 43–59%) and 49% (95% CI 44–55%) of the patients who passed the respective CF test battery also passed the GS test battery. Conclusion: A CF test battery can be as demanding to pass as a GS test battery, 1 year after ACL reconstruction. However, passing a CF test battery only gives patients a chance similar to a “coin flip” of also passing a GS RTS test battery.
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| 2. |
- Ekefjärd, Staffan, et al.
(författare)
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Physical symptoms among professional gamers within eSports : a survey study
- 2024
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Ingår i: BMC Sports Science, Medicine and Rehabilitation. - : Springer Nature. - 2052-1847. ; 16:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: There is a need to establish the prevalence of self-reported physical symptoms such as pain in professional gamers (PGs) and to analyse whether there are correlations between lifestyle factors and self-reported physical symptoms. The purpose of this study was to analyse the prevalence of self-reported physical symptoms including eye-related problems in PGs. A further aim was to analyse the association between physical symptoms and lifestyle factors such as sleep time, play time and physical activity.Methods: This study was designed as a cross-sectional study with data based on an electronic survey, created specifically for this study, through discussion and screening of established validated questionnaires for physical symptoms in musculoskeletal conditions: the Karolinska Sleep Questionnaire and the Nordic Musculoskeletal Questionnaire. The survey comprised age and years of experience as a PG as descriptive variables, as well as questions on sleep, play time, physical activity and physical symptoms for the purpose of analysis. The directors of 10 professional gaming corporations were contacted by email with a link to the study-specific survey to distribute to all employees.Results: A total of 40 answers to the electronic survey were retrieved from 40 PGs, of which 62.5% (n = 25) had experienced at least one physical symptom in the three months prior to answering the survey. There was a significant association between playing time and physical symptoms (OR = 8.0; 95% CI 1.4–44.6, p = 0.018), where playing for more than 35 h a week was positively associated with eight times higher odds of experiencing physical symptoms.Conclusion: There is a high prevalence of physical symptoms, such as headache and eye symptoms, in professional eSports gamers. There was an association between playing more than 35 h per week with the prevalence of physical symptoms.
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| 3. |
- Högberg, Johan, 1994, et al.
(författare)
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Is absolute or relative knee flexor strength related to patient- reported outcomes in patients treated with ACL reconstruction with a hamstring tendon autograft? An analysis of eccentric Nordic hamstring strength and seated concentric isokinetic strength
- 2023
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Ingår i: Knee. - : Elsevier BV. - 0968-0160. ; 41, s. 161-170
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Tidskriftsartikel (refereegranskat)abstract
- Background: There is a need for better understanding of how knee flexor strength influence patient-reported outcomes (PROs) after anterior cruciate ligament (ACL) reconstruction. Our aim was to investigate the relationship between the eccentric NordBord test and the seated concentric Biodex test with PROs, during the first year of rehabilitation after ACL reconstruction with hamstring tendon (HT) autograft.Methods: Patients with an index ACL reconstruction with an HT autograft participating in a rehabilitation registry were screened for inclusion. Outcomes of interest were the correla-tion between absolute (N/kg or Nm/kg) and relative (limb symmetry index) knee flexor strength measured in the NordBord and Biodex with the results of PROs. The significance level was set at p < 0.05 and Pearson's correlation coefficient was used.Results: 137 patients were included (47% women) with a mean age of 24.8 +/- 8.4 years. There were non-significant and weak correlations between relative strength for all PROs. Significant and weak correlations between absolute strength in the Biodex with the Knee Self-Efficacy Scale18 (K-SES18) present at 4 and 8 months, and for the ACL-Return to Sport after Injury scale (ACL-RSI) at 12 months was observed, accounting for 8.4-15.7% of the variance. Significant and weak correlations between absolute strength in the Nordbord with the Knee injury and Osteoarthritis Outcome Scale subscale Sports and Recreation at 4 months, the K-SES18 present and the ACL-RSI at 8 months were observed, accounting for 9.4-14.4% of the variance.
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| 4. |
- Högberg, Johan, 1994, et al.
(författare)
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No Association Between Hamstrings-to-Quadriceps Strength Ratio and Second ACL Injuries After Accounting for Prognostic Factors : A Cohort Study of 574 Patients After ACL-Reconstruction
- 2024
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Ingår i: Sports Medicine - Open. - Heidelberg : Springer. - 2199-1170 .- 2198-9761. ; 10
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Tidskriftsartikel (refereegranskat)abstract
- Background: The stress on the anterior cruciate ligament (ACL) induced by the quadriceps can be attenuated by activation of the hamstrings by exerting an opposing torque to the anterior translation of tibia. Consequently, considering the ratio between strength of the hamstrings-to-quadriceps (HQ-ratio) may be of value to reduce the odds of second ACL injuries. The objective was therefore to evaluate (1) the association between HQ-ratio and the occurrence of a second ACL injury in patients after ACL-reconstruction within 2 years of return to preinjury sport level and (2) to compare the HQ-ratio between males and females after ACL reconstruction. Methods: Patients who had undergone primary ACL reconstruction and participated in knee-strenuous activity preinjury were included. Demographics, the occurrence of a second ACL injury, and muscle strength test results before returning to preinjury sport level were extracted from a rehabilitation registry. The endpoint was set at a second ACL injury or 2 years after return to preinjury sport level. A multivariable logistic regression was used to analyze the association between the HQ-ratio and a second ACL injury. Results: A total of 574 patients (50.0% female) with a mean age of 24.0 ± 9.4 years at primary ACL reconstruction were included. In the univariable logistic regression analysis, the odds of sustaining a second ACL injury decreased by 3% for every 1% increase in the HQ-ratio (OR 0.97 [95% CI 0.95–1.00], p = 0.025). After adjusting for the time from reconstruction to return to preinjury sport level, sex, preinjury sport level, graft choice, age, and body mass index, the results were no longer significant (OR 0.98 [95% CI 0.95–1.01], p = 0.16). Females had a higher HQ-ratio compared with males for both the ACL-reconstructed and uninjured side (3.7% [95% CI 5.7; 1.8%], p = 0.0002 and 3.3% [95% CI 4.6; 2.1], p < 0.001, respectively). Conclusion: The HQ-ratio did not significantly affect the odds for sustaining a second ACL injury upon return to preinjury sports level after primary ACL reconstruction. Females had a significant higher HQ-ratio than males for both the ACL reconstructed and uninjured side. © 2024, The Author(s).
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| 5. |
- Högberg, Johan, 1994, et al.
(författare)
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Persistent knee flexor strength deficits identified through the NordBord eccentric test not seen with “gold standard” isokinetic concentric testing during the first year after anterior cruciate ligament reconstruction with a hamstring tendon autograft
- 2022
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Ingår i: Physical Therapy in Sport. - Oxford : Elsevier. - 1466-853X .- 1873-1600. ; 55, s. 119-124
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To investigate the recovery of knee flexor muscle strength evaluated with a Nordic hamstring eccentric test (NordBord) compared with an isokinetic concentric test (Biodex) during the first year after anterior cruciate ligament (ACL) reconstruction using a hamstring tendon autograft.Design: Prospective observational registry study; level of evidence, 3.Setting: Primary care.Participants: Cross-sectional data of 127 patients (45% women, mean age 24.9 ± 8.1 years) were extracted from a rehabilitation outcome registry at 10 weeks and 4, 8 and 12 months after ACL reconstruction with hamstring tendon autograft.Main outcome measures: All patients performed a concentric Biodex test, and an eccentric NordBord test on the same occasion or within seven days of the concentric test. The primary outcome was the limb symmetry index between the respective tests.Results: A greater knee flexor symmetry deficit was observed with the eccentric test compared with the concentric test at all follow-ups with clinically relevant differences at 4 (11.8% ± 12.7% [CI 7.8–15.8%]) and 8 months (13.4 ± 11.9 [CI 9.7–17.2%].Conclusion: The eccentric NordBord test was able to identify clinically relevant deficits in knee flexor strength symmetry that were not identified by gold standard isokinetic concentric testing during the first year among patients treated with an ACL reconstruction using a hamstring tendon autograft. © 2022 The Authors
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| 6. |
- Högberg, Johan, 1994, et al.
(författare)
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Relationship between hamstring strength and hop performance at 8 and 12 months after ACL reconstruction with hamstring tendon autografts
- 2024
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Ingår i: BMC SPORTS SCIENCE MEDICINE AND REHABILITATION. - 2052-1847. ; 16:1
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Tidskriftsartikel (refereegranskat)abstract
- Background The relationship between hamstring strength and hop performance after anterior cruciate ligament (ACL) reconstruction with hamstring tendon (HT) autografts has not been well elucidated. The aim was to investigate the relationship between eccentric hamstring strength, assessed with the NordBord, and concentric hamstring strength, assessed with the Biodex, with hop performance at 8 and 12 months after ACL reconstruction.Methods Registry study. Patients >= 16 years who had undergone primary ACL reconstruction with HT autograft, followed by muscle strength and hop tests at 8 and 12 months were included. Correlations of the relative hamstring strength (Nm/kg or N/kg) and limb symmetry index (LSI) with hop performance were analyzed. Pearson's correlation coefficient, and coefficient of determination (r2) were used for statistical analysis.Results A total of 90 patients were included, of which 48 (53%) were women. The mean age at ACL reconstruction was 27.0 +/- 8.0 years. Relative hamstring strength had significant positive correlations with hop performance, ranging from r = 0.25-0.66, whereas hamstring strength LSI had significant positive correlations which ranged from r = 0.22-0.37 at 8 and 12 months after ACL reconstruction. At 12 months, the relative hamstring strength in the Biodex explained 32.5-43.6% of the hop performance in vertical hop height, hop for distance relative to height, and the total number of side hops, whereas the relative hamstring strength in the NordBord explained 15.2-23.0% of the hop performance.Conclusion The relative hamstring strength in the Biodex test explained 32.5-43.6% of the hop performance, whereas the relative hamstring strength in the NordBord explained 15.2-23.0%. Thus, our findings suggest that relative hamstring strength, especially in the hip-flexed position may be a better indicator of hop performance at 8 and 12 months after ACL reconstruction in patients treated with HT autograft.
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| 7. |
- Högberg, Johan, 1994, et al.
(författare)
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Restoring Knee Flexor Strength Symmetry Requires 2 Years After ACL Reconstruction, But Does It Matter for Second ACL Injuries? A Systematic Review and Meta-analysis
- 2024
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Ingår i: Sports Medicine – Open. - Heidelberg : SpringerOpen. - 2199-1170 .- 2198-9761. ; 10
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Forskningsöversikt (refereegranskat)abstract
- Background: It is unknown whether knee flexor strength recovers after anterior cruciate ligament (ACL) reconstruction with a hamstring tendon (HT) autograft and whether persistent knee flexor strength asymmetry is associated to a second ACL injury. Objective: We aimed to systematically review (1) whether knee flexor strength recovers after ACL reconstruction with HT autografts, and (2) whether it influences the association with a second ACL injury. A third aim was to summarize the methodology used to assess knee flexor strength. Design: Systematic review and meta-analysis reported according to PRISMA. Methods: A systematic search was performed using the Cochrane Library, Embase, Medline, PEDRo, and AMED databases from inception to December 2021 and until completion in January 2023. Human clinical trials written in English and conducted as randomized controlled trials, longitudinal cohort, cross-sectional, and case–control studies on patients with index ACL reconstructions with HT autografts harvested from the ipsilateral side were considered. Knee flexor strength was measured isokinetically in both the reconstructed and uninjured limb to enable the calculation of the limb symmetry index (LSI). The Risk of Bias Assessment Tool for Non-Randomized Studies was used to assess risk of bias for non-randomized studies and the revised Cochrane Risk of Bias tool was used for randomized controlled trials. For the meta-analysis, the LSI (mean ± standard error) for concentric knee flexor strength at angular velocities of 60°/second (s) and 180°/s preoperatively and at 3 months, 6 months, 12 months, and 24 months were pooled as weighted means with standard errors. Results: The search yielded 64 studies with a total of 8378 patients, which were included for the assessment of recovery of knee flexor strength LSI, and a total of 610 patients from four studies that investigated the association between knee flexor strength and second ACL injuries. At 1 year after ACL reconstruction, the knee flexor strength LSI had recovered to 89.0% (95% CI 87.3; 90.7%) and 88.3% (95% CI 85.5; 91.1%) for the velocities of 60°/s and 180°/s, respectively. At 2 years, the LSI was 91.7% (95% CI 90.8; 92.6%) and 91.2% (95% CI 88.1; 94.2%), for velocities of 60°/s and 180°/s, respectively. For the association between knee flexor strength and second ACL injuries, there was insufficient and contradictory data. Conclusions: There was low to very low certainty of evidence indicating that the recovery of knee flexor strength LSI, defined as ≥ 90% of the uninjured side, takes up to 2 years after ACL reconstruction with HT autografts. Whether knee flexor strength deficits influence the association of second ACL injuries is still uncertain. There was considerable heterogeneity in the methodology used for knee flexor strength assessment, which together with the low to very low certainty of evidence, warrants further caution in the interpretation of our results. Registration number: CRD42022286773. © 2024, The Author(s).
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| 8. |
- Högberg, Johan, 1994, et al.
(författare)
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The NordBord test reveals persistent knee flexor strength asymmetry when assessed two and five years after ACL reconstruction withhamstring tendon autograft
- 2024
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Ingår i: Physical Therapy in Sport. - 1466-853X .- 1873-1600. ; 66, s. 53-60
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Comparison of knee flexor strength limb symmetry index (LSI) between the NordBord-test and the Biodex-test, and to determine the relationship between knee flexor strength and function in patients 2 and 5 years after anterior cruciate ligament reconstruction (ACL-R) with hamstring tendon (HT) autografts. Design: Observational registry study. Setting: Primary care. Patients: Cross-sectional data from 96 patients (55% women) participating in a rehabilitation-registry after ACL-R with HT autografts. Main outcome measures: Comparison of knee flexor strength symmetry between the Biodex-test and the NordBord-test. Secondly, the relationship between knee flexor strength test and perceived knee function, activity level, and hop performance. Results: The NordBord-test demonstrated greater strength deficits compared to the Biodex-test with a mean difference of 12.5% ± 15.1% 95 % CI [8.1; 16.9%] at 2 years, and 11.1% ± 11.9% 95 % CI [7.7; 14.6 %] at 5 years after ACL-R. Relative concentric knee flexor strength (Nm/kg) in the Biodex demonstrated significant weak-to-moderate correlations with activity level and hop performance (r = 0.33–0.67) at 2 and 5 years. Conclusion: The NordBord-test identified deficits in knee flexor strength LSI not seen with the Biodex-test at 2 and 5 years after ACL-R. No significant correlations were found between the persistent knee flexor strength asymmetry and perceived function, activity level or hop performance.
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| 9. |
- Lindskog, Jakob, et al.
(författare)
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Lower rates of return to sport in patients with generalised joint hypermobility two years after ACL reconstruction: a prospective cohort study.
- 2023
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Ingår i: BMC sports science, medicine & rehabilitation. - 2052-1847. ; 15:1
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Tidskriftsartikel (refereegranskat)abstract
- Generalised joint hypermobility (GJH) has been associated with an increased risk of suffering an anterior cruciate ligament (ACL) injury. Patients with GJH exhibit lower muscle strength and poorer scores for patient-reported outcomes after ACL reconstruction, compared with patients without GJH. The aim of this study was to examine differences in the percentages of patients who return to sport (RTS) or pre-injury level of activity (RTP), muscle function and patient-reported outcomes at the time of RTS or RTP, as well as the time of RTS or RTP in patients with GJH compared with patients without GJH in the first two years after ACL reconstruction.This prospective study used data from an ACL- and rehabilitation-specific register located in Gothenburg, Sweden. Patients aged between 16 and 50, who had a primary ACL injury treated with reconstruction, were included. Data up to two years after ACL reconstruction were used and consisted of achieving RTS and RTP, results from isokinetic muscle function tests for knee extension and flexion and patient-reported outcomes (Knee Self-Efficacy Scale, Knee injury and Osteoarthritis Outcome Score and ACL-Return to Sport after Injury scale) at the time of RTS, as well as the time of RTP. A Beighton Score of ≥5/9 was used to define GJH. A Tegner Activity Scale of ≥6 was used to define RTS, while a Tegner equal to or above pre-injury level was used to define RTP.A total of 1,198 patients (54.7% women) with a mean age of 28.5±8.6 years were included. A smaller proportion of patients with GJH achieved RTS compared with patients without GJH (49.2% vs. 57.3%, Odds ratio: 0.720, p=0.041). Furthermore, patients with GJH were marginally less symmetrical on the knee extension strength test, expressed as a Limb Symmetry Index, at the time of RTP compared with patients without GJH (87.3±13.5 vs. 91.7±14.3, Cohen's d=0.142, p=0.022). No further differences were found between groups regarding any muscle function tests or patient-reported outcomes.A smaller proportion of patients with GJH achieved RTS compared with patients without GJH. Patients with GJH displayed less symmetrical knee extension strength at the time of RTP compared with patients without GJH.
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| 10. |
- Matteucci, Angelo, et al.
(författare)
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Comparison of knee flexor strength recovery between semitendinosus alone versus semitendinosus with gracilis autograft for ACL reconstruction: a systematic review and meta-analysis
- 2024
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Ingår i: BMC MUSCULOSKELETAL DISORDERS. - 1471-2474. ; 25:1
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Forskningsöversikt (refereegranskat)abstract
- BackgroundWhether there is a difference in harvesting the semitendinosus tendon alone (S) or in combination with the gracilis tendon (SG) for the recovery of knee flexor strength after anterior cruciate ligament (ACL) reconstruction remains inconclusive. Therefore, this study aimed to assess the recovery of knee flexor strength based on the autograft composition, S or SG autograft at 6, 12, and >= 24 months after ACL reconstruction.MethodsA systematic review and meta-analysis was conducted following the PRISMA guidelines. A comprehensive search was performed encompassing the Cochrane Library, Embase, Medline, PEDRo and AMED databases from inception to January 2023. Inclusion criteria were human clinical trials published in English, comprised of randomized controlled trials (RCTs), longitudinal cohort-, cross-sectional and case-control studies that compared knee flexor strength recovery between S and SG autografts in patients undergoing primary ACL reconstruction. Isokinetic peak torques were summarized for angular velocities of 60 degrees/s, 180 degrees/s, and across all angular velocities, assessed at 6, 12, and >= 24 months after ACL reconstruction. A random-effects model was used with standardized mean differences and 95% confidence intervals. Risk of bias was assessed with the RoBANS for non-randomized studies and the Cochrane RoB 2 tool for RCTs. Certainty of evidence was appraised using the GRADE working group methodology.ResultsAmong the 1,227 patients from the 15 included studies, 604 patients received treatment with S autograft (49%), and 623 received SG autograft (51%). Patients treated with S autograft displayed lesser strength deficits at 6 months across all angular velocities d = -0.25, (95% CI -0.40; -0.10, p = 0.001). Beyond 6 months after ACL reconstruction, no significant difference was observed between autograft compositions.ConclusionThe harvest of S autograft for ACL reconstruction yields superior knee flexor strength recovery compared to SG autograft 6 months after ACL reconstruction, irrespective of angular velocity at isokinetic testing. However, the clinical significance of the observed difference in knee flexor strength between autograft compositions at 6 months is questionable, given the very low certainty of evidence and small effect size. There was no significant difference in knee flexor strength recovery between autograft compositions beyond 6 months after ACL reconstruction.
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| 11. |
- Piussi, Ramana, 1988, et al.
(författare)
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Better safe than sorry? A systematic review and meta-analysis on time to return to sport after ACL reconstruction as a risk factor for second ACL injury.
- 2024
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Ingår i: The Journal of orthopaedic and sports physical therapy. - 1938-1344. ; 54:3, s. 161-175
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To analyse the timing of Return to Sports (RTS) as a potential risk factor for a second anterior cruciate ligament (ACL) injury after ACL reconstruction. DESIGN: Systematic review with meta-analysis. LITERATURE SEARCH: The Cochrane Library, EMbase, MEDLINE, AMED and PEDro databases were searched in August 2021 and November 2022. STUDY SELECTION CRITERIA: Clinical studies published in English in peer-reviewed journals, that reported time to RTS after ACL reconstruction and occurrence of second ACL injury were eligible. DATA SYNTHESIS: We pooled continuous data with random-effects meta-analyses, and pooled estimates were summarised in forest plots. A qualitative data synthesis was performed for data not included in meta-analysis. RESULTS: Twenty-one studies were included in the meta-analysis and 33 were included in the qualitative synthesis. Pooled incidence of a second ACL injury was 16.9% (95% Confidence Interval [CI] 12.8-21.6). Patients who suffered a second ACL injury returned to sport significantly earlier (0.77 months [95% CI 0.26-1.28]). CONCLUSION: Time to RTS was a risk factor for a second ACL injury, where patients who suffered a second ACL injury returned to sport almost one month earlier compared with patients who did not suffer a second ACL injury: 9.1 compared with 8.7 months. There was no difference in time to RTS between professional athletes who suffered a second ACL injury and athletes who did not. The certainty of evidence in the results was graded as "very low".
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| 12. |
- Piussi, Ramana, et al.
(författare)
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'I was young, I wanted to return to sport, and re-ruptured my ACL' - young active female patients' voices on the experience of sustaining an ACL re-rupture, a qualitative study
- 2022
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Ingår i: BMC Musculoskeletal Disorders. - London : Springer Science and Business Media LLC. - 1471-2474. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- Background Despite anterior cruciate ligament (ACL) re-ruptures being common, research on patient experiences after knee trauma has primarily focused on the time after primary ACL reconstruction. Integrating qualitative research and patient experiences can facilitate researchers and clinicians in understanding the burden of an ACL re-rupture. The aim of the study was to explore the experiences of an ACL re-rupture journey in young active females aiming to return to knee-strenuous sports after primary ACL reconstruction. Method Fifteen young (19[range 16-23] years old) active females who suffered an ACL re-rupture were interviewed with semi-structured interviews. Qualitative content analysis using deductive approach based on Wiese-Bjornstal's 'integrated model of response to sport injury' was used. Results The results are presented in two timelines 1) from first ACL injury to ACL re-rupture, and 2) from ACL re-rupture to present day, and further stratified according to the domains of the 'integrated model of psychological response to injury'. Results in the first timeline are summarised into seven categories: Finding hope for the journey; Accepting my ACL injury; I succeeded; What matters now? Who am I?; Where will this end? What is going to happen? In the second timeline, eight categories were identified: Fighting spirit; A helping hand; Working hard; I am a new me; I am destroyed; Loneliness; Painful changes; and, I could have made it to the pro ' s. Conclusion Young active females who suffered an ACL re-rupture did not express any positive experience following their first ACL injury, however, in contrast, expressed positive experiences and personal growth after going through the ACL re-rupture journey, characterized by a lot of struggling, and ultimately led to the experience of becoming a new, stronger person.
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| 13. |
- Piussi, Ramana, 1988, et al.
(författare)
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Measurement properties of the Swedish version of the anterior cruciate ligament return to sport after injury scale (ACL-RSI) : A Rasch analysis
- 2024
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Ingår i: Journal of Experimental Orthopaedics. - : Springer Berlin. - 2197-1153. ; 11:3
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Tidskriftsartikel (refereegranskat)abstract
- Purpose : This study aimed to investigate the measurement properties, according to the Rasch Measurement Theory, of the anterior cruciate ligament return to sport after injury scale (ACL-RSI) in patients treated with ACL reconstruction in Sweden. Methods : ACL-RSI responses from 1065 patients treated with ACL reconstruction were extracted from a rehabilitation-specific registry. Rasch analyses were performed on ACL-RSI item response data using the RUMM2030plus software. The analyses focused on targeting (person-item threshold distribution), item hierarchy, response category thresholds, overall and individual item and person fit, differential item functioning (DIF), unidimensionality and reliability. Results : The ACL-RSI had compromised fit to the Rasch model, including DIF and malfunctioning response categories. Several items correlate with each other and the presumptions to aggregate item responses into one single score were not met. When accounting for local dependency, the measurement properties of the ACL-RSI improved in terms of model fit and DIF and unidimensionality were supported. Conclusion : The ACL-RSI was found to have signs of multidimensionality and local dependency, that is, the answers to one item are influenced by the answers to other items. As such, researchers should be careful when using the ACL-RSI as one single score to evaluate patients treated with ACL reconstruction, unless local dependency is accounted for in the scoring process. Level of Evidence: Level III.
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| 14. |
- Piussi, Ramana, 1988, et al.
(författare)
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No Effect of Return to Sport Test Batteries with and without Psychological PROs on the Risk of a Second ACL Injury: A Critical Assessment of Four Different Test Batteries.
- 2023
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Ingår i: International journal of sports physical therapy. - 2159-2896. ; 18:4, s. 874-886
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Tidskriftsartikel (refereegranskat)abstract
- Patients report psychological barriers as important when returning to sport, however, psychological outcome measures are seldom included in return to sport (RTS) assessment. There is a need for clinical trials to integrate psychological patient-reported outcomes (PROs) in return to sport batteries assessing patients treated with ACL reconstruction.The aim of this study was to determine the association between passing clinical tests of muscle function and psychological PROs and sustaining a second ACL injury in patients who RTS after primary ACL reconstruction.Retrospective Cohort study.Patients' sex, age, height and weight, and the results of strength and hop tests, as well as answers to PRO's (including Tegner activity scale, the ACL Return to Sport after Injury scale (ACL-RSI) as well as the Quality of Life (QoL) subscale of the Knee injury and Osteoarthritis Outcome Score [KOOS]), were extracted from a rehabilitation-specific registry. Four different test batteries comprising muscle function tests and PROs were created to assess whether patients were ready to RTS. Passing each of the test batteries (yes/no) was used as an independent variable. A multivariable Cox proportional hazard model analysis was performed, with sustaining a second ACL injury (either ipsi- or contralateral; yes/no) within two years of RTS as the dependent variable.A total of 419 patients (male, n=214; 51%) were included, of which 51 (12.2%) suffered a second ACL injury within the first two years after RTS. There were no differences in passing rates in the different RTS test batteries comprising muscle function tests and PROs for patients who suffered a second ACL injury compared to patients who did not.No association between passing the RTS clinical tests batteries comprising muscle function and psychological PROs used, and the risk of a second ACL injury could be found.3©The Author(s).
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| 15. |
- Piussi, Ramana, et al.
(författare)
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Psychological Factors in Sports Injury Rehabilitation : How Can a Sports Rehabilitation Practitioner Facilitate Communication?
- 2023
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Ingår i: JOSPT Open. - Alexandria : Movement science media. - 2832-8280. ; 2:1, s. 1-3
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Tidskriftsartikel (refereegranskat)abstract
- SYNOPSIS: Communication, goal setting, and shared decision making are possible tools to address psychological components of rehabilitation process after a sports injury. The nature and quality of interactions between sports rehabilitation practitioners and athletes may have a profound impact on athletes’ emotional processes. High-quality communication between sports rehabilitation practitioners and injured athletes is always referred to, yet rarely specified. Our purpose was to outline a proposed definition of high-quality communication. We propose the “Winning 11 of Communication,” consisting of the following: show respect and empathy, be genuine, be transparent, be concrete, check perceptions, have emotional intelligence, get specific, listen before you fix, value patient input, listen for the “but,” and cooperate. To have the communication skills to establish an environment where the injured athletes feel cared for is one important part to increase the likelihood of positive outcomes of rehabilitation. © The Authors
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| 16. |
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| 17. |
- Piussi, Ramana, et al.
(författare)
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Psychological impairments after ACL injury – Do we know what we are addressing? Experiences from sports physical therapists
- 2021
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Ingår i: Scandinavian Journal of Medicine and Science in Sports. - Chichester : Wiley. - 0905-7188 .- 1600-0838. ; 31:7, s. 1508-1517
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Tidskriftsartikel (refereegranskat)abstract
- Psychological impairments can follow an anterior cruciate ligament (ACL) injury and can impact the rehabilitation process. Our aim was to investigate experiences of sports physical therapists (PTs) in addressing psychological impairments in patients after ACL injury. We conducted four focus group interviews with fourteen sports PTs. The PTs’ experiences of working with psychological impairments after ACL injury were summarized in four main categories: (1) “Calling for a guiding light”, where PTs stated that the most common method of acquiring knowledge on addressing psychological impairments was through discussions with colleagues, and, at the same time, PTs expressed an insufficient knowledge of how to address psychological impairments; (2) “Meeting the burden of psychological impairments” where PTs stated that psychological impairments are greater than physical; (3) “Trying to balance physical and psychological aspects” where patient education and assessments were reported to be important in order to understand psychological impairments during rehabilitation; and (4) “Goal setting: a helpful challenge” where sports PTs expressed a need for specific knowledge of the rehabilitation of psychological impairments following ACL injury. To help provide the current best practice, we encourage researchers to develop psychologically centered interventions for rehabilitation after an ACL injury, and PTs to stay up-to-date with the literature published on the subject, including to implement eventual interventions.
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| 18. |
- Piussi, Ramana, et al.
(författare)
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Psychological Patient-reported Outcomes Cannot Predict a Second Anterior Cruciate Ligament Injury in Patients who Return to Sports after an Anterior Cruciate Ligament Reconstruction.
- 2022
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Ingår i: International journal of sports physical therapy. - : International Journal of Sports Physical Therapy. - 2159-2896. ; 17:7, s. 1340-1350
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Tidskriftsartikel (refereegranskat)abstract
- Psychological patient-reported outcomes (PROs) are recommended for use in test batteries to aid in decision-making, regarding whether patients are well prepared to return to sports (RTS) after anterior cruciate ligament (ACL) reconstruction. However, the values that should be regarded as "pass" or "fail" are still unclear.This study aimed to identify cut-off values for three commonly used psychological PROs that could differentiate patients who suffer a second ACL injury from patients who do not within two years of RTS in patients after ACL reconstruction with respect to recovery of symmetrical quadriceps strength.Diagnostic/prognostic study.Demographic data, isokinetic strength test data for quadriceps, as well as results for the ACL-Return to Sport after Injury scale (ACL-RSI), Knee Injury and Osteoarthritis Outcome Score (KOOS) Quality of Life, and Function in Sport and Recreation sub-scales, and the 18-item version of the Knee Self-Efficacy Scale (K-SES18) were extracted from a registry. Receiver operating characteristic (ROC) curves were calculated for each PRO. Accuracy of the cut-offs was presented with two summary measures for the ROC: the area under the curve (AUC) and Youden index.In total, 641 (355 men, 61%) patients (24.8 [SD 7.6] year old at ACL reconstruction) were included. The cut-off values were not able to differentiate patients who suffered a second ACL injury up to 24 months after RTS and ACL reconstruction from patients who did not. Additionally, achieving symmetrical quadriceps strength did not improve the cut-off psychometric properties.Since cut-off values could not differentiate between patients who suffered a second ACL injury and those who did not, clinicians should not rely only on cut-off values or a single PRO of those analyzed in this study when making decisions on which patients are at risk of experiencing a second ACL injury when returning to sports after ACL reconstruction.Level 3.
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| 19. |
- Piussi, Ramana, et al.
(författare)
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Some, but not all, patients experience full symptom resolution and a positive rehabilitation process after ACL reconstruction: an interview study
- 2023
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Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 31:7, s. 2927-2935
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To gain a deeper understanding of patients’ experiences over 5 years after anterior cruciate ligament (ACL) reconstruction. Methods: Seventeen semi-structured interviews were performed with patients treated with ACL reconstruction at least 5years earlier without a second knee injury. Interviews were transcribed and analyzed using qualitative content analysis according to methods described by Graneheim and Lundman. Results: Patients’ long-term experiences after an ACL reconstruction were summarized as: “to cope or not to cope, that is the question”, and five maincategories: (1) Adapting life after knee symptom: the past will not come back; (2) An arduous and demanding rehabilitation: sailing against the wind; (3) Accepting what cannot be changed: biting the bullet; (4) Being satisfied with results: end of a chapter; (5) Apprehensively peregrinating on an unknown road. Conclusions: More than 5years after ACL reconstruction, patients can experience full symptom resolution and the ACL injury process as positive, or experience persistent symptoms and are forced to accept negative life-changing choices due to the injury. Level of evidence: IV.
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| 20. |
- Piussi, Ramana, et al.
(författare)
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Superior knee self-efficacy and quality of life throughout the first year in patients who recover symmetrical muscle function after ACL reconstruction
- 2020
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Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 28, s. 555-567
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Tidskriftsartikel (refereegranskat)abstract
- © 2019, The Author(s). Purpose: The aim of this study was to (1) describe psychological outcomes during the first year after an anterior cruciate ligament (ACL) reconstruction and (2) compare psychological outcomes in patients who recover symmetrical muscle function with patients who do not. Methods: The included patients had undergone a unilateral ACL reconstruction. Patients with a re-rupture and contralateral ACL injury were excluded. Three groups, based on the results from 5 tests of muscle function 12months after reconstruction, were created. Three validated questionnaires (the Knee Self-Efficacy Scale; the Knee injury and Osteoarthritis Outcome Score subscale “Quality of Life”; the ACL Return to Sport after Injury scale) and a single question “Have you achieved your goal with rehabilitation?” were analysed in 4 different follow-ups after ACL reconstruction (10weeks, 4, 8 and 12months). Means and standard deviations were analysed with standard t tests and reported with 95% confidence intervals. Results: A total of 328 patients (120 men, 37%), mean age 27.8 ± 10years, were included. Patients who did not recover symmetrical muscle function (n = 56; 17%) at the 12-month follow-up reported inferior knee-related self-efficacy and quality of life than patients who recovered symmetrical muscle function (n = 96; 29%) at all follow-ups, except quality of life at 4months. The proportion of patients who stated they achieved their rehabilitation goal at 12months was 17% for the entire cohort, 24% for patients who recovered muscle function and 5% for patients who did not recover muscle function. Conclusion: Patients who recovered strength and hop symmetry 12months after ACL reconstruction had superior knee-related self-efficacy and greater quality of life during the whole first year after ACL reconstruction. These results can aid clinicians in the decision-making process by providing knowledge of patients who might need further attention during rehabilitation. Level of evidence: III.
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| 21. |
- Piussi, Ramana, et al.
(författare)
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When context creates uncertainty : experiences of patients who choose rehabilitation as a treatment after an ACL injury
- 2023
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Ingår i: BMJ Open Sport and Exercise Medicine. - London : BMJ Publishing Group Ltd. - 2055-7647. ; 9:1
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Tidskriftsartikel (refereegranskat)abstract
- Up to 50% of patients who suffer an anterior cruciate ligament (ACL) injury receive or opt for rehabilitation alone as initial treatment in Scandinavia. Knowledge of whether patients treated with rehabilitation alone after ACL injury are satisfied is lacking. This study aimed to explore the experiences of patients treated with rehabilitation alone after an ACL injury. Fourteen patients (35.9 (19-56) years old) who suffered an ACL injury treated with rehabilitation alone, a mean of 32 months before inclusion, were interviewed. The interview transcripts were analysed using qualitative content analysis with an inductive approach. The experiences of patients treated with rehabilitation after an ACL injury were summarised in one theme: Is the grass greener on the other side? Context characterised by uncertainty', supported by three main categories and nine subcategories. Uncertainty permeated the context of all levels of knee-related life following ACL injury: (1) in the past, patients felt uncertainty regarding treatment choices, (2) in the present, patients felt uncertainty regarding their physical capacity and knee self-efficacy, and (3) for the future, patients felt uncertainty regarding what might happen. With few exceptions, patients' experiences after an ACL injury treated with rehabilitation alone are characterised by uncertainty regarding their physical function, psychological impairments and possible future limitation of knee function. Uncertainty is experienced by patients in the past, the present and the future. Patients experience the knee as a symptomatic obstacle and need to adapt the physical activity to the presence of symptoms. © 2023 BMJ Publishing Group. All rights reserved.
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| 22. |
- Piussi, Ramana, 1988, et al.
(författare)
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Wrestling with a ghost : facing an opponent I can neither see nor clinch – the experience of professional wrestlers who have suffered an ACL injury
- 2024
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Ingår i: BMJ Open Sport and Exercise Medicine. - London : BMJ Publishing Group Ltd. - 2055-7647. ; 10:1, s. 1-11
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Tidskriftsartikel (refereegranskat)abstract
- This study explored professional wrestlers’ experiences of the consequences of an anterior cruciate ligament (ACL) injury and their perception of whether the ACL injury could have been prevented. We interviewed 10 professional wrestlers (60% women, age range 21–34) treated with ACL reconstruction with semistructured interviews. Transcripts were analysed using qualitative content analysis: One major theme, ‘Wrestling with a ghost: facing an opponent I can neither see nor clinch’, supported by five main categories, emerged from the collected data. The five main categories were: My ACL injury: bad luck or bad planning?; The way back: a fight to return to sport; Only performance counts; The injury’s impact on life: a wrestling with emotions; In hindsight, personal growth. Professional wrestlers who experienced an ACL injury expressed that not only the injury itself but also the subsequent recovery posed major challenges that they did not know how to deal with and that, in some cases, ended the athletes’ wrestling careers. Professional wrestlers attributed their ACL injuries to bad luck or large training loads and wished that they had more support from the wrestling community when injured. © Author(s) (or their employer(s)) 2024.
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| 23. |
- Simonson, Rebecca, et al.
(författare)
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Effect of Quadriceps and Hamstring Strength Relative to Body Weight on Risk of a Second ACL Injury: A Cohort Study of 835 Patients Who Returned to Sport After ACL Reconstruction
- 2023
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Ingår i: Orthopaedic Journal of Sports Medicine. ; 11:4
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Tidskriftsartikel (refereegranskat)abstract
- Background:Anterior cruciate ligament (ACL) injuries are common sports-related injuries with a high risk of reinjury after return to sport (RTS). Rehabilitation aims to regain symmetrical knee strength and function to minimize the risk of a second ACL injury after RTS. Purpose:To determine the effect of absolute quadriceps and hamstring strength, normalized by body weight, on the risk of a second ACL injury during the first 2 years after RTS in patients who have undergone ACL reconstruction (ACLR). Study Design:Cohort study; Level of evidence, 3. Methods:Data from patients after index ACLR at the time of RTS were extracted from a rehabilitation registry-Project ACL. Patients who had performed isokinetic tests for quadriceps and hamstring strength and hop tests before RTS were included. The endpoint was a second ACL injury or a follow-up of 2 years after RTS after ACLR. Results:A total of 835 patients (46% women), with a mean age of 23.9 +/- 7.7 years, were included. During the study period, 69 (8.3%) second ACL injuries (ipsilateral and contralateral) occurred. Greater relative quadriceps strength in the injured leg increased the risk of a second ACL injury (relative risk [RR], 1.69 [95% CI, 1.05-2.74]; P = .032). In patients who had recovered symmetrical quadriceps strength (limb symmetry index >= 90%), there was no effect of quadriceps strength on the risk of second ACL injury (RR, 1.33 [95% CI, 0.69-2.56]; P = .39). Quadriceps strength on the healthy side or hamstring strength, regardless of side, had no effect on the risk of a second ACL injury. Conclusion:Greater relative quadriceps strength in the injured leg at the time of RTS after ACLR was associated with an increased risk of a second ACL injury. There was no effect of relative quadriceps strength on the risk of a second ACL injury in patients who had recovered symmetrical quadriceps strength.
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| 24. |
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| 25. |
- Simonsson, Rebecca, 1991, et al.
(författare)
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To achieve the unachievable—Patients' experiences of opting for delayed anterior cruciate ligament reconstruction after trying rehabilitation alone as primary treatment : A qualitative study
- 2024
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Ingår i: Scandinavian Journal of Medicine and Science in Sports. - West Sussex : Wiley-Blackwell Publishing Inc.. - 0905-7188 .- 1600-0838. ; 34:2, s. 1-14
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: About 50% of patients who sustain an anterior cruciate ligament (ACL) injury are treated without ACL reconstruction (ACL-R). A significant proportion of these patients opt for late ACL-R. Patients' experience of changing treatment has not yet been investigated and presented in the scientific literature. Aim: To explore patients' experiences before and after changing treatment from ACL rehabilitation alone to ACL-R. Method: Fifteen patients were interviewed in semi-structured interviews, which were recorded, transcribed, and analyzed with qualitative content analysis, based on the method described by Graneheim and Lundman. Patients were between 26 and 58 years old, and had tried rehabilitation for a minimum of 9 months prior to ACL-R. Results: Two themes, “Expecting what could not be achieved: the struggle to recover and not becoming stable”, and “Internal completeness: expectations can be achieved”, emerged from the analysis. Each theme was supported by three main categories and 5–6 subcategories. The first theme represents the journey before ACL-R, where patients experienced getting stronger, but perceived the knee as unstable. The second theme represents the journey after ACL-R, where patients expressed that they felt whole after their ACL-R, and where able to achieve their expections. Patients experienced a greater support from the healthcare system, and ultimately expressed a feeling of having achieved the unachievable after ACL-R. Summary: Patients who cross over from ACL rehabilitation to ACL-R experienced rehabilitation alone as insufficient to achieve the desired outcomes, which resulted in a need to opt for delayed ACL-R. Healthcare providers need to support patients, who primarily choose to undergo rehabilitation alone and later opt for ACL-R, throughout the whole rehabilitation process. © 2024 The Authors.
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| 26. |
- Svantesson, Eleonor, et al.
(författare)
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Only 10% of Patients With a Concomitant MCL Injury Return to Their Preinjury Level of Sport 1 Year After ACL Reconstruction: A Matched Comparison With Isolated ACL Reconstruction.
- 2023
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Ingår i: Sports health. - : SAGE Publications. - 1941-0921.
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Tidskriftsartikel (refereegranskat)abstract
- There is a need for an increased understanding of the way a concomitant medial collateral ligament (MCL) injury may influence outcome after anterior cruciate ligament (ACL) reconstruction.Patients with a concomitant MCL injury would have inferior clinical outcomes compared with a matched cohort of patients undergoing ACL reconstruction without an MCL injury.Matched registry-based cohort study; case-control.Level 3.Data from the Swedish National Knee Ligament Registry and a local rehabilitation outcome registry were utilized. Patients who had undergone a primary ACL reconstruction with a concomitant nonsurgically treated MCL injury (ACL + MCL group) were matched with patients who had undergone an ACL reconstruction without an MCL injury (ACL group), in a 1:3 ratio. The primary outcome was return to knee-strenuous sport, defined as a Tegner activity scale ≥6, at the 1-year follow-up. In addition, return to preinjury level of sport, muscle function tests, and patient-reported outcomes (PROs) were compared between the groups.The ACL + MCL group comprised 30 patients, matched with 90 patients in the ACL group. At the 1-year follow-up, 14 patients (46.7%) in the ACL + MCL group had return to sport (RTS) compared with 44 patients (48.9%) in the ACL group (P = 0.37). A significantly lower proportion of patients in the ACL + MCL group had returned to their preinjury level of sport compared with the ACL group (10.0% compared with 25.6%, adjusted P = 0.01). No differences were found between the groups across a battery of strength and hop tests or in any of the assessed PROs. The ACL + MCL group reported a mean 1-year ACL-RSI after injury of 59.4 (SD 21.6), whereas the ACL group reported 57.9 (SD 19.4), P = 0.60.Patients with a concomitant nonsurgically treated MCL injury did not return to their preinjury level of sport to the same extent as patients without an MCL injury 1 year after ACL reconstruction. However, there was no difference between the groups in terms of return to knee strenuous activity, muscle function, or PROs.Patients with a concomitant nonsurgically treated MCL injury may reach outcomes similar to those of patients without an MCL injury 1 year after an ACL reconstruction. However, few patients return to their preinjury level of sport at 1 year.
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| 27. |
- Svantesson, Jasmine, et al.
(författare)
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Shedding light on the non-operative treatment of the forgotten side of the knee: Rehabilitation of medial collateral ligament injuries - A systematic review
- 2024
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Ingår i: BMJ Open Sport and Exercise Medicine. - 2055-7647. ; 10
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Forskningsöversikt (refereegranskat)abstract
- Objective The purpose of this study was to review the current literature regarding the non-operative treatment of isolated medial collateral ligament (MCL) injuries. Design Systematic review, registered in the Open Science Framework (https://doi.org/10.17605/OSF.IO/E9CP4). Data sources The Embase, MEDLINE and PEDro databases were searched; last search was performed on December 2023. Eligibility criteria Peer-reviewed original reports from studies that included information about individuals who sustained an isolated MCL injury with non-surgical treatment as an intervention, or reports comparing surgical with non-surgical treatment were eligible for inclusion. Included reports were synthesised qualitatively. Risk of bias was assessed with the Risk of Bias Assessment tool for Non-randomized Studies. Certainty of evidence was determined using the Grading of Recommendations Assessment Development and Evaluation. Results A total of 26 reports (1912 patients) were included, of which 18 were published before the year 2000 and 8 after. No differences in non-operative treatment were reported between grade I and II injuries, where immediate weight bearing and ambulation were tolerated, and rehabilitation comprised different types of strengthening exercises with poorly reported details. Some reports used immobilisation with a brace as a treatment method, while others did not use any equipment. The use of a brace and duration of use was inconsistently reported. Conclusion There is substantial heterogeneity and lack of detail regarding the non-operative treatment of isolated MCL injuries. This should prompt researchers and clinicians to produce high-quality evidence studies on the promising non-operative treatment of isolated MCL injuries to aid in decision-making and guide rehabilitation after MCL injury. Level of evidence Level I, systematic review.
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| 28. |
- Thorolfsson, Baldur, et al.
(författare)
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Greater self-efficacy, psychological readiness and return to sport amongst paediatric patients compared with adolescents and young adults, 8 and 12months after ACL reconstruction.
- 2023
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Ingår i: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA. - 0942-2056 .- 1433-7347. ; 31:12, s. 5629-5640
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this study was to evaluate differences in rehabilitation-specific outcomes between paediatric patients, adolescents and young adults within the first 2years after anterior cruciate ligament (ACL) reconstruction. A further aim was to determine whether patient age was associated with an increased risk of not achieving symmetrical muscle function within the first 2years after ACL reconstruction.The patient data in the present study were extracted from the rehabilitation outcome registry, Project ACL. Patients aged 11-25years registered for primary ACL reconstruction with a hamstring tendon autograft between April 1, 2013 and November 23, 2020 were included. A total of 691 patients met the inclusion criteria and were included in the study; 41 paediatric patients (females 11-13, males 11-15years), 347 adolescents (females 14-19, males 16-19years) and 303 young adults (females 20-25, males 20-25years).The comparison between groups revealed that 70% of paediatric patients, 39% of adolescents and 35% of young adults had returned to knee-strenuous sport at 8 months and that 90% of paediatric patients, 71% of adolescents and 62% of young adults had returned to sport at 12months. Paediatric patients also reported higher scores compared with both the other patient groups on the Knee Self-Efficacy Scale (K-SES) and the Anterior Cruciate Ligament Return to Sport after Injury scale (ACL-RSI) at 8 and 12months.A larger proportion of paediatric patients had returned to sport compared with adolescents and young adults 8 and 12months after ACL reconstruction. Paediatric patients also reported higher self-efficacy and greater psychological readiness to return to sport at 8 and 12months than the other two groups. No differences in terms of muscle function tests when comparing paediatric patients, adolescents and young adults were found.II.
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| 29. |
- Zsidai, Balint, 1993, et al.
(författare)
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Generalised joint hypermobility leads to increased odds of sustaining a second ACL injury within 12 months of return to sport after ACL reconstruction.
- 2023
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Ingår i: British journal of sports medicine. - 0306-3674 .- 1473-0480. ; 57:15, s. 972-978
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Tidskriftsartikel (refereegranskat)abstract
- To determine the 12-month risk of a second anterior cruciate ligament (ACL) injury in a population of patients with and without generalised joint hypermobility (GJH) who return to sports (RTS) at competition level after ACL reconstruction (ACL-R).Data were extracted from a rehabilitation-specific registry for 16-50-year-old patients treated with ACL-R between 2014 and 2019. Demographics, outcome data and the incidence of a second ACL injury within 12 months of RTS, defined as a new ipsilateral or contralateral ACL, were compared between patients with and without GJH. Univariable logistic regression and Cox proportional hazards regression were performed to determine the influence of GJH and time of RTS on the odds of a second ACL injury, and ACL-R survival without a second ACL injury after RTS.A total of 153 patients, 50 (22.2%) with GJH and 175 (77.8%) without GJH, were included. Within 12 months of RTS, 7 (14.0%) patients with GJH and 5 (2.9%) without GJH had a second ACL injury (p=0.012). The odds of sustaining a second ipsilateral or contralateral ACL injury were 5.53 (95% CI 1.67 to 18.29) higher in patients with GJH compared with patients without GJH (p=0.014). The lifetime HR of a second ACL injury after RTS was 4.24 (95% CI 2.05 to 8.80; p=0.0001) in patients with GJH. No between-group differences were observed in patient-reported outcome measures.Patients with GJH undergoing ACL-R have over five times greater odds of sustaining a second ACL injury after RTS. The importance of joint laxity assessment should be emphasised in patients who aim to return to high-intensity sports following ACL-R.
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