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- Dijkstra, H Paul, et al.
(author)
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Primary cam morphology; bump, burden or bog-standard? : A concept analysis
- 2021
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In: British Journal of Sports Medicine. - : BMJ. - 0306-3674 .- 1473-0480. ; 55:21, s. 1212-1221
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Journal article (peer-reviewed)abstract
- BACKGROUND: Cam morphology, a distinct bony morphology of the hip, is prevalent in many athletes, and a risk factor for hip-related pain and osteoarthritis. Secondary cam morphology, due to existing or previous hip disease (eg, Legg-Calve-Perthes disease), is well-described. Cam morphology not clearly associated with a disease is a challenging concept for clinicians, scientists and patients. We propose this morphology, which likely develops during skeletal maturation as a physiological response to load, should be referred to as primary cam morphology. The aim of this study was to introduce and clarify the concept of primary cam morphology.DESIGN: We conducted a concept analysis of primary cam morphology using articles that reported risk factors associated with primary cam morphology; we excluded articles on secondary cam morphology. The concept analysis method is a rigorous eight-step process designed to clarify complex 'concepts'; the end product is a precise definition that supports the theoretical basis of the chosen concept.RESULTS: We propose five defining attributes of primary cam morphology-tissue type, size, site, shape and ownership-in a new conceptual and operational definition. Primary cam morphology is a cartilage or bony prominence (bump) of varying size at the femoral head-neck junction, which changes the shape of the femoral head from spherical to aspherical. It often occurs in asymptomatic male athletes in both hips. The cartilage or bone alpha angle (calculated from radiographs, CT or MRI) is the most common method to measure cam morphology. We found inconsistent reporting of primary cam morphology taxonomy, terminology, and how the morphology is operationalised.CONCLUSION: We introduce and clarify primary cam morphology, and propose a new conceptual and operational definition. Several elements of the concept of primary cam morphology remain unclear and contested. Experts need to agree on the new taxonomy, terminology and definition that better reflect the primary cam morphology landscape-a bog-standard bump in most athletic hips, and a possible hip disease burden in a selected few.
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| 2. |
- Moksnes, Håvard, et al.
(author)
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Assessing implementation, limited efficacy, and acceptability of the BEAST tool : A rehabilitation and return-to-sport decision tool for nonprofessional athletes with anterior cruciate ligament reconstruction
- 2021
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In: Physical Therapy in Sport. - : Elsevier BV. - 1466-853X .- 1873-1600. ; 52, s. 147-154
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Journal article (peer-reviewed)abstract
- OBJECTIVES: To assess the implementation, limited efficacy, and acceptability of the BEAST (better and safer return to sport) tool - a rehabilitation and return-to-sport (RTS) decision tool after anterior cruciate ligament reconstruction (ACLR) in nonprofessional athletes.DESIGN: Prospective cohort.PARTICIPANTS: 43 nonprofessional pivoting sport athletes with ACLR.MAIN OUTCOME: Clinician- and athlete-experienced implementation challenges (implementation), changes in quadriceps power, side hop and triple hop performance from 6 to 8 months after ACLR (limited efficacy), athletes' beliefs about the individual rehabilitation and RTS plans produced by the BEAST tool (acceptability).RESULTS: The BEAST tool was developed and then implemented as planned for 39/43 (91%) athletes. Hop and quadriceps power performance improved significantly, with the largest improvement in involved quadriceps power (standardised response mean 1.4, 95% CI:1.1-1.8). Athletes believed the rehabilitation and RTS plan would facilitate RTS (8.2 [SD: 2.0]) and reduce injury risk (8.3 [SD: 1.2]; 0 = not likely at all, 10 = extremely likely).CONCLUSION: The BEAST tool was implemented with few challenges and adjustments were rarely necessary. Athletes had large improvements in quadriceps power and hop performance on the involved leg. Athletes believed that the individual rehabilitation and RTS plans produced by the tool would facilitate RTS and reduce injury risk.
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| 3. |
- Sonesson, Sofi, et al.
(author)
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Low correlation between functional performance and patient reported outcome measures in individuals with non-surgically treated ACL injury.
- 2021
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In: Physical Therapy in Sport. - EDINBURGH SCOTLAND : Elsevier BV. - 1466-853X .- 1873-1600. ; 47, s. 185-192
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Journal article (peer-reviewed)abstract
- OBJECTIVE: Describe a consecutive cohort of people with a non-surgically treated ACL injury and evaluate correlations between functional performance and patient reported outcome measures (PROMs).DESIGN: Cross-sectional.PARTICIPANTS: Sixty-eight individuals (38 males, 18-45 years old) 2-5 years after ACL injury.MAIN OUTCOME MEASURES: Tegner Activity Scale, International Knee Documentation Committee Subjective Knee Form (IKDC-SKF), Anterior Cruciate Ligament Return to Sport after Injury scale (ACL-RSI) and ACL-Quality of Life (ACL-QoL) were completed. Functional performance was assessed using 4 hop tests and a squat test.RESULTS: Mean IKDC-SKF score was 72 ± 17 and mean LSI on performance tests were above 90%. Tegner Activity Scale was reduced from median 8 pre-injury to 5 at follow up. Satisfaction with activity level was median 7 on a 10-point ordinal scale. Correlations were moderate to strong (r = 0.552-0.856) between PROMs, negligible to weak (r = 0.003-0.403) between performance tests and PROMs and negligible to moderate (r = 0.142-0.683) between performance tests.CONCLUSION: Functional performance had negligible or weak correlation to PROMs, which indicates the need for multi-modal assessment strategies. Activity level was reduced 2-5 years after a non-surgically treated ACL injury, but most patients were able to resume physical activity at a sufficient level to maintain health and displayed symmetrical functional performance.LEVEL OF EVIDENCE: Retrospective cohort study, Level III.
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| 4. |
- Tigerstrand Grevnerts, Hanna, et al.
(author)
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Decision Making for Treatment After ACL Injury From an Orthopaedic Surgeon and Patient Perspective: Results From the NACOX Study
- 2021
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In: The Orthopaedic Journal of Sports Medicine. - : Sage Publications. - 2325-9671. ; 9:4
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Journal article (peer-reviewed)abstract
- Background: In the treatment of anterior cruciate ligament (ACL) injuries, there is little evidence of when and why a decision for ACL reconstruction (ACLR) or nonoperative treatment (non-ACLR) is made. Purpose: To (1) describe the key characteristics of ACL injury treatment decisions and (2) compare patient-reported knee instability, function, and preinjury activity level between patients with non-ACLR and ACLR treatment decisions. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 216 patients with acute ACL injury were evaluated during the first year after injury. The treatment decision was non-ACLR in 73 patients and ACLR in 143. Reasons guiding treatment decision were obtained from medical charts and questionnaires to patients and orthopaedic surgeons. Patient-reported instability and function were obtained via questionnaires and compared between patients with non-ACLR and ACLR treatment decisions. The ACLR treatment group was classified retrospectively by decision phase: acute phase (decision made between injury day and 31 days after injury), subacute phase (decision made between 32 days and up to 5 months after injury), and late phase (decision made 5-12 months after injury). Data were evaluated using descriptive statistics, and group comparisons were made using parametric or nonparametric tests as appropriate. Results: The main reasons for a non-ACLR treatment decision were no knee instability and no problems with knee function. The main reasons for an ACLR treatment decision were high activity demands and knee instability. Patients in the non-ACLR group were significantly older (P = .031) and had a lower preinjury activity level than did those in the acute-phase (P < .01) and subacute-phase (P = .006) ACLR decision groups. There were no differences in patient-reported instability and function between treatment decision groups at baseline, 4 weeks after injury, or 3 months after injury. Conclusion: Activity demands, not patient-reported knee instability, may be the most important factor in the decision-making process for treatment after ACL injury. We suggest a decision-making algorithm for patients with ACL injuries and no high activity demands; waiting for >3 months can help distinguish those who need surgical intervention from those who can undergo nonoperative management.
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