| 1. |
- Beischer, Susanne, et al.
(författare)
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Validation of an 18-item version of the Swedish Knee Self-Efficacy Scale for patients after ACL injury and ACL reconstruction
- 2021
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Ingår i: Journal of Experimental Orthopaedics. - : Springer Science and Business Media LLC. - 2197-1153. ; 8:1
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Tidskriftsartikel (refereegranskat)abstract
- Purpose To evaluate the measurement properties of a new version of the Swedish Knee Self-Efficacy Scale (K-SES) in samples of individuals with an anterior cruciate ligament (ACL) injury and after ACL reconstruction. A secondary aim was to translate the new version of K-SES into English in order to prepare for future complete cross-cultural adaptation. Methods The reliability, structural validity, internal consistency and construct validity of the new, 18-item version of the K-SES (K-SES18) were assessed according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist for evaluating methodological quality. The Swedish version of the K-SES18 was translated to English using recommended guidelines. Results The test-retest reliability for the K-SES18 subscale present and the K-SES18 subscale future showed an Interclass Correlation Coefficient (ICC) = 0.92. In addition, the K-SES18 had a Cronbach's alpha ranging from 0.93 to 0.96 for the K-SES18 subscale present and from 0.81 to 0.91 for the K-SES18 subscale future. No floor and ceiling effects were identified for the subscale present or the subscale future of the K-SES18. A factor analysis produced 2 factors of importance; K-SES(18)present and K-SES(18)future. Seven predefined hypotheses were confirmed. Conclusion The K-SES18 has acceptable reliability and validity to assess knee self-efficacy in patients up to 18 months after ACL injury and reconstruction.
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| 2. |
- Beischer, Susanne, et al.
(författare)
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Young Athletes Who Return to Sport Before 9 Months After Anterior Cruciate Ligament Reconstruction Have a Rate of New Injury 7 Times That of Those Who Delay Return
- 2020
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Ingår i: Journal of Orthopaedic & Sports Physical Therapy. - : Journal of Orthopaedic & Sports Physical Therapy (JOSPT). - 0190-6011 .- 1938-1344. ; 50:2, s. 83-90
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To investigate the association between sustaining a second anterior cruciate ligament (ACL) injury and (1) time to return to sport, (2) symmetrical muscle function, and (3) symmetrical quadriceps strength at the time of return to sport in young athletes after primary ACL reconstruction. DESIGN: Prospective cohort study. METHODS: Patient demographics and results from 5 tests of muscle function (2 strength tests and 3 hop tests) were extracted from a rehabilitation registry. A questionnaire was sent to athletes (1530 years old) who were involved in knee-strenuous sport before the injury and had undergone primary ACL reconstruction to determine time of return to knee-strenuous sport (preinjury Tegner Activity Scale score of 6 or greater). We used the Cox proportional hazard regression model to analyze time to event. RESULTS: One hundred fifty-nine (32% of initial sample) athletes (mean +/- SD age, 21.5 +/- 4.4 years; 64% female) were included. Athletes with a higher preinjury Tegner Activity Scale score had a higher rate of second ACL injury (hazard ratio = 2.1; 95% confidence interval: 1.2, 3.6; P<.01). Athletes who returned to knee-strenuous sport before 9 months after reconstruction had a higher rate of second ACL injury (hazard ratio = 6.7; 95% confidence interval: 2.6,16.7; P<.001). There was no association between symmetrical muscle function or quadriceps strength and second ACL injury. CONCLUSION: Returning to knee-strenuous sport before 9 months after ACL reconstruction was associated with an approximately 7-fold increased rate of sustaining a second ACL injury. Achieving symmetrical muscle function or quadriceps strength was not associated with new ACL injury in young athletes.
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| 3. |
- Bergman, Henrik, et al.
(författare)
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Physical performance and physical activity of patients under compulsory forensic psychiatric inpatient care.
- 2020
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Ingår i: Physiotherapy theory and practice. - : Informa UK Limited. - 1532-5040 .- 0959-3985. ; 36:4, s. 507-15
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Tidskriftsartikel (refereegranskat)abstract
- Research stresses the importance of physical activity in general psychiatric care. There is very little research made in the area of forensic psychiatric care. The aim of this exploratory, cross-sectional study was to assess various physical, psychological, and health variables of patients under compulsory forensic psychiatric inpatient care, and to examine correlations among these variables. Maximal oxygen uptake (VO2max), walking ability, running speed, and explosive leg strength were examined in 28 patients. Patients answered questionnaires about physical activity, aggression, stress, character maturity, and health-related quality of life (HRQL). The patients had a mean age of 33.6years, a mean VO2max of 25.3 (8.4) mL 02/min/kg and a mean physical activity level of 268.0 (272.4) min/week. Results from the 6-min walk test were 612.5 (102.8) m. Nine patients had physical activity levels below the international recommendations of 150min/week. Levels of aggression and stress were high and HRQL was low. The results indicate that patients in forensic psychiatric care are in a very poor physical state, which warrants physiotherapeutic interventions, adapted to the unique demands of forensic psychiatric care.
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| 4. |
- Bergman, Henrik, et al.
(författare)
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The use of physical exercise in forensic psychiatric care in Sweden: a nationwide survey.
- 2021
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Ingår i: Journal of mental health (Abingdon, England). - : Informa UK Limited. - 1360-0567 .- 0963-8237. ; , s. 1-9
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Tidskriftsartikel (refereegranskat)abstract
- Exercise protects against somatic comorbidities and positively affects cognitive function and psychiatric symptoms in patients with severe mental illness. In forensic psychiatry, exercise is a novel concept. Staff at inpatient care facilities may be important resources for successful intervention. Little is known about staff's knowledge, attitudes and behaviors regarding exercise in forensic psychiatric care.To translate, culturally adapt and test the feasibility of the Exercise in Mental Health Questionnaire-Health Professionals Version (EMIQ-HP) in the Swedish context, and to use this EMIQ-HP-Swedish version to describe staff's knowledge, attitudes and behaviors regarding exercise.The EMIQ-HP was translated, culturally adapted, pilot-tested and thereafter used in a cross-sectional nationwide survey.Ten of 25 clinics and 239 health professionals (50.1%) participated. Two parts of the EMIQ-HP-Swedish version showed problems. Most participants considered exercise to be a low-risk treatment (92.4%) that is beneficial (99.2%). Training in exercise prescription was reported by 16.3%. Half of participants (52.7%) prescribed exercise and 50.0% of those undertook formal assessments prior to prescribing.Creation of the EMIQ-HP-Swedish version was successful, despite some clarity problems. Exercise appears to be prescribed informally by non-experts in Swedish forensic psychiatric care and does not address treatment goals.
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| 5. |
- Piussi, R., et al.
(författare)
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Greater Psychological Readiness to Return to Sport, as Well as Greater Present and Future Knee-Related Self-Efficacy, Can Increase the Risk for an Anterior Cruciate Ligament Re-Rupture: A Matched Cohort Study
- 2022
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Ingår i: Arthroscopy - Journal of Arthroscopic and Related Surgery. - : Elsevier BV. - 0749-8063. ; 38:4
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To determine the psychological characteristics and strength outcomes of patients who sustained an early anterior cruciate ligament (ACL) re-rupture after their primary ACL reconstruction and cross-sectionally compare them with a matched cohort of patients who did not sustain a reinjury during the first 2 years after primary ACL reconstruction. Methods: In this matched cohort study, data for quadriceps and hamstring strength and 3 hop tests and answers to standardized patient-reported outcomes (the Anterior Cruciate Ligament Return to Sport after Injury scale and a short version of the Knee Self-Efficacy Scale) were extracted from a rehabilitation outcome registry. Data for patients suffering a re-rupture were extracted, and patients were matched in terms of sex, age, and activity level with patients not suffering an ACL re-rupture within 2 years of primary reconstruction. The groups were compared 10 weeks and 4, 8, and 12 months after the primary reconstruction. Results: A total of 36 patients suffering an ACL re-rupture were matched with 108 patients not suffering a re-rupture after ACL reconstruction. Patients who suffered an ACL re-rupture had greater psychological readiness, that is, greater confidence in performance, lesser negative emotions, and lesser risk appraisal, to return to sport (RTS) at 8 months (81.2 vs 67.9 [95% Δconfidence interval {CI} 2.7-23.8) P = .014) and at 12 months (95.2 vs 67.1, (95% ΔCI 14.3-41.8) P ≤ .001), and greater knee-related self-efficacy at 8 months (8.6 vs 8.0 [95% ΔCI 0.1-1.2], P = .021) and 12 months (9.4 vs 8.1, [95% ΔCI 0.3-2.2] P = .012) after primary ACL reconstruction, compared with the matched group. Conclusions: A stronger psychological profile, defined by a greater psychological readiness to RTS and knee-related self-efficacy, may be associated with an ACL re-rupture within 2 years of the primary reconstruction. Level of Evidence: Matched cohort study, level III. © 2021 The Author(s).
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| 6. |
- Sundemo, David, et al.
(författare)
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Generalized joint hypermobility does not influence 1-year patient satisfaction or functional outcome after ACL reconstruction
- 2022
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Ingår i: Knee Surgery Sports Traumatology Arthroscopy. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 30, s. 4173-4180
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Tidskriftsartikel (refereegranskat)abstract
- Purpose The purpose of this study was to evaluate whether generalized joint hypermobility (GJH) influences postoperative results, including return to sport, patientreported outcomes, functional performance (hop tests), muscular strength, and the occurrence of ACL re-injury, in patients 1 year after anterior cruciate ligament (ACL) reconstruction. Methods Data was extracted from a regional rehabilitation-specific registry containing information on patients with ACL injury. Patients between the ages of 16-50 years previously undergoing ACL reconstruction with available 1 year follow-up data were eligible for inclusion. Generalized joint hypermobility was assessed using the Beighton score (BS). Patients were examined one year postoperatively in terms of return to sport, patient-reported outcome, hop tests, muscular strength and the occurrence of reinjury. For purpose of analysis, patients were allocated into two groups, depending on the existence of GJH. The KOOS subscale of sports and recreation was considered the primary outcome. Analyses were performed both dichotomously and by using adjusted logistic regression, to consider potential confounders. Results A total of 356 patients (41% males) were included, of which 76 (24% male) were categorized as having GJH. Patients with GJH had an inferior limb symmetry index preoperatively in terms of knee extension (mean 81.6 [SD 16.4] vs. 91.4 [SD 15.9], p = 0.02) and flexion strength (mean 91.9 vs. 99.1, p = 0.047) compared to patients without GJH. There was no difference between the groups in terms of the primary outcome, nor in any of the other postoperative outcomes. Nine patients (11.8%) in the group with GJH suffered ACL re-injury, compared with 13 patients (4.6%) in the control group (n.s.). Conclusion One year after ACL reconstruction the existence of GJH did not affect postoperative patient satisfaction, strength or functional outcome. No conclusive statements can be made regarding the influence of GJH on the risk of ACL re-injury in this particular study.
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| 7. |
- 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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| 8. |
- Beischer, Susanne, et al.
(författare)
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Patients that maintain their pre-injury level of physical activity 3-5 years after ACL reconstruction are, 18months after surgery, characterised by higher levels of readiness to return to sport.
- 2023
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Ingår i: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA. - : Springer Science and Business Media LLC. - 1433-7347. ; 31:2, s. 596-607
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Tidskriftsartikel (refereegranskat)abstract
- To characterise patients who had returned to their pre-injury physical activity (PA) or higher at 18 months and maintained that level of PA 3-5 years after the primary ACL reconstruction and to describe the level, frequency, and type of PA participation during the first 5 years after ACL reconstruction METHOD: Data, from follow-ups at 18 months and 3-5 years after an ACL reconstruction, were extracted from a rehabilitation-specific register. Patients, 15-65 years of age, were included. The data comprised patient-reported outcomes and the results from two questions with respect to the level, frequency, and type of PA. Comparisonswere made betweenpatients who had and had not maintained their pre-injury level of PA at the follow-up 3-5 years after an ACL reconstruction.A total of 272 patients met the inclusion criteria. The mean follow-up time was 3.8 years (min-max: 2.9-5.1) after the ACL reconstruction. Of patients who had returned to their pre-injury or a higher level of PA at the 18month follow-up (n = 114), 68% (n = 78) maintained that level at the 3- to 5-year follow-up after ACL reconstruction. These patients reported a higher level of psychological readiness to return to sport (98 versus 79; p = 0.013). Moreover, these patients were 6.0 years older (p = 0.016) and were characterised by male sex (56% versus 44%; p = 0.028) and a lower level of pre-injury PA (p = 0.013). At the follow-up 3-5 years after the ACL reconstruction, more than 90% met the recommendations for PA. However, the prevalence of physical inactivity had increased and the involvement in organised PA had decreased compared with the 18-month follow-up.Two out of three patients who have returned to their previous level of PA at 18 months can be expected to maintain that level, 3-5 years following ACL reconstruction. These patients were mainly characterised by a higher level of psychological readiness, especially in patients who participated in knee-strenuous sport and were younger than 20 years of age. The results of this study suggest that patients become more physically inactive over time, implicating the importance of clinicians helping patients find a suitable PA that may help patients maintain an active lifestyle.
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| 9. |
- 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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| 10. |
- 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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| 11. |
- Högberg, Johan, 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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| 12. |
- Högberg, Johan, 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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| 13. |
- 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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| 14. |
- 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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| 15. |
- 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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| 16. |
- Piussi, R., et al.
(författare)
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Hop tests and psychological PROs provide a demanding and clinician-friendly RTS assessment of patients after ACL reconstruction, a registry study
- 2020
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Ingår i: Bmc Sports Science Medicine and Rehabilitation. - : Springer Science and Business Media LLC. - 2052-1847. ; 12:1
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Tidskriftsartikel (refereegranskat)abstract
- Background There is growing interest in assessing psychological well-being in patients after anterior cruciate ligament (ACL) reconstruction. It is unknown whether an assessment of psychological outcome in addition to tests of muscle function can facilitate decisions on return to sport (RTS). Therefore, the aim of this study was to evaluate passing rates in different physical RTS test batteries, with and without the inclusion of psychological outcome measures 1 year after ACL reconstruction. Method In this cross-sectional cohort study a total of 320 patients (51% men) aged 18-65 years were included 1 year after ACL reconstruction. Passing rates on different muscle function (MF) test batteries (with results presented as Limb Symmetry Index (LSI)), consisting of knee extension and flexion strength tests, 3 hop tests, and 2 psychological patient-reported outcomes (PROs); Quality of Life subscale from the Knee injury and Osteoarthritis Outcome Score (KOOS QoL) and ACL Return to Sport after Injury (ACL-RSI), were evaluated 1 year after ACL reconstruction. Muscle function test batteries comprised: 2 MF tests (vertical hop and hop for distance; pass = 90% LSI); 2 MF tests and 2 PRO (pass = 90% LSI, 62.5 points on KOOS QoL and 76.6 points on ACL-RSI), 5 MF tests (2 strength and 3 hop tests, pass = 90% LSI), and 5 MF tests and 2 PRO (pass = 90% LSI, 62.5 points on KOOS QoL and 76.6 points on ACL-RSI). Results Passing rates in the different test batteries were 47% for 2 MF tests, 19% for 2 MF tests and 2 PROs, 29% for 5 MF tests and 13% for 5 MF tests and 2 PROs. The use of psychological PROs together with tests of muscle function gave the lowest passing rate (13%). There was a very strong correlation between passing 2 hop tests and 2 PROs and passing 5 MF tests (r phi = 0.41) as well as passing 5 MF tests and 2 PROs (r phi = 0.79). Conclusion The use of hop tests together with psychological PROs provides a clinician-friendly RTS test battery for assessment 1 year after ACL reconstruction as the passing rate was 19% when using 2 hop-tests combined with 2 PROs, compared with 29% when using 5 tests of MF requiring advanced testing equipment.
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| 17. |
- 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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| 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, R., et al.
(författare)
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Recovery of preoperative absolute knee extension and flexion strength after ACL reconstruction
- 2020
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Ingår i: BMC Sports Science, Medicine and Rehabilitation. - : Springer Science and Business Media LLC. - 2052-1847. ; 12:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: The recovery of muscle function after an Anterior Cruciate Ligament (ACL) reconstruction is most commonly reported as limb-to-limb differences using the Limb Symmetry Index (LSI), which is not free from limitations. The purpose of this study was to compare the proportion of patients who recover their Preoperative Absolute Muscle Strength (PAMS) 8 and 12 months after ACL reconstruction with the proportion of patients who recover their symmetrical knee strength. A secondary aim was to assess the relationship between psychological Patient-Reported Outcomes (PROs) and recovering PAMS at 8 and 12 months after ACL reconstruction and rehabilitation. Method: Preoperative, 8- and 12-month results from quadriceps and hamstring strength tests and PROs for 117 patients were extracted from a rehabilitation registry. Individual preoperative peak torques from strength tests were compared with results from the 8- and 12-month follow-ups respectively. Patients were defined as having recovered their PAMS upon reaching 90% of their preoperative peak torque for both quadriceps and hamstring strength. Patients were defined as having recovered their LSI upon reaching a value ≥90% when comparing the results for their injured knee with those of their healthy knee. Correlations between the recovery of PAMS and PROs at 8 and 12 months were analyzed. Results: There was no difference in the proportion of patients who recovered their PAMS compared with patients who recovered their LSI. In all, 30% and 32% of the patients who recovered their LSI had not recovered their PAMS at 8 months and 12 months respectively. In the patients who had recovered their PAMS, 24% and 31% had not recovered their symmetrical LSI at 8 months and 12 months respectively. There was no significant correlation between the recovery of PAMS and psychological PROs. Conclusion: The use of both PAMS and LSI provides more detailed information on the recovery of muscle strength after ACL reconstruction. The recovery of PAMS was not correlated with psychological traits, which implies that both PROs and PAMS are important when evaluating patients after ACL reconstruction. Trial registration: This trial was not registered. © 2020, The Author(s).
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| 20. |
- 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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| 21. |
- 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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| 22. |
- 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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| 23. |
- 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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| 24. |
- Stigert, Maja, et al.
(författare)
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Physical inactivity 5-8 years after anterior cruciate ligament reconstruction is associated with knee-related self-efficacy and psychological readiness to return to sport.
- 2023
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Ingår i: BMJ open sport & exercise medicine. - 2055-7647. ; 9:4
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Tidskriftsartikel (refereegranskat)abstract
- To investigate whether patient demographics and patient-reported outcomes (PROs), respectively, are associated with physical inactivity (PI) 5-8years after primary anterior cruciate ligament reconstruction (ACLR).This case control observational study included individuals who had undergone primary ACLR between the ages of 15 and 65 years and had responded to PROs 18 months postoperatively. These individuals were asked to answer a questionnaire regarding their present level of physical activity (PA) at 5-8years after ACLR. Patient-demographic data and results from the Knee injury and Osteoarthritis Outcome Score, the Knee Self-Efficacy Scale and the ACL Return to Sport (RTS) after Injury scale from 18 months after ACLR were extracted from a rehabilitation-specific register. Univariable logistic regression analyses were performed with PI (<150min PA per week/≥150min PA/week) as the dependent variable.Of 292 eligible participants, 173 (47% women; mean±SDage = 31±11 years) responded to the PA questionnaire. In all, 14% (n=25; 28%women) were classified as physically inactive. Participants with lower levels of present and future self-efficacy, OR 1.35 (CI 1.05 to 1.72) and OR 1.20 (CI 1.12 to 1.45), and lower levels of psychological readiness to RTS, OR 1.19 (CI 1 to 1.43), at the 18-month follow-up, had higher odds of being physically inactive 5-8years after ACLR. None of the patient demographic variables was able to predict PI.Lower levels of knee-related self-efficacy and psychological readiness to RTS, 18 months after ACLR, were associated with PI 5-8years after surgery.
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| 25. |
- 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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| 26. |
- 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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