After an intense bout of exercise, foam rolling is thought to alleviate muscle fatigue and soreness (ie, delayed-onset muscle soreness [DOMS]) and improve muscular performance. Potentially, foam rolling may be an effective therapeutic modality to reduce DOMS while enhancing the recovery of muscular performance. To examine the effects of foam rolling as a recovery tool after an intense exercise protocol through assessment of pressure-pain threshold, sprint time, change-of-direction speed, power, and dynamic strength-endurance. Controlled laboratory study. University laboratory. A total of 8 healthy, physically active males (age = 22.1 ± 2.5 years, height = 177.0 ± 7.5 cm, mass = 88.4 ± 11.4 kg) participated. Participants performed 2 conditions, separated by 4 weeks, involving 10 sets of 10 repetitions of back squats at 60% of their 1-repetition maximum, followed by either no foam rolling or 20 minutes of foam rolling immediately, 24, and 48 hours postexercise. Pressure-pain threshold, sprint speed (30-m sprint time), power (broad-jump distance), change-of-direction speed (T-test), and dynamic strength-endurance. Foam rolling substantially improved quadriceps muscle tenderness by a moderate to large amount in the days after fatigue (Cohen d range, 0.59 to 0.84). Substantial effects ranged from small to large in sprint time (Cohen d range, 0.68 to 0.77), power (Cohen d range, 0.48 to 0.87), and dynamic strength-endurance (Cohen d = 0.54). Foam rolling effectively reduced DOMS and associated decrements in most dynamic performance measures.Context:
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Insufficient hip and thigh strength may increase an athlete's susceptibility to injury. However, screening for strength deficits using isometric and isokinetic instrumentation may not be practical in all clinical scenarios. To determine if functional performance tests are valid indicators of hip and thigh strength. Descriptive laboratory study. Research laboratory. Sixty-two recreationally athletic men (n = 30, age = 21.07 years, height = 173.84 cm, mass = 81.47 kg) and women (n = 32, age = 21.03 years, height = 168.77 cm, mass = 68.22 kg) participants were recruited. During session 1, we measured isometric peak force and rate of force development for 8 lower extremity muscle groups, followed by an isometric endurance test. During session 2, participants performed functional performance tests. Peak force, rate of force development, fatigue index, hop distance (or height), work (joules), and number of hops performed during the 30-second lateral-hop test were assessed. The r values were squared to calculate r 2. We used Pearson correlations to evaluate the associations between functional performance and strength. In men, the strongest relationship was observed between triple-hop work and hip-adductor peak force (r2 = 50, P ≤ .001). Triple-hop work also was related to hip-adductor (r2 = 38, P ≤ .01) and hip-flexor (r2 = 37, P ≤ .01) rate of force development. For women, the strongest relationships were between single-legged vertical-jump work and knee-flexor peak force (r2 = 0.44, P ≤ .01) and single-legged vertical-jump height and knee-flexor peak force (r2 = 0.42, P ≤ .01). Single-legged vertical-jump height also was related to knee-flexor rate of force development (r2 = 0.49, P ≤ .001). The 30-second lateral-hop test did not account for a significant portion of the variance in strength endurance. Hop tests alone did not provide clinicians with enough information to make evidence-based decisions about lower extremity strength in isolated muscle groups.Context:
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Fatigue is suggested to be a risk factor for anterior cruciate ligament injury. Fatiguing exercise can affect neuromuscular control and laxity of the knee joint, which may render the knee less able to resist externally applied loads. Few authors have examined the effects of fatiguing exercise on knee biomechanics during the in vivo transition of the knee from non–weight bearing to weight bearing, the time when anterior cruciate ligament injury likely occurs. To investigate the effect of fatiguing exercise on tibiofemoral joint biomechanics during the transition from non–weight bearing to early weight bearing. Cross-sectional study. Research laboratory. Ten participants (5 men and 5 women; age = 25.3 ± 4.0 years) with no previous history of knee-ligament injury to the dominant leg. Participants were tested before (preexercise) and after (postexercise) a protocol consisting of repeated leg presses (15 repetitions from 10°–40° of knee flexion, 10 seconds' rest) against a 60% body-weight load until they were unable to complete a full bout of repetitions. Electromagnetic sensors measured anterior tibial translation and knee-flexion excursion during the application of a 40% body-weight axial compressive load to the bottom of the foot, simulating weight acceptance. A force transducer recorded axial compressive force. The axial compressive force (351.8 ± 44.3 N versus 374.0 ± 47.9 N; P = .018), knee-flexion excursion (8.0° ± 4.0° versus 10.2° ± 3.7°; P = .046), and anterior tibial translation (6.7 ± 1.7 mm versus 8.2 ± 1.9 mm; P < .001) increased from preexercise to postexercise. No significant correlations were noted. Neuromuscular fatigue may impair initial knee-joint stabilization during weight acceptance, leading to greater accessory motion at the knee and the potential for greater anterior cruciate ligament loading.Context:
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In clinical practice, the range of motion (ROM) of the noninvolved side often serves as the reference for comparison with the injured side. Previous investigations of non–weight-bearing (NWB) ankle dorsiflexion (DF) ROM measurements have indicated bilateral symmetry for the most part. Less is known about ankle DF measured under weight-bearing (WB) conditions. Because WB and NWB ankle DF are not strongly correlated, there is a need to determine whether WB ankle DF is also symmetrical in a healthy population. To determine whether WB ankle DF is bilaterally symmetrical. A secondary goal was to further explore the correlation between WB and NWB ankle DF ROM. Cross-sectional study. Training facility of the Israeli Defense Forces. A total of 64 healthy males (age = 19.6 ± 1.0 years, height = 175.0 ± 6.4 cm, and body mass = 71.4 ± 7.7 kg). Dorsiflexion ROM in WB was measured with an inclinometer and DF ROM in NWB was measured with a universal goniometer. All measurements were taken bilaterally by a single examiner. Weight-bearing ankle DF was greater on the nondominant side compared with the dominant side (P < .001). Non–weight-bearing ankle DF was not different between sides (P = .64). The correlation between WB and NWB DF was moderate, with the NWB DF measurement accounting for 30% to 37% of the variance of the WB measurement. Weight-bearing ankle DF ROM should not be assumed to be bilaterally symmetrical. These findings suggest that side-to-side differences in WB DF may need to be interpreted while considering which side is dominant. The difference in bilateral symmetry between the WB and NWB measurements, as well as the only moderate level of correlation between them, suggests that both measurements should be performed routinely.Context:
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Although lateral ankle sprains are common in athletes and can lead to chronic ankle instability (CAI), strength-training rehabilitation protocols may improve the deficits often associated with CAI. To determine whether strength-training protocols affect strength, dynamic balance, functional performance, and perceived instability in individuals with CAI. Randomized controlled trial. Athletic training research laboratory. A total of 39 individuals with CAI (17 men [44%], 22 women [56%]) participated in this study. Chronic ankle instability was determined by the Identification of Functional Ankle Instability Questionnaire, and participants were randomly assigned to a resistance-band–protocol group (n = 13 [33%] age = 19.7 ± 2.2 years, height = 172.9 ± 12.8 cm, weight = 69.1 ± 13.5 kg), a proprioceptive neuromuscular facilitation strength-protocol group (n = 13 [33%], age = 18.9 ± 1.3 years, height = 172.5 ± 5.9 cm, weight = 72.7 ± 14.6 kg), or a control group (n = 13 [33%], age = 20.5 ± 2.1 years, height = 175.2 ± 8.1 cm, weight = 70.2 ± 11.1 kg). Both rehabilitation groups completed their protocols 3 times/wk for 6 weeks. The control group did not attend rehabilitation sessions. Before the interventions, participants were pretested by completing the figure-8 hop test for time, the triple-crossover hop test for distance, isometric strength tests (dorsiflexion, plantar flexion, inversion, and eversion), the Y-Balance test, and the visual analog scale for perceived ankle instability. Participants were again tested 6 weeks later. We conducted 2 separate, multivariate, repeated-measures analyses of variance, followed by univariate analyses on any significant findings. The resistance-band protocol group improved in strength (dorsiflexion, inversion, and eversion) and on the visual analog scale (P < .05); the proprioceptive neuromuscular facilitation group improved in strength (inversion and eversion) and on the visual analog scale (P < .05) as well. No improvements were seen in the triple-crossover hop or the Y-Balance tests for either intervention group or in the control group for any dependent variable (P > .05). Although the resistance-band protocol is common in rehabilitation, the proprioceptive neuromuscular facilitation strength protocol is also an effective treatment to improve strength in individuals with CAI. Both protocols showed clinical benefits in strength and perceived instability. To improve functional outcomes, clinicians should consider using additional multiplanar and multijoint exercises.Context:
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Near-infrared (NIR) light therapy is purported to act as an ergogenic aid by enhancing the contractile function of skeletal muscle. Improving muscle function is a new avenue for research in the area of laser therapy; however, very few researchers have examined the ergogenic effects of NIR light therapy and the influence it may have on the recovery process during rehabilitation. To evaluate the ergogenic effect of NIR light therapy on skeletal muscle function. Crossover study. Controlled laboratory. Thirty-nine healthy men (n = 21) and women (n = 18; age = 20.0 ± 0.2 years, height = 169 ± 2 cm, mass = 68.4 ± 1.8 kg, body mass index = 23.8 ± 0.4 kg/m2). Each participant received active and sham treatments on the biceps brachii muscle on 2 separate days. The order of treatment was randomized. A class 4 laser with a cumulative dose of 360 J was used for the active treatment. After receiving the treatment on each day, participants completed an elbow-flexion resistance-exercise protocol. The dependent variables were elbow range of motion, muscle point tenderness, and strength (peak torque). Analysis of variance with repeated measures was used to assess changes in these measures between treatments at baseline and at follow-up, 48 hours postexercise. Additionally, immediate strength loss postexercise was compared between treatments using a paired t test. Preexercise to postexercise strength loss for the active laser treatment, although small, was less than with the sham treatment (P = .05). Applied to skeletal muscle before resistance exercise, NIR light therapy effectively attenuated strength loss. Therefore, NIR light therapy may be a beneficial, noninvasive modality for improving muscle function during rehabilitation after musculoskeletal injury. However, future studies using higher treatment doses are warranted.Context:
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During team athletic events, athletic trainers commonly provide fluids with water bottles. When a limited number of water bottles exist, various techniques are used to deliver fluids. To determine whether fluid delivered via water-bottle administration influenced fluid consumption and hydration status. Crossover study. Outdoor field (22.2°C ± 3.5°C). Nineteen participants (14 men, 5 women, age = 30 ± 10 years, height = 176 ± 8 cm, mass = 72.5 ± 10 kg) were recruited from the university and local running clubs. The independent variable was fluid delivery with 3 levels: self-administration with mouth-to-bottle direct contact (SA-DC), self-administration with no contact between mouth and bottle (SA-NC), and external administration with no contact between the mouth and the bottle (EA-NC). Participants warmed up for 10 minutes before completing 5 exercise stations, after which an ad libitum fluid break was given, for a total of 6 breaks. We measured the fluid variables of total volume consumed, total number of squirts, and average volume per squirt. Hydration status via urine osmolality and body-mass loss, and perceptual variables for thirst and fullness were recorded. We calculated repeated-measures analyses of variance to assess hydration status, fluid variables, and perceptual measures to analyze conditions across time. The total volume consumed for EA-NC was lower than for SA-DC (P = .001) and SA-NC (P = .001). The total number of squirts for SA-DC was lower than for SA-NC (P = .009). The average volume per squirt for EA-NC was lower than for SA-DC (P = .020) and SA-NC (P = .009). Participants arrived (601.0 ± 21.3 mOsm/L) and remained (622.3 ± 38.3 mOsm/L) hydrated, with no difference between conditions (P = .544); however, the EA-NC condition lost more body mass than did the SA-DC condition (P = .001). There was no main effect for condition on thirst (P = .147) or fullness (P = .475). External administration of fluid decreased total volume consumed via a decreased average volume per squirt. The SA-DC method requires fewer squirts within a specific time frame. Fluid breaks every 15 minutes resulted in maintenance of euhydration; however, loss of body mass was influenced by fluid administration. Athletic trainers should avoid external administration to promote positive hydration behaviors. When fluid is self-administered, individual bottles may be the best clinical practice because more volume can be consumed per squirt.Context:
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Urine specific gravity (Usg), measured by a handheld manual refractometer (MAN), has been recognized as a valid and practical means of assessing hydration status. Newer, digital refractometers are faster and more user friendly but have not been validated against the traditional MAN. To compare the reliability and validity of 2 digital refractometer models and a MAN. Descriptive laboratory study. Research laboratory. Sample of convenience was recruited from the local university and surrounding community (n = 82). Participants provided multiple urine samples (n = 124) over a 5-month period under various hydration conditions. Urine specific gravity was compared among a MAN, a digital refractometer requiring the prism to be dipped (DIP) into a urine sample, and a digital refractometer that requires urine to be pipetted (PIP) onto its prism for analysis. The MAN measurements were strongly correlated with the DIP (r = 0.99, P < .001) and PIP (r = 0.97, P < .001) measurements. Bland-Altman analyses revealed slight mean underestimation (95% upper and lower levels of agreement) between MAN and DIP (−0.0012 [0.0028] and PIP −0.0011 [0.0035], respectively) and trends toward increased underestimation at higher Usg. Measurement error ≥ .005 was greater for PIP (4/124, 3.2%) than for DIP (2/124, 1.6%). Negligible differences were exhibited between PIP and DIP, with both displaying acceptable reliability and validity compared with the MAN. However, the Bland-Altman analysis suggests underestimation bias for the DIP and PIP as Usg increases, with the potential for rare but substantial underestimation when using PIP that should be recognized by clinicians, particularly when used as a screening measure in weight-class sports.Context:
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The Foot and Ankle Ability Measure (FAAM) is a valid, reliable, and self-reported outcome instrument for the foot and ankle region. To provide evidence for translation, cross-cultural adaptation, validity, and reliability of the Japanese version of the FAAM (FAAM-J). Cross-sectional study. Collegiate athletic training/sports medicine clinical setting. Eighty-three collegiate athletes. All participants completed the Activities of Daily Living and Sports subscales of the FAAM-J and the Physical Functioning and Mental Health subscales of the Japanese version of the Short Form-36v2 (SF-36). Also, 19 participants (23%) whose conditions were expected to be stable completed another FAAM-J 2 to 6 days later for test-retest reliability. We analyzed the scores of those subscales for convergent and divergent validity, internal consistency, and test-retest reliability. The Activities of Daily Living and Sports subscales of the FAAM-J had correlation coefficients of 0.86 and 0.75, respectively, with the Physical Functioning section of the SF-36 for convergent validity. For divergent validity, the correlation coefficients with Mental Health of the SF-36 were 0.29 and 0.27 for each subscale, respectively. Cronbach α for internal consistency was 0.99 for the Activities of Daily Living and 0.98 for the Sports subscale. A 95% confidence interval with a single measure was ±8.1 and ±14.0 points for each subscale. The test-retest reliability measures revealed intraclass correlation coefficient values of 0.87 for the Activities of Daily Living and 0.91 for the Sports subscales with minimal detectable changes of ±6.8 and ±13.7 for the respective subscales. The FAAM was successfully translated for a Japanese version, and the FAAM-J was adapted cross-culturally. Thus, the FAAM-J can be used as a self-reported outcome measure for Japanese-speaking individuals; however, the scores must be interpreted with caution, especially when applied to different populations and other types of injury than those included in this study.Context:
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Very few women have leadership positions in athletic training (ie, head athletic training positions) in intercollegiate athletics. Research exists on the barriers to attaining the role; however, our understanding about the experiences of those currently engaged in the role is limited. To examine the experiences of female head athletic trainers as they worked toward and attained the position of head athletic trainer. Qualitative study. National Collegiate Athletic Association Division I setting. Eight female athletic trainers serving in the role of head athletic trainer participated in our study. The mean age of the participants was 45 ± 12 years, with 5 ± 1.5 years of experience in the role of head athletic trainer and 21 ± 10 years of experience as athletic trainers. We conducted phone interviews with the 8 participants following a semistructured format. Interviews were transcribed verbatim and analyzed following a general inductive approach as described by Thomas. To establish credibility, we used a peer reviewer, member checks, and multiple-analyst triangulation. Six major themes emerged from our analysis regarding the experiences of female head athletic trainers. Opportunities to become a head athletic trainer, leadership qualities, and unique personal characteristics were discussed as factors leading to the assumption of the role of the head athletic trainer. Where women hold back, family challenges, and organizational barriers speak to the potential obstacles to assuming the role of head athletic trainer. Female head athletic trainers did not seek the role, but through persistence and encouragement, they find themselves assuming the role. Leadership skills were discussed as important for success in the role of head athletic trainer. Life balancing and parenting were identified as barriers to women seeking the role of head athletic trainer.Context:
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Supervisor support has been identified as key to the fulfillment of work-life balance for the athletic trainer (AT), yet limited literature exists on the perspectives of supervisors. To investigate how the head AT facilitates work-life balance among staff members within the National Collegiate Athletic Association Division I setting. Qualitative study. Web-based management system. A total of 18 head ATs (13 men, 5 women; age = 44 ± 8 years, athletic training experience = 22 ± 7 years) volunteered for an asynchronous, Web-based interview. Participants responded to a series of questions by journaling their thoughts and experiences. We included multiple-analyst triangulation, stakeholder checks, and peer review to establish data credibility. We analyzed the data via a general inductive approach. Four prevailing themes emerged from the data: modeling work-life balance, encouraging disengagement from the AT role, cooperation and community workplace, and administrative support and understanding. Head ATs at the Division I level recognized the need to promote work-life balance among their staffs. They not only were supportive of policies that promote work-life balance, including spending time away from the role of the AT and teamwork among staff members, but also modeled and practiced the strategies that they promoted.Context:
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Work-life balance has been examined at the collegiate level from multiple perspectives except for the athletic trainer (AT) serving in a managerial or leadership role. To investigate challenges and strategies used in achieving work-life balance from the perspective of the head AT at a National Collegiate Athletic Association Division I university. Qualitative study. Web-based management system. A total of 18 head ATs (13 men, 5 women; age = 44 ± 8 years, athletic training experience = 22 ± 7 years) volunteered. Participants journaled their thoughts and experiences in response to a series of questions. To establish data credibility, we included multiple-analyst triangulation, stakeholder checks, and peer review. We used a general inductive approach to analyze the data. Two higher-order themes emerged from our analysis of the data: organizational challenges and work-life balance strategies. The organizational challenges theme contained 2 lower-order themes: lack of autonomy and role demands. The work-life balance strategies theme contained 3 lower-order themes: prioritization of commitments, strategic boundary setting, and work-family integration. Head ATs are susceptible to experiencing work-life imbalance just as ATs in nonsupervisory roles are. Although not avoidable, the causes are manageable. Head ATs are encouraged to prioritize their personal time, make efforts to spend time away from their demanding positions, and reduce the number of additional responsibilities that can impede time available to spend away from work.Context:
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Athletic trainers have traditionally conceptualized rehabilitation programs in terms of 3 distinct physiologic phases; however, these phases appear to neglect athletes' psychosocial responses to their injuries. To document injured athletes' psychosocial responses during the different phases of injury rehabilitation. Qualitative study. National Collegiate Athletic Association Division II university in the mid-Atlantic region of the United States. A total of 8 previously injured athletes (4 men and 4 women) participated in the study. We collected participant data by using semistructured interviews, transcribed verbatim and analyzed by directed content analysis. Established themes were triangulated to determine trustworthiness. Initially, athletes' cognitive appraisals were predominately negative in nature, leading to negative emotions. These appraisals changed after diagnosis and when moving to the reaction-to-rehabilitation phase and the reaction-to-sport phase. During the reaction-to-rehabilitation phase, athletes reported mixed cognitive appraisals and identified frustration as the main emotional response. When returning to sport, athletes reflected on the lessons learned, yet they expressed some doubts related to their ability to return to play. These cognitive appraisals served as a precursor to the resulting emotional responses of nervousness and reinjury anxiety, as well as excitement. Throughout the various phases of rehabilitation, athletes reported seeking out social support: initially from significant others and then from their athletic trainers during the reaction-to-rehabilitation phase. The results appear to support the use of the integrated model of psychological response to sport injury and the rehabilitation process and the 3 phases of rehabilitation as a framework for understanding how physical and psychosocial factors may interact during sport-injury rehabilitation. Understanding this interaction may help athletic trainers provide better care to their injured athletes.Context:
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Shoulder instability is a common disorder of the shoulder that can result in debilitating pain and decreased function. Poorly treated cases of instability result in excessive mobility, possibly leading to labral tears and degenerative arthritis. The purpose of my systematic review was to compare the effectiveness of 2 popular arthroscopic techniques used to reduce shoulder instability: capsular plication and thermal capsulorrhaphy. Articles were retrieved from PubMed, Cochrane Library, and Ovid/MEDLINE searches using the terms capsular plication, capsular shift, capsular shrinkage, shoulder capsulorrhaphy, and treatment of shoulder instability. I sought cohort studies, case reviews, and randomized controlled trials published from 2000 through March 2013 that evaluated the outcomes of the 2 surgical procedures, which resulted in a total of 12 studies. Outcome measures were range of motion, satisfaction, and return to previous activity level. The overall success rates of the reviewed studies were 91% for arthroscopic capsular plication and 76.5% for thermal capsulorrhaphy. Arthroscopic capsular plication had a higher rate of success than thermal capsulorrhaphy. However, postoperative management varied more among the thermal capsulorrhaphy studies and was generally less conservative than management involving standardized capsular-plication protocols. Future authors should investigate operative techniques and postoperative management, which may help to improve thermal capsulorrhaphy outcomes.Objective:
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Frobell RB, Roos HP, Roos EM, Roemer FW, Ranstam J, Lohmander LS. Treatment for acute anterior cruciate ligament tear: five year outcome of randomised trial. BMJ. 2013;346:F232. Does early anterior cruciate ligament (ACL) reconstruction with rehabilitation lead to better patient-reported outcomes and a lower incidence of osteoarthritis at 5 years postinjury compared with delayed ACL reconstruction with rehabilitation? This randomized controlled trial with extended follow-up at 5 years postrandomization was conducted in 2 Swedish orthopaedic departments. The authors studied a total of 121 moderately active adults (age = 18–35 years) with an acute ACL rupture in a knee with no other history of trauma. Excluded were patients with a collateral ligament rupture, full-thickness cartilage defect, or extensive meniscal fixation. One patient assigned to the early ACL-reconstruction group did not attend the 5-year follow-up visit. Patients were randomly assigned to (1) an early ACL reconstruction plus structured rehabilitation group (n = 62, surgery within 10 weeks of injury) or (2) optional-delayed ACL reconstruction plus structured rehabilitation group (n = 59). The primary outcome measure was change in the average of 4 out of 5 subscales of the Knee Injury and Osteoarthritis Outcome Score (KOOS). The authors also assessed crude KOOS (combined 4 subscales), KOOS subscale scores, general physical and mental health (Short-Form 36), activity level (Tegner Activity Scale), mechanical knee stability (Lachman and pivot shift tests), meniscal surgery status, and presence of knee osteoarthritis on radiographs. Among patients randomized to the optional-delayed ACL-reconstruction group, 30 (51%) opted for an ACL reconstruction. The treatment groups had comparable 5-year patient-reported outcomes and changes in patient-reported outcomes (eg, knee pain, knee symptoms, activities of daily living, sport and recreational levels, knee-related quality of life, general physical health, and general mental health). Patients in the optional-delayed ACL-reconstruction group had greater mechanical knee instability than patients who received early ACL reconstruction; however, this was primarily among the patients opting for conservative management alone. In the overall sample, 61 knees (51%) required meniscal surgery over 5 years, regardless of treatment group. At 5 years, radiographs were available for 113 patients (93%). Overall, 29 patients (26%) had knee osteoarthritis at 5 years. Specifically, 13 patients (12%) developed tibiofemoral radiographic osteoarthritis (9 patients [16%] in the early ACL-reconstruction group, 4 [7%] in the optional-delayed ACL-reconstruction group) and 22 (19%) developed patellofemoral osteoarthritis (14 patients [24%] in the early ACL-reconstruction group, 8 [15%] in the optional-delayed ACL-reconstruction group). Patients with patellar tendon grafts (n = 40) had a greater incidence of ipsilateral patellofemoral osteoarthritis than patients with hamstrings tendon grafts (n = 51), but the 2 groups had similar incidences of ipsilateral tibiofemoral osteoarthritis. Six knees (5%) had both tibiofemoral and patellofemoral osteoarthritis. Early ACL reconstruction plus rehabilitation did not provide better results at 5 years compared with optional-delayed ACL reconstruction plus rehabilitation. Furthermore, the authors found no radiographic differences among patients with early ACL reconstruction, delayed ACL reconstruction, or no ACL reconstruction (rehabilitation alone).Reference/Citation:
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JAT eISSN: 1938-162X
JAT ISSN: 1062-6050
ATEJ ISSN: 1947-380X