The American journal of sports medicine
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Identifying predictors of contralateral anterior cruciate ligament (ACL) reconstruction is important to focus preventive strategies and related research on high-risk groups. ⋯ In both male and female participants, age <20 years predicted an almost 3 times higher 5-year risk of contralateral ACL reconstruction. Among female participants undergoing reconstruction with autograft hamstring, a contralateral harvest predicted a more than 3 times higher 5-year risk of contralateral ACL reconstruction. Patient sex, activity at the time of index injury, graft selection, meniscal injury, and chondral injury were not predictors of contralateral ACL reconstruction.
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Multicenter Study
Novel radiographic feature classification of knee osteochondritis dissecans: a multicenter reliability study.
Osteochondritis dissecans (OCD) is a vexing condition for patients, parents, and physicians because of the frequent slow healing and nonhealing that leads to prolonged treatment. Several features on plain radiographs have been identified as predictors of healing, but the reliability of their measurement has not been established. ⋯ Many diagnostic features of femoral condyle OCD lesions can be reliably classified on plain radiographs, supporting their future testing in multifactorial classification systems and multicenter research to develop prognostic algorithms. Other radiographic features should be excluded, however, because of poor reliability.
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Fear of reinjury and lack of confidence influence return-to-sport outcomes after anterior cruciate ligament (ACL) reconstruction. The physical, psychosocial, and functional recovery of patients reporting fear of reinjury or lack of confidence as their primary barrier to resuming sports participation is unknown. ⋯ Elevated pain-related fear of movement/reinjury, quadriceps weakness, and reduced IKDC score distinguish patients who are unable to return to preinjury sports participation because of fear of reinjury/lack of confidence. Despite low average pain ratings, fear of pain may influence function in this subgroup. Assessment of fear of reinjury, quadriceps strength, and self-reported function at 6 months may help identify patients at risk for not returning to sports at 1 year and should be considered for inclusion in return-to-sport guidelines.
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In pediatric patients, anterior cruciate ligament (ACL) reconstruction is controversial; however, delaying surgery until skeletal maturity is complete may increase the risk of secondary meniscal and articular cartilage injury. ⋯ Delayed ACL reconstruction increased the risks of secondary meniscal and chondral injuries in this population of pediatric patients.
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Femoral nerve block (FNB) has become a popular method of postoperative analgesia for anterior cruciate ligament (ACL) reconstruction in pediatric and adolescent patients. Successful rehabilitation after surgery involves return of quadriceps and hamstring strength. ⋯ Pediatric and adolescent patients treated with FNB for postoperative analgesia after ACL reconstruction had significant isokinetic deficits in knee extension and flexion strength at 6 months when compared with patients who did not receive a nerve block. Patients without a block were 4 times more likely to meet criteria for clearance to return to sports at 6 months.