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8. Variable Guidelines for Pediatric Medial Patellofemoral Ligament Reconstruction Rehabilitation Exists Across PRiSM Member Organizations.

Author

Greenberg, Elliot, Hannon, Joseph, Chaclas, Nathan, Albaugh, Jeffrey, Molony, Joseph, and Williams, Brendan A.

Abstract

Medial patellofemoral ligament (MPFL) reconstruction, typically used to restore stability to the patellofemoral joint after dislocation, often requires extensive rehabilitation to address acute impairment related to surgical intervention and also underlying non-anatomical deficits that may have contributed to the index injury. Rehabilitation guidelines, including objective functional performance assessment criteria, are lacking in the literature. We sought to summarize the clinical guidelines for rehabilitation and return to activity assessment after MPFL reconstruction as advocated by the member organizations of the Pediatric Research in Sports Medicine (PRiSM) Patellofemoral Research Interest Group (PF-RIG). We obtained and reviewed MPFL rehabilitation guidelines from 11 member organizations of the PRiSM PF-RIG, extracting information on weight-bearing advancement, bracing, use of supplemental strengthening modalities, and any objective criteria for advancing rehabilitation phases. We found highly variable agreement among guideline parameters at each treatment stage, with time-based criteria most widely used for early progression. Although functional metrics like strength or movement tests were more widely used in later phases of rehabilitation, there was substantial variation in testing mode and level of acceptable performance. Our review found that significant variability exists in current practice among PRiSM and PF-RIG member institutions regarding rehabilitation standards after MPFL reconstruction. Although we found broad consensus that objective strength or performance criteria should be employed to establish a better framework for clinical decision-making, most current guidelines lack standardization and sufficient detail to guide ideal clinical practice. [ABSTRACT FROM AUTHOR]

Published
2024
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10. List of Contributors

Author

Abzug, Joshua M., primary, Allgier, Allison, additional, Ashworth, Sarah, additional, Berggren, Jamie, additional, Burn, Matthew B., additional, Case, Alexandria L., additional, Chan, Jennifer M., additional, Cornwall, Roger, additional, Dorich, Jenny M., additional, Douglas, Reeti R., additional, Ferry, Kelly Anne, additional, Ganley, Theodore J., additional, Gardner, Richard, additional, Goel, Ritu, additional, Goldsmith, Donald, additional, Grampurohit, Namrata, additional, Greenberg, Elliot, additional, Ho, Christine A., additional, Hogarth, Danielle A., additional, Humpl, Deborah, additional, Kim, Gina, additional, Kozin, Scott H., additional, Krochak, Ryan, additional, Ladd, Amy L., additional, Lake, Amy, additional, Levis, Carolyn M., additional, Little, Kevin J., additional, Meisel, Erin, additional, Hsia, Michelle, additional, Mulcahey, M.J., additional, Neiduski, Rebecca, additional, Oishi, Scott, additional, Parikh, Heta, additional, Pehnke, Meagan, additional, Pulos, Nicholas, additional, Rawlins, Lydia D., additional, Ciocco, Roberta, additional, Safford, Daniel W., additional, Schmieg, Sandra, additional, Shah, Apurva S., additional, Soldado, Francisco, additional, Stevanovic, Milan, additional, Konieczny, Tami, additional, Tate, Kathleen, additional, Waltho, Daniel, additional, Weesner, Heather, additional, Wolff, Aviva, additional, Zalieckas, Cheryl, additional, and Zlotolow, Dan A., additional

Published
2020
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12. Anterior Cruciate Ligament Rehabilitation for the 10- to 18-Year-Old Adolescent Athlete: Practice Guidelines Based on International Delphi Consensus

Author

van Melick, Nicky, Dietvorst, Martijn, van Oort, Maaike I.A.M., Claessens, Remco L.A., Janssen, Rob P.A., Bogie, Rob, Adolescent ACL Rehabilitation Group, Claussen, William, Greenberg, Elliot M., Grindem, Hege, Kearney, Sharon, van Keulen, Matthijs, Lips, Martijn, Macrina, Lenny, McWilliam, David, Moksnes, Håvard, Norris, Richard, Paterno, Mark V., Picot, Brice, Piskulic, David, Prato, Luis F., Sayer, Timothy A., Sethi, Faraz, Silvers-Granelli, Holly, Truong, Linda, Whalan, Matthew, Witvrouw, Erik, van Melick, Nicky, Dietvorst, Martijn, van Oort, Maaike I.A.M., Claessens, Remco L.A., Janssen, Rob P.A., Bogie, Rob, Adolescent ACL Rehabilitation Group, Claussen, William, Greenberg, Elliot M., Grindem, Hege, Kearney, Sharon, van Keulen, Matthijs, Lips, Martijn, Macrina, Lenny, McWilliam, David, Moksnes, Håvard, Norris, Richard, Paterno, Mark V., Picot, Brice, Piskulic, David, Prato, Luis F., Sayer, Timothy A., Sethi, Faraz, Silvers-Granelli, Holly, Truong, Linda, Whalan, Matthew, and Witvrouw, Erik

Abstract

Background: There are 2 treatment options for adolescent athletes with anterior cruciate ligament (ACL) injuries—rehabilitation alone (nonsurgical treatment) or ACL reconstruction plus rehabilitation. However, there is no clear consensus on how to include strength and neuromuscular training during each phase of rehabilitation. Purpose: To develop a practical consensus for adolescent ACL rehabilitation to help provide care to this age group using an international Delphi panel. Study Design: Consensus statement. Methods: A 3-round online international Delphi consensus study was conducted. A mix of open and closed literature-based statements were formulated and sent out to an international panel of 20 ACL rehabilitation experts. Statements were divided into 3 domains as follows: (1) nonsurgical rehabilitation; (2) prehabilitation; and (3) postoperative rehabilitation. Consensus was defined as 70% agreement between panel members. Results: Panel members agreed that rehabilitation should consist of 3 criterion-based phases, with continued injury prevention serving as a fourth phase. They also reached a consensus on rehabilitation being different for 10- to 16-year-olds compared with 17- and 18-year-olds, with a need to distinguish between prepubertal (Tanner stage 1) and mid- to postpubertal (Tanner stages 2-5) athletes. The panel members reached a consensus on the following topics: educational topics during rehabilitation; psychological interventions during rehabilitation; additional consultation of the orthopaedic surgeon; duration of postoperative rehabilitation; exercises during phase 1 of nonsurgical and postoperative rehabilitation; criteria for progression from phase 1 to phase 2; resistance training during phase 2; jumping exercises during phase 2; criteria for progression from phase 2 to phase 3; and criteria for return to sports (RTS). The most notable differences in recommendations for prepubertal compared

Published
2023

43. Pro bono services: overcoming ethical and legal dilemmas

Author

Greenberg, Elliot

Subjects
Social aspects, Ethical aspects, Services, Health aspects, Laws, regulations and rules, Government regulation, Volunteerism -- Health aspects, Medical care -- Social aspects -- Laws, regulations and rules -- United States, Physical therapists -- Services -- Ethical aspects, Emergency Medical Treatment and Active Labor Act of 1985
Abstract

In the past decade, the number of uninsured Americans has been steadily increasing. In 2010, this number rose to record high of 49.9 million--or 16.3% of the population, up from [...]

Published
2012

49. REHABILITATION CONSIDERATIONS FOR ALL EPIPHYSEAL ACL RECONSTRUCTION

Author

Greenberg, Elliot M., Albaugh, Jeffrey, Ganley, Theodore J., and Lawrence, J. Todd R.

Subjects
Case Report
Abstract

The management of the pediatric patient with an Anterior Cruciate Ligament (ACL) rupture is evolving towards earlier reconstruction. The rehabilitation progression and outcomes for skeletally immature individuals undergoing ACL reconstruction (ACL-R) are not well described in the literature. Differences in surgical procedure, age related physiology, and emotional maturity may have a significant impact on recovery and return to sports. The purpose of this case report is to present the rehabilitation and outcome of a skeletally immature patient that underwent an all-epiphyseal ACL-R, highlight important considerations in the rehabilitation process and present topics for future research.Single subject case report of an 8 year-old boy who underwent all epiphyseal ACL-R after complete ACL rupture.The patient was able to achieve at least 90% strength symmetry and pass all necessary functional criteria to return to sports by 9 months post surgery. Two year follow up data indicated that the patient was able to make a full return to previous level of athletic activity, as well as maintain lower extremity strength and power over time.Objective outcome measures, rehabilitation protocols and time frame for return to sports for skeletally immature patients following physeal sparing or all epiphyseal ACL-R are not well described in the literature. This case report outlines objective measures of strength and functional recovery in a patient from this unique population. As ACL-R in the skeletally immature patient is studied more, new information on rehabilitation progression and outcomes may alter the rehabilitation program and timeline for return to unrestricted activity.4, Case Report.

Published
2012

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