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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 with mid- to postpubertal athletes were described for resistance training and RTS criteria. Conclusion: Together with available evidence, this international Delphi statement provides a framework based on expert consensus and describes a practice guideline for adolescent ACL rehabilitation, which can be used in day-to-day practice. This is an important step toward reducing practice inconsistencies, improving the quality of rehabilitation after adolescent ACL injuries, and closing the evidence-practice gap while waiting for further studies to provide clarity. [ABSTRACT FROM AUTHOR]

Background: Patient reported outcome measures (PROM) allow for a comprehensive assessment of physical and emotional factors not accounted for by functional performance testing after anterior cruciate ligament reconstruction (ACLR). The ACL-RSI gauges an athlete's psychological readiness to return to sport and recent evidence suggest this measure may help identify individuals at risk of secondary injury. Our current knowledge of how physical function and psychological preparedness change during recovery after ACLR in youth athletes it limited. Understanding the change and interplay between these factors will help optimize rehabilitation and improve patient care. Purpose: The purpose of this study was to evaluate changes in psychological readiness (ACL-RSI), knee related function (Pedi-IKDC) and generalized activity (Pedi-FABS) throughout the course of rehabilitation in a group of pre-adolescents after ACLR. Methods: A prospective observational cohort study of pre-adolescent athletes who underwent ACLR within a single institution. All subjects had surgery between 12/2017-12/2020 and followed institutional specific protocol emphasizing clinical rehabilitation for a duration of 7-9 months. Subjects completed a series of PROM (ACL-RSI, Pedi-IKDC and Pedi-FABS) quarterly for the initial 12 months following ACLR. Friedman's test for repeated measures and Wilcoxon Matched Pairs Signed Ranks Test with a Bonferonni correction (p <= 0.017) was used to determine if differences existed amongst each measure over time. Results: A total of 28 subjects were included in this analysis (21 male; mean age 12.43 ± 1.40 yrs). Pedi-FABS and Pedi-IKDC both demonstrated significant changes from 3 months (Pedi-FABS 2.63 ± 3.95, Pedi-IKDC 70.84 ± 11.36) to 6 months (Pedi-FABS 9.9 ± 8.55, Pedi-IKDC 87.05 ± 8.03) and from 6 to 9 months (Pedi-FABS 16.57 ± 6.88, Pedi-IKDC 94.40 ± 5.24) (p <= 0.017)(Figure 1 & 2). ACL-RSI approached significance for 3 months (57.81 ± 24.73) to 6 months (70.36 ± 19.77) (p = 0.019) and was definitively significant for changes between 6 to 9 months (85.83 ± 11.02) (p = 0.003) (Figure 3). No significant change was observed between 9-12 months post-operatively for any of these measures. Conclusion: In preadolescent athletes, steady improvements in generalized activity and knee function occur during the first 9 months following ACLR. Psychological readiness to return to sport trended upwards, but didn't reach statistical significance until later in recovery. Beyond 9 months, physical function and psychological preparedness remain largely unchanged. These data support a prolonged recovery period is required to maximize self-reported function and psychological readiness after ACLR in preadolescent athletes. Figure 1. Median and Percentile distribution of Pedi-FABS scores over the initial 12 months following ACLR. Significant change in score was found to be from both 3 to 6 months and 6 to 9 months (p = 0.007 and 0.004, respectively) Figure 2. Median and Percentile distribution of Pedi-IKDC scores over the initial 12 months following ACLR. Significant change in score was found to be from both 3 to 6 months and 6 to 9 months (p = 0.000 and 0.001, respectively) Figure 3. Median and Percentile distribution of ACL-RSI scores over the initial 12 months following ACLR. Nearly significant change in score was noted from 3 to 6 months (p = 0.019). Significant change in score was found to be from 6 to 9 months (p = 0.003) [ABSTRACT FROM AUTHOR]

Background: Previous research has demonstrated individuals with public insurance may encounter delays accessing care and experience different orthopedic management for musculoskeletal injuries. Rehabilitation after anterior cruciate ligament reconstruction (ACLR) is critical to optimize outcomes. The effect of insurance status on rehabilitation practice and patient outcomes among youth athletes has not been explored. Purpose: To examine the effect of insurance type (public vs private) on physical therapy (PT) visit utilization and outcomes within pediatric and adolescent patients after ACLR. Methods: This was a sub-analysis of a larger retrospective dataset of patients who underwent primary ACLR between 2013 and 2019 at 5 institutions. All patients followed a structured rehabilitation protocol as directed by the treating institution and completed a battery of return to sport (RTS) tests which included single-legged hop testing. PT visit frequency was assessed both overall and by time period (first 6 weeks, week 7-month 3, 3-6 months, and 6+ months). PT visits were recorded up until the time of last recorded hop test within 12 months post-surgery. The average number of visits attended per week during the observed time was calculated for each patient. The effect of insurance status on PT management was analyzed using T-tests. The effect of insurance status on the odds of passing hop tests was assessed using multivariable logistic regression with a random effect of site. Adjusted models controlled for time to test in months. An alpha level of p<0.05 was used to determine significance. Results: 281 (15.7 ± 1.9 years, 58% male) patients were included in this analysis. The groups were demographically similar, with 45.5% classified as having public insurance. (Table 2) Patients with public insurance experienced a longer delay from surgery to the time of hop test (8.3±2.2 vs 7.7±1.5 months, p=0.009) and had a lower number of PT visits per week (0.92±0.37 vs 1.04±0.38, p=0.005). Publicly insured subjects attended fewer PT visits from week 7-3 months (1.06±0.50 vs 1.26±0.52, p=0.001) and 3-6 months (0.88±0.45 vs 0.99±0.45, p=0.04). Insurance status had a statistically significant effect (p=0.01) on the odds of passing the single leg hop test (OR, 2.72; 95% CI, 1.27-5.81) and was nearly significant (p=0.06) for all hop tests (OR, 1.74; 95% CI, 0.98-3.07). Conclusion: Publicly insured youth athletes average a lower number of weekly PT visits, experienced a longer delay from surgery to hop test and were 2.7 times less likely to pass the single leg hop test. Table 1. Table 2. Demographics [ABSTRACT FROM AUTHOR]

The article discusses a cross-sectional cohort study that examines the effects of humeral retrotorsion (HRT) on pitching velocity in a group of youth baseball players. Highlights include a positive association between pitching velocity and increased HRT, factors that contribute to pitching velocity, and the use of a Stalker Sport II radar gun to assess maximum pitching velocity.

Background: The relationship between physical therapy (PT) visit utilization and performance during single-legged hop testing after anterior cruciate ligament reconstruction (ACLR) in young patients is unclear. Purpose: To examine the effect of PT utilization on hop testing performance in pediatric and adolescent patients after ACLR. Methods: A retrospective review of patients who underwent primary ACLR between 2013 and 2019 at 5 institutions was conducted. All patients followed a structured rehabilitation protocol as directed by the treating institution and completed a return to sport (RTS) test which included single-legged hop testing. PT frequency was assessed both overall and by time period (first 6 weeks, week 7-month 3, 3-6 months, and 6-12 months). PT visits were recorded up until the time of hop testing. To account for variability, the average number of visits attended per week during the observed time was calculated for each patient. The effect of PT visit rate on the odds of passing a hop test was assessed using multivariable logistic regression controlling for time to test, age, sex, and insurance status. Passing was defined as achieving a limb symmetry index (LSI) ≥ 90% on all available tests (single hop, triple hop, crossover hop, and timed hop, if performed), as well as passing just the single hop test. The primary predictor of interest included the average rate of PT visits at the time of hop test (≥1 visit per week vs. <1 visit per week). Results: 289 patients were identified (mean age, 15.7 ± 1.9 years). The mean time from surgery to the first PT visit was 0.36 ± 0.24 months. RTS testing was performed at a mean of 8.0 ± 1.9 months. Patients averaged 0.98 ± 0.38 visits per week until the RTS test. Mean LSIs for the single hop, triple hop, crossover hop, and timed hop were 96.3 ± 8.2, 97.1 ± 6.5, 98.5 ± 7.8, and 98.2 ± 7.4, respectively. 68.9% of patients passed all performed test; 85.5% passed the single hop test. The weekly rate of PT visits had no statistically significant effect on the odds of passing all performed hop tests (OR, 0.98; 95% CI, 0.56-1.71) or the single hop test (OR, 1.05; 95% CI, 0.51-2.18). Furthermore, the distribution of PT visits did not affect hop testing performance (Table 1). Conclusion: The rate and distribution of PT visit utilization was not associated with hop testing performance in pediatric and adolescent patients after ACLR. Table 1. Adjusted Odds Ratios (95% CI) for Passing Hop Test (All Performed and Single Hop Only), by PT Weekly Visit Rate During 1st 6 weeks, 7 weeks to 3 months, After 3 Months [ABSTRACT FROM AUTHOR]

Background: The restoration of quadriceps strength after anterior cruciate ligament reconstruction (ACLR) is critical to restore optimal patient function and reduce the incidence of secondary ACL injury. Strength is typically quantified during return to sport assessments, by comparing the strength in the involved limb to that of the uninvolved limb. A limb symmetry index (LSI) is calculated and used to determine if any residual strength deficits persist. Recent evidence demonstrates that the uninvolved limb may lose strength during ACLR recovery and suggests that pre-operative uninvolved limb strength values may offer a better representation and more stringent indicator of strength recovery after ACLR. However, this body of literature is limited and no studies have specifically evaluated this occurrence within youth athletes. Purpose: To evaluate the change in strength in the uninvolved limb from pre-operative to 6 months post-ACLR, and assess the effect of pre-operative strength comparison on 6-month post-op LSI. Methods: A retrospective cohort analysis of pediatric patients (≤18 years) undergoing primary ACLR from 1/2018-1/2020 without concomitant multi-ligamentous reconstruction was conducted. Isokinetic peak torque values for the uninvolved and involved quadriceps were extracted at pre-operative (uninvolved only) and 6 months post-operative. Strength changes were analyzed using paired-samples t-test. Results: Complete data was available for a total of 17 subjects (mean age 15.1±1.7, 53% female). Pre-operative strength assessment was performed a mean of 11.5 days (range 1-26) prior to surgery. The mean 6-month post-operative assessment occurred at 177 days (range 127-246). The uninvolved limb was significantly stronger (p<0.001) at 6 months compared to preoperatively, with a mean improvement of 12.1ft/lbs (95%CI 18.3 – 7.2) with a change from 82.4ft/lbs to 95.1 ft/lbs. The LSI was calculated using both pre-operative and 6-month post-operative uninvolved limb values and demonstrated substantially lower LSI values when using concurrent 6-month data (LSIpre 91.3% vs LSI6M 76.9%). Conclusions: Among this sample, the uninvolved limb got stronger during post-ACLR recovery and comparison to concurrently assessed strength values led to a more stringent determination of LSI. Differences in rehabilitation programming, adolescent physiology, and pre-injury training patterns may explain why these results differ than those found in older cohorts. [ABSTRACT FROM AUTHOR]