Search

Context: Rehabilitation after anterior cruciate ligament reconstruction (ACLR) is challenging for adolescent patients concurrently experiencing growth and development, changes in attitudes and social interactions, and a gradual shift toward independence., Objective: To examine the perceptions of information sharing and interpersonal communication among adolescent patients going through ACLR, their parents, and physical therapists (PTs) treating adolescent patients with ACLR., Design: Cross-sectional study., Setting: University-affiliated sports medicine clinic., Patients or Other Participants: Nine adolescent patients who had recently completed physical rehabilitation after ACLR, one of their parents, and PTs who treated adolescent patients with ACLR were recruited and enrolled., Main Outcome Measure(s): Participants completed semistructured interviews. The interview scripts for patients, parents, and PTs intentionally addressed the same topics, with only minor modifications in wording as appropriate for each role. All interviews were recorded, transcribed verbatim, and analyzed using a hybrid of deductive and inductive coding by trained members of the study team., Results: Patients, parents, and PTs perceived that interpersonal dynamics (eg, communication, external motivation) and stakeholder knowledge (eg, understanding of the psychological consequences of injury) influenced intrapersonal experiences (eg, emotional response, intrinsic motivation) during rehabilitation after ACLR. Additionally, patients and parents indicated that a lack of information about the rehabilitation process hindered their ability to obtain additional information from the PT and surgeon., Conclusions: Participants from all stakeholder groups reported that orthopaedic surgeons and other members of the health care team may consider being more consistent when setting expectations, physical restrictions, and recovery timelines., (© by the National Athletic Trainers' Association, Inc.)

Context: Previously, the most common treatment for a concussion was prolonged physical and cognitive rest. Recently, researchers have suggested that earlier physical activity (PA) may be better at promoting recovery. Researchers have not evaluated the relationship between free-living PA (eg, walking) and symptom reporting or recovery duration., Objective: To assess the relationship between free-living PA participation and 2 recovery outcomes in college-aged adults with a concussion., Design: Prospective cohort., Setting: National Collegiate Athletic Association Division I and III universities., Patients or Other Participants: Thirty-two college-aged adults (68.8% female, age = 19.8 ± 1.4 years) with a concussion., Main Outcome Measure(s): Participants completed a postconcussion symptom evaluation at visits 1 (<72 hours from concussion) and 2 (8 days later). Between visits, each participant's PA was monitored using an Actigraph GT9X Link PA monitor and expressed as total PA (counts per minute) and percentage of PA time spent in moderate-to-vigorous intensity (%MVPA). Recovery time was the number of days from injury occurrence to medical clearance. With separate hierarchical multiple regressions, we evaluated the relationship between total PA and each recovery variable (visit 2 symptom severity, recovery time). Additionally, with separate exploratory hierarchical multiple regressions, we evaluated the relationship between %MVPA and each recovery variable. Statistical significance was set a priori at P ≤ .05., Results: Participants averaged 2446 ± 441 counts per minute and spent 12.1% ± 4.2% of their PA performing MVPA. Participants yielded median (interquartile) symptom severities of 28 (24) and 2 (8) for visit 1 and 2, respectively. Average recovery time was 14.7 ± 7.5 days. Total PA did not significantly contribute to the model for visit 2 symptom severity (P = .122) or recovery time (P = .301). Similarly, %MVPA had little contribution to the model for visit 2 symptom severity (P = .358) or recovery time (P = .276)., Conclusions: We suggest that free-living PA may not be enough to reduce symptoms or shorten recovery. Thus, clinicians may need to provide patients with more structured PA protocols mimicking findings from previous researchers., (© by the National Athletic Trainers' Association, Inc.)

Context: The sex-based differences in the structure and rules of boys' and girls' lacrosse result in very different styles of play, which may have significant implications for the rates and patterns of injuries., Objective: To compare the epidemiology of injuries sustained by boys' and girls' lacrosse players., Design: Descriptive epidemiology study., Setting: Web-based online surveillance system., Patients or Other Participants: The High School Reporting Information Online database was used to analyze injuries reported by certified athletic trainers from 2008-2009 through 2015-2016., Main Outcome Measure(s): Practice and competition injury rates, body site, diagnosis, and mechanism., Results: Boys had a higher injury rate than girls (20.9 versus 15.7 per 10 000 athlete-exposures, respectively; rate ratio = 1.3, 95% confidence interval = 1.2, 1.4). The most commonly injured body sites for boys and girls, respectively, were the lower extremities (38.0%, 56.4%) and the head/neck (28.3%, 29.8%). More specifically, the most frequently diagnosed injuries for both boys and girls, respectively, in competitions were concussions (23.1%, 25.6%), ankle ligament sprains (7.8%, 15.3%), upper leg strains (4.8%, 6.7%), and knee ligament sprains (4.2%, 6.7%). The most cited mechanism of injury overall was contact with another player (22.0%); among boys, it was contact with a stick (14.8%) and among girls, the most frequent mechanisms were overuse (25.0%) and contact with a stick (14.7%)., Conclusions: Injury rates and mechanisms of injuries differed between high school boys' and girls' lacrosse players. Boys had a higher rate of injury, with the most common mechanism of injury being contact with another player compared with overuse in girls. However, similarities were seen between sexes for the most frequently injured body sites and injury diagnoses. Future authors should continue to compare differences in injury rates, equipment upgrades, and rule changes in boys' and girls' lacrosse.

Context: Return to activity in the presence of quadriceps dysfunction may predispose individuals with anterior cruciate ligament reconstruction (ACLR) to long-term joint degeneration. Asymmetry may manifest during movement and result in altered knee-joint-loading patterns; however, the underlying neurophysiologic mechanisms remain unclear., Objective: To compare limb symmetry of quadriceps neuromuscular function between participants with ACLR and participants serving as healthy controls., Design: Descriptive laboratory study., Setting: Research laboratory., Patients or Other Participants: A total of 22 individuals with ACLR (12 men, 10 women) and 24 individuals serving as healthy controls (12 men, 12 women)., Main Outcome Measure(s): Normalized knee-extension maximal voluntary isometric contraction (MVIC) torque (Nm/kg), quadriceps central activation ratio (CAR) (%), quadriceps motor-neuron-pool excitability (Hoffmann reflex to motor wave ratio), and quadriceps active motor threshold (AMT) (% 2.0 T) were measured bilaterally and used to calculate limb symmetry indices for comparison between groups. We used analyses of variance to compare quadriceps Hoffmann reflex to motor wave ratio, normalized knee-extension MVIC torque, quadriceps CAR, and quadriceps AMT between groups and limbs., Results: The ACLR group exhibited greater asymmetry in knee-extension MVIC torque (ACLR group = 0.85 ± 0.21, healthy group = 0.97 ± 0.14; t44 = 2.26, P = .03), quadriceps CAR (ACLR group = 0.94 ± 0.11, healthy group = 1.00 ± 0.08; t44 = 2.22, P = .04), and quadriceps AMT (ACLR group = 1.13 ± 0.18, healthy group = 1.02 ± 0.11; t34 = -2.46, P = .04) than the healthy control group., Conclusions: Asymmetries in measures of quadriceps function and cortical excitability were present in patients with ACLR. Asymmetry in quadriceps strength, activation, and cortical excitability persisted in individuals with ACLR beyond return to recreational activity. Measuring the magnitude of asymmetry after ACLR represents an important step in understanding long-term reductions in self-reported function and increased rate of subsequent joint injury in otherwise healthy, active individuals after ACLR.