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Background Acetabular dysplasia (AD) causes pain, limited function, and development of early hip osteoarthritis. Periacetabular osteotomy (PAO) is a surgical treatment for AD that aims to reposition the acetabulum to reduce pain and improve function. Purpose To examine pain recovery and physical activity (PA) before and during the six months after PAO. Study Design Case series, prospective Methods Individuals with AD scheduled for PAO were enrolled. Pain intensity was evaluated before PAO and at one week and one, three, and six months following PAO. PA levels was evaluated before and six months following PAO using accelerometers (time spent in sedentary behavior, light PA, moderate-to-vigorous PA [MVPA], and daily steps) and the International Physical Activity Questionnaire (IPAQ; time spent in walking and in MVPA). Pain improvements was examined over time following PAO using a repeated-measures one-way ANOVA as well as improvements in PA levels before and six months after PAO using paired-sample t tests. In addition, time spent in MVPA was qualitatively summarized at each time point (before and six months after PAO) measured by both the accelerometers and IPAQ. Results Out of 49 screened participants, 28 were enrolled, and 23 individuals (22 females; age=23.1±7.9 years) completed both study visits. Compared to pre-PAO pain, participants reported significant improvements in pain at one month and onward following PAO (p<0.011). However, PA levels at six months following PAO did not differ from pre-PAO PA levels (p>0.05). Qualitatively, participants reported spending more time in MVPA recorded by the IPAQ (pre-PAO=73.3±150.2 mins/day; six-months after PAO=121.2±192.2 mins/day), compared with MVPA recorded by accelerometers (pre-PAO=22.6±25.2 mins/ day; six-months after PAO=25.0±21.4 mins/day). Conclusions Individuals with AD reported significant pain reduction at one month and up to six months after PAO, but PA levels did not change six months after PAO compared to baseline testing. Future studies should consider examining longitudinal pain recovery and PA improvements over longer periods of time with larger samples of individuals with AD undergoing PAO and identifying modifiable factors to minimize pain and increase PA participation. Level of Evidence III [ABSTRACT FROM AUTHOR]

Femoroacetabular impingement syndrome (FAIS) causes pain and functional limitations. Little is known regarding walking characteristics, volume, and intensity evaluated in laboratory and free-living conditions and whether these measures differ between those with FAIS and uninjured individuals. To examine the differences in laboratory gait measures and free-living step-based metrics between individuals with FAIS and uninjured control participants. Comparative, cross-sectional study. We enrolled 25 participants with FAIS and 14 uninjured controls. We evaluated laboratory spatiotemporal gait measures (cadence, velocity, step length, stride length) during self-selected and fast walking speeds using an instrumented walkway. Participants then wore an accelerometer around the waist during waking hours for 7 consecutive days. Free-living step-based metrics included average daily steps, peak 1- and 30-minute cadence, and average daily time spent in walking cadence bands. We compared laboratory gait measures and step-based metrics between groups. The groups did not differ in laboratory spatiotemporal gait measures during both speeds (all P >.05). The FAIS group took fewer daily steps (5346 ± 2141 versus 7338 ± 2787 steps/d; P =.030) and had lower peak 1-minute (92.9 ± 23.9 versus 119.6 ± 16.3 steps/min; P <.001) and 30-minute cadences (60.9 ± 27.1 versus 86.8 ± 22.4 steps/min; P =.003) compared with uninjured controls, respectively. The FAIS group also spent less time in slow (6.0 ± 3.6 versus 10.3 ± 3.4 min/d; P =.001), medium (4.5 ± 4.2 versus 8.9 ± 4.4 min/d; P =.005), and brisk/moderate (4.5 ± 6.2 versus 12.2 ± 10.3; P =.020) cadence bands compared with uninjured controls. Clinical/laboratory gait measures alone may not be representative of real-world walking-related physical activity behavior in individuals with FAIS. [ABSTRACT FROM AUTHOR]

Introduction: It has been shown that 45%–85% of patients with anterior cruciate ligament reconstruction (ACLR) will have early-onset arthritis within 10–12 years following surgery. Over the past two decades, the amount of literature regarding ACLR, gait maladaptations after ACLR and their potential link to early-onset arthritis, and rehabilitation techniques has grown exponentially; however, long-term patient outcomes remain modest. Methods: To evaluate current clinicians' attitudes, perspectives, and clinical practice approach for rehabilitation of patients following ACLR, a survey questionnaire was designed using the Delphi technique. Results: Of the 263 respondents, 84.4% (n = 226) reported that they believed gait training to be "Very" or "Extremely Important." However, only 35.7% (n = 94) reported objectively measuring gait during ACLR rehabilitation. Of the total respondents, only 6.8% (n = 18) assessed gait during rehabilitation using two-dimensional or three-dimensional motion capture technologies. Discussion: Our results suggest that while gait evaluation was perceived as important, most respondents did not objectively measure gait metrics as a clinical outcome during ACLR rehabilitation. These findings provide a prospective rehabilitation target to potentially mitigate a known risk factor of early-onset arthritis (gait maladaptations) in individuals following ACLR. [ABSTRACT FROM AUTHOR]

Introduction: Individuals with acetabular dysplasia often report hip joint instability, pain, and poor hip‐related function. Periacetabular osteotomy (PAO) is a surgical procedure that aims to reposition the acetabulum to improve joint congruency and improve pain and function. We aimed to examine the influence of presurgery clinical measures on functional recovery following PAO and the associations among clinical outcomes after PAO. Methods: We screened 49 potential participants, 28 were enrolled, and 23 completed both study visits (pre‐PAO and 6 months post‐PAO). We evaluated dynamometer‐measured hip and thigh strength, loading patterns during a squat and countermovement jump (CMJ), pain intensity, and device‐measured physical activity (PA) levels (light, moderate‐to‐vigorous PA [MVPA], and daily steps). We used linear regression models to examine the influence of muscle strength (peak torque; limb symmetry index [LSI]) and loading patterns before PAO on pain intensity and PA levels in individuals 6 months following PAO. Additionally, we used Pearson correlation coefficient to examine cross‐sectional associations among all variables 6 months following PAO. Results: Lower extremity muscle strength and loading patterns during the squat and CMJ before PAO did not predict pain intensity or device‐measured PA levels in individuals 6 months following PAO (p > 0.05). Six months following PAO, higher knee extensor LSI was associated with higher time spent in MVPA (r = 0.56; p = 0.016), higher hip abductor LSI was associated with both lower pain (r = 0.50; p = 0.036) and higher involved limb loading during the squat task (r = 0.59; p = 0.010). Lastly, higher hip flexor LSI was associated with higher CMJ takeoff involved limb loading (r = 0.52; p = 0.021) and higher involved hip extensor strength was associated with higher CMJ landing involved limb loading (r = 0.56; p = 0.012). Conclusion: Six months after PAO, higher hip and thigh muscle strength and strength symmetry were associated with lower pain, higher PA levels, and greater normalized limb loading during dynamic movement tasks. [ABSTRACT FROM AUTHOR]

Background: Long-term outcomes for isolated anterior cruciate ligament (ACL) reconstructions in competitive American football athletes are well reported in the literature, but little data currently exist regarding multiligament knee injury (MLKI) reconstruction outcomes. Purpose: To examine patient-reported and return-to-sport outcomes of competitive American football athletes who underwent primary, single-staged, multiligament knee reconstruction. Study Design: Case series; Level of evidence, 4 Methods: We identified patients from our institution's prospectively collected data repository between 2001 and 2020 who underwent single-staged surgical reconstruction of an MLKI sustained during competitive participation in American football. We assessed patient-reported outcomes at a minimum of 2 years after surgery using the International Knee Documentation Committee (IKDC) Subjective Knee Form and questions regarding surgical satisfaction and return to sport. Successful return to sport was defined as a return to preinjury level of competition. We summarized all outcome data and compared outcomes between 2-ligament and >2-ligament groups and between ACL-only MLKI injury and bicruciate MLKI injury groups using independent t test for IKDC scores and chi-square test for return to sport. Additionally, we evaluated predictors of postoperative IKDC scores using linear regression and predictors of return to sport using logistic regression. Results: Outcome data were successfully collected for 53 of 73 total eligible patients (73%; mean follow-up time, 7.7 ± 4.0 years; all male; mean age at surgery, 18.1 ± 2.7 years). The mean postoperative IKDC score was 84 ± 16. The most common level of preinjury competition was high school (n = 36; 68%), followed by college (n = 10; 19%). Seven patients did not return to sport competition at any level due to limitations from their knee surgery, and 82% of patients that attempted to return to preinjury level of sport were able to do so. A total of 50 patients (94%) were satisfied or very satisfied with their surgical outcome. The 2-ligament (n = 39) and >2-ligament (n = 14) groups did not significantly differ in IKDC scores (P =.96) or proportions with successful return to sport (P =.77). Similarly, the ACL-MLKI injury (n = 39) and bicruciate MLKI injury (n = 14) groups did not significantly differ in IKDC scores (P =.89) or proportions with successful return to sport (P =.77). Age and body mass index were not significantly associated with IKDC scores or successful return to sport at follow-up (all P >.05). Conclusion: This study may represent the largest cohort of competitive American football athletes evaluated for longitudinal outcomes after multiligament knee reconstruction. Despite the severity of these injuries, we found good knee-related function and that the large majority of athletes who attempted to return to sport were successful. The majority of athletes (94%) were satisfied with their operative treatment. [ABSTRACT FROM AUTHOR]

Background: In the event that nonoperative treatment for sports hernia fails, surgical repair may be warranted. Bilateral repair can occur in up to 45% of surgically treated patients. Purpose: To investigate the clinical outcomes of athletes who underwent unilateral sports hernia repair and determine the proportion of patients who required contralateral sports hernia repair. Study Design: Case series; Level of evidence, 4. Methods: We identified patients at our institution who underwent primary unilateral sports hernia repair (rectus abdominis–adductor longus aponeurotic plate repair and adductor lengthening) with a single surgeon between 2015 and 2020. We assessed patient-reported outcomes using the Hip Outcome Score–Sport (HOS–Sport), the Numeric Pain Rating Scale, and an internally developed return-to-play questionnaire. We further collected data regarding subsequent sports hernia procedures on the ipsilateral or contralateral side. We calculated summary statistics for outcomes and examined the association between preinjury patient characteristics and the HOS–Sport score at follow-up or successful return to preinjury sport using linear and logistic regression, respectively. Results: A total of 104 of 128 (81.3%) eligible patients (mean age at surgery, 23.0 ± 6.2 years; 94.2% male; 51.9% American football athletes) completed follow-up at a mean time of 4.4 ± 1.5 years. Overall, 79.8% of athletes (n = 83) were able to return to their preinjury sport/activity, but 90.2% (83/92) who attempted to return were able to do so. When examining reasons for not returning to preinjury sport, only 9 patients reported not returning to preinjury sport because of limitations or persistent symptoms from their original injury. Only 4 patients underwent subsequent sports hernia procedures (3 contralateral, 1 ipsilateral revision) after their index unilateral sports hernia repair. At follow-up, the mean HOS–Sport score was high (94.0 ± 10.8), and the mean Numeric Pain Rating Scale score was low (0.31 ± 1.26). There were no preinjury patient characteristics associated with either the HOS–Sport score at follow-up or the successful return to preinjury sport. Conclusion: Patients with unilateral sports hernia symptoms can undergo repair and return to sport at the preinjury level with little concern for injuries to the contralateral groin. In our cohort, patient-reported hip function and pain outcomes at follow-up were excellent. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate change in involved and uninvolved quadriceps and hamstring strength and limb symmetry indices (LSI) in regular intervals over the first 6 months following anterior cruciate ligament reconstruction (ACLR). Design: Prospective cohort study. Participants: Thirty-eight male participants (mean age: 24.2 [6.4] y, mean body mass index: 23.6 [4.2] kg/m2), who underwent ACLR were included. Main outcome measures: Isometric strength testing of the quadriceps and hamstring muscles was performed at 1, 2, 3, and 6 months after ACLR. Quadriceps and hamstring peak torques for each limb and LSI were calculated. Repeated-measures analysis of covariance and paired t tests were used to evaluate changes in strength over time and between limbs, respectively. Results: Quadriceps and hamstring peak torques of the involved limb consistently increased between each time point from 1 to 6 months (P < .001 and P = .01, respectively), whereas the uninvolved limb values did not change after ACLR (P > .05). In addition, uninvolved limb peak torque values were higher than involved limb values at each time point after ACLR for both the quadriceps and hamstrings (all P < .01). At 6 months after ACLR, 28.9% of participants demonstrated LSI greater than 90% for quadriceps strength, 36.8% demonstrated LSI greater than 90% for hamstring strength, and 15.8% of participants demonstrated greater than 90% LSI for both quadriceps and hamstring strength. Conclusions: Participants demonstrated a consistent increase in quadriceps and hamstring strength of the involved limb, with no notable change in uninvolved limb strength over the 6 months after ACLR. However, at 6 months after ACLR, only approximately 16% of participants demonstrated both quadriceps and hamstring strength LSI greater than 90%, the typically recommended cutoff value for return to sport. [ABSTRACT FROM AUTHOR]

Background: The countermovement jump (CMJ) is a valid and reliable test of lower extremity (LE) muscle power. However, the CMJ may not be appropriate during early-stage rehabilitation of injuries. Functional muscle strength tests (FMSTs) could evaluate LE muscle power with lower joint reaction forces. Hypothesis: The lateral step-up test (LSUT), 5 times sit to stand (5×STS), and 30-s chair stand test (30CST) could predict CMJ jump height (JHt) and jump peak power (JPow). Study Design: Cross-sectional study. Level of Evidence: Level 2. Methods: Eighty-one young adults performed 3 CMJs to measure JHt and JPow using an electronic jump mat and speed analyzer. Participants also performed three FMSTs: 1 trial of the LSUT and a modified trial of LSUT touching the ground with the heel only (MLSUT); 2 trials of the 5×STS; and 2 trials of the 30CST, in a randomized order. Spearman rho correlations and hierarchal multiple linear regressions were used to determine whether FMST performances predicted JHt and JPow, after controlling for sex, body height, and body mass. Results: 30CST, LSUT, MLSUT, sex, body mass, and body height were significantly associated with JHt (P < 0.05). LSUT, sex, body height, and body mass were significantly associated with JPow (P < 0.05). Hierarchical regression analyses showed that the 30CST significantly predicted JHt (P < 0.01) and JPow (P = 0.03), independent of sex, body height, and body mass. Conclusion: 30CST performance predicted JHt and JPow in young adults. Clinical Relevance: The 30CST is easy to perform, requires equipment found readily in clinics, and predicts LE muscle power. This test could be used to track progress during the early stages of LE injury rehabilitation. [ABSTRACT FROM AUTHOR]

We sought to evaluate the sagittal plane knee joint loading patterns during a double‐leg landing task among young athletes who passed or failed return‐to‐sport (RTS) criteria following anterior cruciate ligament reconstruction reconstruction (ACLR), and in uninjured athletes. Participants completed quadriceps strength testing, a hop test battery, and the International Knee Documentation Committee subjective form following medical RTS clearance. ACLR participants "passed" RTS criteria (RTS‐PASS) if they met ≥90 limb symmetry (%) or score on all measures and were categorized as "failing" (RTS‐FAIL) if not. All participants completed three‐dimensional motion analysis testing. Sagittal plane kinematic and kinetic variables were calculated during a double‐leg drop vertical jump task. Mean limb values and limb symmetry indices (LSI; %) were calculated and compared using a one‐way analysis of variance (ANOVA) (for LSI) and mixed between‐within ANOVA (for group × limb differences). A total of 205 participants were included, with 39 in the RTS‐PASS group, 109 in the RTS‐FAIL group, and 57 control groups (CTRLs). The RTS‐FAIL group demonstrated lower symmetry values for peak vertical ground reaction force, peak internal knee extension moment, and peak knee flexion angle. Group × limb interactions were observed for peak vertical ground reaction force and peak internal knee extension moment. Involved limb values were reduced in the RTS‐PASS and RTS‐FAIL groups compared to CTRLs, while the RTS‐PASS groups had lower uninvolved limb values compared to the RTS‐FAIL and CTRLs. Clinical Significance: Young athletes who pass RTS criteria after ACLR land symmetrically during a double‐leg task, but symmetry was achieved by reducing loading on both limbs. [ABSTRACT FROM AUTHOR]

Quadriceps femoris strength asymmetry at the time of return to sports participation after anterior cruciate ligament (ACL) reconstruction contributes to worse function and asymmetric landing patterns, but the impact on longitudinal outcomes is not known. This study determined if young athletes after ACL reconstruction with quadriceps femoris strength asymmetry at a return to sports clearance would demonstrate markers of knee cartilage degeneration 5 years later compared to those with symmetric quadriceps femoris strength at return to sports. Participants (n = 27) were enrolled at the time of medical clearance for sports participation (baseline testing) and followed for 5 years. At baseline, quadriceps femoris strength was measured bilaterally and a limb symmetry index was used to divide the cohort into two groups: return to sport clearance with high quadriceps femoris strength (RTS‐HQ; limb symmetry index ≥ 90%) and return to sport clearance with low quadriceps femoris strength (RTS‐LQ; limb symmetry index < 85%). At 5 years post‐baseline, quantitative magnetic resonance imaging (T2 relaxation times (ms): involved knee medial/lateral femoral condyle and tibial plateau) data were collected. Group differences were evaluated with independent samples t tests. At 5 years post‐return to sports, the RTS‐LQ strength group (n = 14) demonstrated elevated T2 relaxation times at the anterior region of the lateral femoral condyle compared to the RTS‐HQ strength group (n = 13). Clinical Significance: Just over 50% of this cohort was cleared for sports participation with involved limb quadriceps femoris strength deficits that may contribute to early markers of knee cartilage degeneration within the subsequent 5 years. [ABSTRACT FROM AUTHOR]

Acetabular dysplasia (AD) is characterized by incomplete acetabulum development often leading to pain and decreased hip-related function and quality-of-life. Periacetabular osteotomy (PAO) is a hip preservation surgical treatment option for those with AD that aims to reposition the acetabulum to increase bony coverage of the femoral head in order to improve hip pain and function. Not all persons with AD are candidates for PAO, and less research has examined the impact of rehabilitation interventions on clinical outcomes. We synthesized and summarized the current evidence regarding rehabilitation interventions for persons with AD with and without PAO. We searched in PubMed, SPORTDiscus, CINAHL, Embase, and Scopus databases for relevant studies using predefined search terms. Two independent authors reviewed titles/abstracts and full texts for inclusion. We included studies that enrolled persons with AD and reported rehabilitation interventions either before PAO or both before and after PAO. We excluded studies not in English, review articles, or conference proceedings. We summarized study characteristics and findings, including the study design, sample size, demographics, and rehabilitation protocols before and/or after PAO. Lastly, descriptive consolidation and qualitative synthesis were performed for the included studies. Out of 696 potential studies, only 5 studies were included (1 protocol/guideline, 1 feasibility study, and 3 prospective studies). All included studies reported rehabilitation protocols used before and/or after PAO; however, only one study tested the impact of rehabilitation interventions on outcomes over a 6-month period. In this study (n=36), persons with AD reported significant improvements in pain, symptoms, and hip function 6 months after rehabilitation. Rehabilitation protocols included patient education (e.g., advice on pain management and activity) and exercise including range of motion, balance, and muscle strength interventions. Few studies have reported or examined the impact of rehabilitation interventions in persons with AD without or after PAO. Future studies should develop and evaluate the efficacy of targeted rehabilitation interventions as a potential non-surgical intervention for those with AD. Authors declare no conflict of interest. [ABSTRACT FROM AUTHOR]