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Gait analysis of national athletes after anterior cruciate ligament reconstruction following three stages of rehabilitation program: Symmetrical perspective

Hadizadeh M, Amri S, Mohafez H, Roohi SA, Mokhtar AH

Gait Posture, 2016 07;48:152-158.
PMID: 27318454 DOI: 10.1016/j.gaitpost.2016.05.002

This study aimed to objectively evaluate changes in gait kinematics, kinetics and symmetry among anterior cruciate ligament (ACL) reconstructed athletes during rehabilitation. Twenty-two national athletes with ACL reconstruction and 15 healthy athletes were recruited for the study. Gait data were collected between the weeks 4-5, 8-9, and 12-13 post-operation using three-dimensional motion analysis system. Five separate components, including knee range of motion (ROM), vertical ground reaction force (VGRF), their symmetries and knee extension moment were evaluated. One way and repeated measure multivariate analysis of variance (MANOVA) were used to analyze the knee ROMs. The VGRF and extension moment were tested using repeated measure ANOVA and independent sample t-test. Findings indicated significant alterations in all measured components between patients' Test 1 and control group. Repeated measure analysis revealed significant effect for time in components of knee angular and VGRF (P<0.001), their symmetry index (P=0.03) and knee extension moment (P=0.045). Univariate outcomes demonstrated significant improvement in the injured limb's stance and swing (P<0.001), and single-stance (P=0.005) ROMs over time. Symmetry indexes of stance and swing ROM, and VGRF reduced significantly by 26.3% (P=0.001), 17.9% (P<0.001), and 31.9% (P=0.03) respectively. After three months, symmetry indexes of single-stance ROM and VGRF along with operated knee extension moment were the only variables which showed significant differences with control group. The rehabilitation program allowed national athletes to restore the operated limb's gait parameters except knee extension moment by 12-13 weeks post-reconstruction; however, more time is required to normalize single-stance ROM and VGRF asymmetries.

Matched MeSH terms: Athletic Injuries/surgery
A Silver Medal Winner at the 13th World Wu Shu Championship 2015 17 Months After Selective Thoracic Fusion for Adolescent Idiopathic Scoliosis: A Case Report

Chan CYW, Aziz I, Chai FW, Kwan MK

Spine (Phila Pa 1976), 2017 Feb 15;42(4):E248-E252.
PMID: 28207671 DOI: 10.1097/BRS.0000000000001748

STUDY DESIGN: Case report.
OBJECTIVE: To report the successful rehabilitation and the training progress of an elite high performance martial art exponent after selective thoracic fusion for Adolescent Idiopathic Scoliosis (AIS).
SUMMARY OF BACKGROUND DATA: Posterior spinal fusion for AIS will result in loss of spinal flexibility. The process of rehabilitation after posterior spinal fusion for AIS remains controversial and there are few reports of return to elite sports performance after posterior spinal fusion for AIS.
METHODS: We report a case of a 25-year-old lady who was a national Wu Shu exponent. She was a Taolu (Exhibition) exponent. She underwent Selective Thoracic Fusion (T4 to T12) using alternate level pedicle screw placement augmented with autogenous local bone graft in June 2014. She commenced her training at 3-month postsurgery and the intensity of her training was increased after 6 months postsurgery. We followed her up to 2 years postsurgery and showed no instrumentation failure or lost of correction.
RESULTS: After selective thoracic fusion, her training process consisted of mainly speed training, core strengthening, limb strengthening, and flexibility exercises. At 17 months of postoperation, she participated in 13th World Wu Shu Championship 2015 and won the silver medal.
CONCLUSION: Return to elite high-performance martial arts sports was possible after selective thoracic fusion for AIS. The accelerated and intensive training regime did not lead to any instrumentation failure and complications.
LEVEL OF EVIDENCE: 2.

Matched MeSH terms: Athletic Injuries/surgery*
Assessment of Gait Symmetry Improvements in National Athletes after Anterior Cruciate Ligament Reconstruction during Rehabilitation

Hadizadeh M, Amri S, Roohi SA, Mohafez H

Int J Sports Med, 2016 Nov;37(12):997-1002.
PMID: 27551935

This study aimed to quantify changes in gait parameters and their symmetries among athletes with anterior cruciate ligament (ACL) reconstructions during a rehabilitation program. Twenty-two national players with ACL reconstructions and 15 healthy athletes were recruited. The gait data were collected between postoperative weeks 4-5, 8-9 and 12-13 using a three-dimensional motion analysis system. The spatio-temporal gait parameters and symmetry indexes (SIs) were evaluated for the patients and the control group. One-way and repeated-measures multivariate analysis of variance were used to analyse the data. The results demonstrated significant differences among spatio-temporal (P<0.001) and SIs (P=0.007) of patients for Test 1 and the control group. Repeated measure analysis revealed significant changes in the linear combinations of spatio-temporal gait variables (P=0.002) and SIs (P=0.043) over time. The injured limb's step length, cadence and weight acceptance time presented significant improvement across time (P<0.001). Moreover, the SI of the stance time was reduced significantly by 46.48% (P=0.004) among SI parameters. After three months, no significant differences were found between patients and healthy controls for the measured gait components (P>0.05). The rehabilitation program allowed national athletes to restore symmetry in spatio-temporal gait parameters toward the control group's range 12-13 weeks post-reconstruction.

Matched MeSH terms: Athletic Injuries/surgery
Unexpected-Disturbance Program for Rehabilitation of High-Performance Athletes

Teichmann J, Suwarganda EK, Lendewig C, Wilson BD, Yeo WK, Aziz RA, et al.

J Sport Rehabil, 2016 May;25(2):126-32.
PMID: 25658597 DOI: 10-1123/jsr.2014-0280

CONTEXT: The Unexpected-Disturbance Program (UDP) promotes exercises in response to so-called involuntary short- to midlatency disturbances.
OBJECTIVE: This study investigated the effectiveness of the UDP in the last 6 wk of rehabilitation.
DESIGN: Pre-post study with 2-tailed paired t tests for limited a priori comparisons to examine differences.
SETTING: National Sports Institute of Malaysia.
PARTICIPANTS: 24 Malaysian national athletes.
INTERVENTIONS: 7 sessions/wk of 90 min with 3 sessions allocated for 5 or 6 UDP exercises.
MAIN OUTCOMES: Significant improvements for men and women were noted. Tests included 20-m sprint, 1-repetition-maximum single-leg press, standing long jump, single-leg sway, and a psychological questionnaire.
RESULTS: For men and women, respectively, average strength improvements of 22% (d = 0.96) and 29% (d = 1.05), sprint time of 3% (d = 1.06) and 4% (d = 0.58), and distance jumped of 4% (d = 0.59) and 6% (d = 0.47) were noted. In addition, athletes reported improved perceived confidence in their abilities. All athletes improved in each functional test except for long jump in 2 of the athletes. Mediolateral sway decreased in 18 of the 22 athletes for the injured limb.
CONCLUSION: The prevention training with UDP resulted in improved conditioning and seems to decrease mediolateral sway.

Matched MeSH terms: Athletic Injuries/surgery
Medium-term (5-year) comparison of the functional outcomes of combined anterior cruciate ligament and posterolateral corner reconstruction compared with isolated anterior cruciate ligament reconstruction

Cartwright-Terry M, Yates J, Tan CK, Pengas IP, Banks JV, McNicholas MJ

Arthroscopy, 2014 Jul;30(7):811-7.
PMID: 24794571 DOI: 10.1016/j.arthro.2014.02.039

To present a 5-year comparison of the functional outcomes of combined anterior cruciate ligament (ACL) and posterolateral corner (PLC) reconstruction with those of isolated ACL reconstruction.

Matched MeSH terms: Athletic Injuries/surgery