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Fältström, A., Kvist, J., Gauffin, H. & Hägglund, M. (2019). Female Soccer Players With Anterior Cruciate Ligament Reconstruction Have a Higher Risk of New Knee Injuries and Quit Soccer to a Higher Degree Than Knee-Healthy Controls. American Journal of Sports Medicine, 47(1), 31-40
Open this publication in new window or tab >>Female Soccer Players With Anterior Cruciate Ligament Reconstruction Have a Higher Risk of New Knee Injuries and Quit Soccer to a Higher Degree Than Knee-Healthy Controls
2019 (English)In: American Journal of Sports Medicine, ISSN 0363-5465, E-ISSN 1552-3365, Vol. 47, no 1, p. 31-40Article in journal (Refereed) Published
Abstract [en]

Background:

Many patients with anterior cruciate ligament (ACL) reconstruction who return to sport suffer new ACL injuries or quit sports soon after returning.

Purpose:

To prospectively follow a cohort of female soccer players with primary unilateral ACL reconstruction and matched knee-healthy controls from the same soccer teams to compare (1) the rate of new traumatic and nontraumatic knee injuries and other injuries, (2) the proportion of players who quit soccer, and (3) player-reported activity level and satisfaction with activity level and knee function.

Study Design:

Cohort study; Level of evidence, 2.

Methods:

A total of 117 active female soccer players (mean ± SD age, 19.9 ± 2.5 years) 18.9 ± 8.7 months after ACL reconstruction and 119 knee-healthy female soccer players (19.5 ± 2.5 years) matched from the same teams were prospectively followed for 2 years for new knee injuries, other injuries, soccer playing level, activity level according to the Tegner Activity Scale, and satisfaction with activity level and knee function.

Results:

Players with ACL reconstruction had a higher rate of new ACL injuries (n = 29 vs 8; 19 vs 4 per 100 player years; rate ratio [RR], 4.82; 95% CI, 2.20-10.54; P < .001), other traumatic knee injuries (29 vs 16 per 100 player years; RR, 1.84; 95% CI, 1.16-2.93; P < .01), and nontraumatic knee injuries (33 vs 9 per 100 player years; RR, 3.62; 95% CI, 2.11-6.21; P < .001) as compared with controls. There was no difference in the rate of other (not knee) injuries (43 vs 48 per 100 player years; RR, 0.90; 95% CI, 0.65-1.23; P = .494). During the 2-year follow-up, 72 (62%) players with ACL reconstruction quit soccer, as opposed to 43 (36%) controls (P = .001). The median Tegner Activity Scale score decreased in both groups (P < .001) but more for the ACL-reconstructed group (P < .015).

Conclusion:

Female soccer players with ACL reconstruction had nearly a 5-fold-higher rate of new ACL injuries and a 2- to 4-fold-higher rate of other new knee injuries, quit soccer to a higher degree, and reduced their activity level to a greater extent as compared with knee-healthy controls.

Place, publisher, year, edition, pages
Sage Publications, 2019
Keywords
Female, football, soccer, anterior cruciate ligament, return to sports, reinjury, satisfaction
National Category
Physiotherapy Orthopaedics Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-153246 (URN)10.1177/0363546518808006 (DOI)000454146900010 ()30481050 (PubMedID)
Available from: 2018-12-05 Created: 2018-12-05 Last updated: 2019-01-11Bibliographically approved
Arundale, A., Kvist, J., Hägglund, M. & Fältström, A. (2019). Jumping performance based on duration of rehabilitation in female football players after anterior cruciate ligament reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy, 27(2), 556-563
Open this publication in new window or tab >>Jumping performance based on duration of rehabilitation in female football players after anterior cruciate ligament reconstruction
2019 (English)In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 27, no 2, p. 556-563Article in journal (Refereed) Published
Abstract [en]

Purpose

To determine if female football players who had longer durations of rehabilitation, measured in months, after anterior cruciate ligament reconstruction would have lower tuck jump scores (fewer technique flaws) and smaller asymmetries during drop vertical jump landing.

Methods

One-hundred-and-seventeen female football players, aged 16ᅵ25 years, after primary unilateral ACL reconstruction (median 16 months, range 6ᅵ39) were included. Athletes reported the duration of rehabilitation they performed after anterior cruciate ligament reconstruction. Athletes also performed the tuck jump and drop vertical jump tests. Outcome variables were: tuck jump score, frontal plane knee motion and probability of peak knee abduction moment during drop vertical jump landing.

Results

There was no difference in tuck jump score based on duration of rehabilitation (n.s.). No interaction (n.s.), difference between limbs (n.s.), or duration of rehabilitation (n.s.) was found for peak knee abduction moment during drop vertical jump landing. No interaction (n.s.) or difference between limbs (n.s.) was found for frontal plane knee motion, but there was a difference based on duration of rehabilitation (P?=?0.01). Athletes with >?9 months of rehabilitation had more frontal plane knee motion (medial knee displacement) than athletes with <?6 months (P?=?0.01) or 6ᅵ9 months (P?=?0.03).

Conclusion

As there was no difference in tuck jump score or peak knee abduction moment based on duration of rehabilitation, the results of this study press upon clinicians the importance of using objective measures to progress rehabilitation and clear athletes for return to sport, rather than time alone.

Place, publisher, year, edition, pages
Springer Berlin/Heidelberg, 2019
National Category
Public Health, Global Health, Social Medicine and Epidemiology Physiotherapy Sport and Fitness Sciences
Identifiers
urn:nbn:se:liu:diva-151695 (URN)10.1007/s00167-018-5154-5 (DOI)000460315200027 ()30267186 (PubMedID)
Note

Funding agencies: Swedish Research Council for Sport Science [CIF P2015-0150, FO2016-0021]; Futurum-the Academy for Healthcare, Region Jonkoping County; Medical Research Council of Southeast Sweden; Faculty of Health Sciences at Linkoping University; Swedish Football Assoc

Available from: 2018-10-01 Created: 2018-10-01 Last updated: 2019-03-20Bibliographically approved
Fältström, A., Hägglund, M. & Kvist, J. (2016). Factors associated with playing football after anterior cruciate ligament reconstruction in female football players.. Scandinavian Journal of Medicine and Science in Sports, 26(11), 1343-1352
Open this publication in new window or tab >>Factors associated with playing football after anterior cruciate ligament reconstruction in female football players.
2016 (English)In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 26, no 11, p. 1343-1352Article in journal (Refereed) Published
Abstract [en]

This study investigated whether player-related factors (demographic, personality, or psychological factors) or the characteristics of the anterior cruciate ligament (ACL) injury were associated with the return to playing football in females after ACL reconstruction (ACLR). We also compared current knee function, knee related quality of life and readiness to return to sport between females who returned to football and those who had not returned. Females who sustained a primary ACL rupture while playing football and underwent ACLR 6-36 months ago were eligible. Of the 460 contacted, 274 (60%) completed a battery of questionnaires, and 182 were included a median of 18 months (IQR 13) after ACLR. Of these, 94 (52%) returned to football and were currently playing, and 88 (48%) had not returned. Multiple logistic regression analysis identified two factors associated with returning to football: short time between injury and ACLR (0-3 months, OR 5.6; 3-12 months OR 4.7 vs reference group > 12 months) and high motivation. Current players showed higher ratings for current knee function, knee-related quality of life, and psychological readiness to return to sport (P < 0.001). Undergoing ACLR sooner after injury and high motivation to return to sports may impact a player's return to football after ACLR.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2016
Keywords
ACL; knee; return to sport; soccer
National Category
Physiotherapy
Identifiers
urn:nbn:se:liu:diva-123889 (URN)10.1111/sms.12588 (DOI)000386938300009 ()26589671 (PubMedID)
Note

Funding agencies:The authors acknowledge statistician Henrik Magnusson. The study was supported financially by Futurum-The Academy for Healthcare, Jonkoping County Council, the Medical Research Council of Southeast Sweden, the Faculty of Health Sciences at Linkoping University, and the Swedish National Centre for Research in Sports (CIF).

Available from: 2016-01-13 Created: 2016-01-13 Last updated: 2017-11-30Bibliographically approved
Fältström, A. (2016). One Anterior Cruciate Ligament injury is enough!: Focus on female football players. (Doctoral dissertation). Linköping: Linköping University Electronic Press
Open this publication in new window or tab >>One Anterior Cruciate Ligament injury is enough!: Focus on female football players
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Anterior cruciate ligament (ACL) injury is a severe and common injury, and females have 2-4 times higher injury risk compared to men. Return to sport (RTS) is a common goal after an ACL reconstruction (ACLR), but only about two thirds of patients RTS. Young patients who RTS may have a 30-40 times increased risk of sustaining an additional ACL injury to the ipsi- or contralateral knee compared with an uninjured person.

Aims: The overall aim of this thesis was to increase the knowledge about female football players with ACLR, and patients with bilateral ACL injuries, and to identify predictors for additional ipsi- and/or contralateral ACLR.

Methods: This thesis comprises four studies. Study I and II were cross-sectional, including females who sustained a primary ACL rupture while playing football and underwent ACLR 6–36 months prior to study inclusion. In study I, 182 females were included at a median of 18 months (IQR 13) after ACLR. All players completed a battery of questionnaires. Ninety-four players (52%) returned to football and were playing at the time of completing the questionnaires, and 88 (48%) had not returned. In study II, 77 of the 94 active female football players (from study I) with an ACLR and 77 kneehealthy female football players were included. A battery of tests was used to assess postural control (the Star excursion balance test) and hop performance (the one-leg hop for distance, the five jump test and the side hop). Movement asymmetries in the lower limbs and trunk were assessed with the drop vertical jump and the tuck jump using two-dimensional analyses. Study III, was a cohort study including all patients with a primary ACLR (n=22,429) registered in the Swedish national ACL register between January 2005 and February 2013. Data extracted from the register to identify predictors for additional ACLR were: patient age at primary ACLR, sex, activity performed at the time of ACL injury, primary injury to the right- or left knee, time between injury and primary ACLR, presence of any concomitant injuries, graft type, Knee injury and Osteoarthritis Outcome Score and Euroqol Index Five Dimensions measured pre-operatively. Study IV was cross-sectional. In this study, patient-reported knee function, quality of life and activity level in 66 patients with bilateral ACL injuries was investigated and outcomes were compared with 182 patients with unilateral ACLR.

Results: Factors associated with returning to football in females were; short time between injury and ACLR (0–3 months, OR 5.6; 3–12 months OR 4.7 vs. reference group >12 months) and high motivation (study I). In all functional tests, the reconstructed and uninvolved limbs did not differ, and players with ACLR and controls differed only minimally. Nine to 49% of the players with ACLR and controls had side-to-side differences and movement asymmetries and only one fifth had results that met the recommended guidelines for successful outcome on all the different tests (study II). Main predictors for revision and contralateral ACLR were younger age (fourfold increased rate for <16 vs. >35-year-old patients), having ACLR early after the primary injury (two to threefold increased rate for ACLR within 3 months vs. >12 months), and incurring the primary injury while playing football (study III). Patients with bilateral ACL injuries reported poorer knee function and quality of life compared to those who had undergone unilateral ACLR. They had a high activity level before their first and second ACL injuries but an impaired activity level at follow-up after their second injury (study IV).

Conclusions: Female football players who returned to football after an ACLR had high motivation and had undergone ACLR within one year after injury. Players with ACLR had similar functional performance to healthy controls. Movement asymmetries, which in previous studies have been associated with increased risk for primary and secondary ACL injury, occurred to a high degree in both groups. The rate of additional ACLR seemed to be increased in a selected group of young patients who desire to return to strenuous sports like football quickly after primary ACLR. Sustaining a contralateral ACL injury led to impaired knee function and activity level.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2016. p. 97
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1525
National Category
Physiotherapy Orthopaedics Sport and Fitness Sciences
Identifiers
urn:nbn:se:liu:diva-130923 (URN)10.3384/diss.diva-130923 (DOI)9789176857366 (ISBN)
Public defence
2016-09-30, Berzeliussalen, Campus US, Linköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2016-08-31 Created: 2016-08-31 Last updated: 2019-10-29Bibliographically approved
Fältström, A., Hägglund, M., Magnusson, H., Forssblad, M. & Kvist, J. (2016). Predictors for additional anterior cruciate ligament reconstruction: data from the Swedish national ACL register.. Knee Surgery, Sports Traumatology, Arthroscopy, 24(3), 885-894
Open this publication in new window or tab >>Predictors for additional anterior cruciate ligament reconstruction: data from the Swedish national ACL register.
Show others...
2016 (English)In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 24, no 3, p. 885-894Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To identify predictors for additional anterior cruciate ligament (ACL) reconstruction.

METHODS: Patients from the Swedish national ACL register who underwent ACL reconstruction between January 2005 and February 2013 (follow-up duration 6-104 months) were included. Cox regression analyses included the following independent variables regarding primary injury: age, sex, time between injury and primary ACL reconstruction, activity at primary injury, concomitant injuries, injury side, graft type, and pre-surgery KOOS and EQ-5D scores.

RESULTS: Among ACL reconstruction procedures, 93 % involved hamstring tendon (HT) autografts. Graft type did not predict additional ACL reconstruction. Final regression models only included patients with HT autograft (n = 20,824). Of these, 702 had revision and 591 contralateral ACL reconstructions. The 5-year post-operative rates of revision and contralateral ACL reconstruction were 4.3 and 3.8 %, respectively. Significant predictors for additional ACL reconstruction were age (fourfold increased rate for <16-year-old patients vs. >35-year-old patients), time between injury and primary surgery (two to threefold increased rate for ACL reconstruction within 0-90 days vs. >365 days), and playing football at primary injury.

CONCLUSION: This study identified younger age, having ACL reconstruction early after the primary injury, and incurring the primary injury while playing football as the main predictors for revision and contralateral ACL reconstruction. This suggests that the rate of additional ACL reconstruction is increased in a selected group of young patients aiming to return to strenuous sports after primary surgery and should be taken into consideration when discussing primary ACL reconstruction, return to sports, and during post-surgery rehabilitation. LEVEL OF EVIDENCE: II.

National Category
Physiotherapy Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-115943 (URN)10.1007/s00167-014-3406-6 (DOI)000371300400036 ()25366191 (PubMedID)
Note

Funding agencies:The study was financially supported by Futurum-the academy for healthcare, County Council, Jonkoping, the Faculty of Health Sciences at Linkoping University, and the Swedish National Centre for Research in Sports (CIF).

Available from: 2015-03-24 Created: 2015-03-24 Last updated: 2018-10-29Bibliographically approved
Fältström, A., Hägglund, M. & Kvist, J. (2013). Patient-Reported Knee Function, Quality of Life, and Activity Level After Bilateral Anterior Cruciate Ligament Injuries. American Journal of Sports Medicine, 41(12), 2805-2813
Open this publication in new window or tab >>Patient-Reported Knee Function, Quality of Life, and Activity Level After Bilateral Anterior Cruciate Ligament Injuries
2013 (English)In: American Journal of Sports Medicine, ISSN 0363-5465, E-ISSN 1552-3365, Vol. 41, no 12, p. 2805-2813Article in journal (Refereed) Published
Abstract [en]

Background: About 12% of patients who have undergone primary anterior cruciate ligament (ACL) reconstruction sustain a contralateral ACL injury within 5 years. less thanbrgreater than less thanbrgreater thanPurpose: To investigate patient-reported knee function, quality of life, and activity level in patients with bilateral ACL injuries. less thanbrgreater than less thanbrgreater thanStudy Design: Cohort study; Level of evidence, 3. less thanbrgreater than less thanbrgreater thanMethods: A search of hospital records identified 147 patients, aged 18 to 45 years, with bilateral ACL injuries. Of these, 83 met the inclusion criteria, having had their first ACL injury up to 12 years ago with no other major injuries to the knee joint. Sixty-six of these patients (80% of total; 47% female; mean age, 29.1 7.2 years) answered a questionnaire packet. Patients who had undergone unilateral ACL reconstruction (n = 182) were used for comparison. less thanbrgreater than less thanbrgreater thanResults: Patients with bilateral ACL injuries had a median Lysholm knee score of 82 (range, 34-100). The mean EuroQol index (EQ-5D) score of the overall health status was 0.77 +/- 0.22, and the mean EQ-5D visual analog scale score was 75.5 +/- 17.6. The median Tegner activity level was 9 (range, 1-9) before any injuries, 7 (range, 1-9) before the second ACL injury, and 4 (range, 1-9) at the time of follow-up. The activity level before the second injury was higher compared with the follow-up for patients who had undergone unilateral ACL reconstruction. At follow-up, 23% of the patients with bilateral ACL injuries returned to their previous activity, and 12% of patients returned to the same level as before their injuries compared with 43% (P = .004) and 28% (P = .01) in patients who had undergone unilateral ACL reconstruction, respectively. Patients with bilateral ACL injuries had significantly lower values in the Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales for pain, function in sports and recreation, and knee-related quality of life as well as the ACL Deficiency Quality of Life (ACL-QOL) score compared with patients who had undergone unilateral ACL reconstruction. less thanbrgreater than less thanbrgreater thanConclusion: Patients with bilateral ACL injuries reported poorer knee function and quality of life compared with those who had undergone unilateral ACL reconstruction. Their activities had changed, and they were dissatisfied with their current activity level. They had a high activity level before their first and second ACL injuries but an impaired activity level after their contralateral injury at follow-up.

Place, publisher, year, edition, pages
SAGE Publications (UK and US): No SAGE Choice, 2013
Keywords
knee, ligaments, ACL, contralateral, return to sport, subsequent injury, Tegner activity scale
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-102774 (URN)10.1177/0363546513502309 (DOI)000327473300013 ()
Note

Funding Agencies|Futurum-The Academy for Healthcare, Jonkoping County Council||Medical Research Council of Southeast Sweden||Faculty of Health Sciences at Linkoping University||Swedish National Centre for Research in Sports||

Available from: 2014-01-07 Created: 2013-12-26 Last updated: 2017-12-06
Hultman, K., Fältström, A. & Öberg, U. (2010). The effect of early physiotherapy after an acute ankle sprain. Advances in Physiotherapy, 12(2), 65-73
Open this publication in new window or tab >>The effect of early physiotherapy after an acute ankle sprain
2010 (English)In: Advances in Physiotherapy, ISSN 1403-8196, E-ISSN 1651-1948, Vol. 12, no 2, p. 65-73Article in journal (Refereed) Published
Abstract [en]

Ankle sprain is one of the most common injuries treated in emergency departments (ED). In clinical practice, these injuries are expected to heal by themselves, often without any treatment other than short information about the RICE regime (rest, ice, compression and elevation). Still, remaining symptoms are reported to occur in 30% of the cases. The aim of this study was to evaluate the effect of early physiotherapy intervention after an acute ankle sprain. Sixty-five patients were recruited from the ED at a general hospital in Sweden (mean age 35 years; 30 women), and allocated into an intervention group with early physiotherapy or a control group. Both groups were evaluated 6 weeks and 3 months after their injury. As primary outcome, the disease-specific Foot and Ankle Outcome Score (FAOS) was used. The patients also rated their physical activity ability and how satisfied they were with their ankle on a visual analogue scale (VAS). The intervention group made significant improvements compared with the control group at both evaluations measured with FAOS and the VAS questions. These findings indicate that early physiotherapy intervention has a positive effect on patient-focused foot and ankle function after an acute ankle sprain. © 2010 Informa UK Ltd.

Place, publisher, year, edition, pages
Taylor & Francis, 2010
Keywords
FAOS, Outcome, Rehabilitation, Self-care, acute disease, adult, aged, ankle sprain, article, controlled study, early intervention, emergency ward, female, human, joint function, major clinical study, male, outcome assessment, physical activity, physiotherapy, therapy effect
National Category
Health Sciences
Identifiers
urn:nbn:se:liu:diva-152672 (URN)10.3109/14038190903174262 (DOI)2-s2.0-77953218583 (Scopus ID)
Note

Cited By :5; Export Date: 12 November 2018; Article; CODEN: APDHA; Correspondence Address: Hultman, K.; Department of Physiotherapy, Ryhov County Hospital, S-551 85 Jönköping, Sweden; email: kristin.hultman@lj.se

Available from: 2018-11-12 Created: 2018-11-12 Last updated: 2018-11-16Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-3811-7381

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