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Ardern C.L.,La Trobe University | Ardern C.L.,Linkoping University | Taylor N.F.,La Trobe University | Feller J.A.,La Trobe University | And 2 more authors.
American Journal of Sports Medicine | Year: 2015

Background: A return to their preinjury level of sport is frequently expected within 1 year after anterior cruciate ligament (ACL) reconstruction, yet up to two-thirds of athletes may not have achieved this milestone. The subsequent sports participation outcomes of athletes who have not returned to their preinjury level sport by 1 year after surgery have not previously been investigated. Purpose: To investigate return-to-sport rates at 2 years after surgery in athletes who had not returned to their preinjury level sport at 1 year after ACL reconstruction. Study Design: Case series; Level of evidence, 4. Methods: A consecutive cohort of competitive- and recreational-level athletes was recruited prospectively before undergoing ACL reconstruction at a private orthopaedic clinic. Participants were followed up at 1 and 2 years after surgery with a sports activity questionnaire that collected information regarding returning to sport, sports participation, and psychological responses. An independent physical therapist evaluated physical function at 1 year using hop tests and the International Knee Documentation Committee knee examination form and subjective knee evaluation. Results: A group of 122 competitive- and recreational-level athletes who had not returned to their preinjury level sport at 1 year after ACL reconstruction participated. Ninety-one percent of the athletes returned to some form of sport after surgery. At 2 years after surgery, 66% were playing sport, with 41% playing their preinjury level of sport and 25% playing a lower level of sport. Having a previous ACL reconstruction to either knee, poorer hop-test symmetry and subjective knee function, and more negative psychological responses were associated with not playing the preinjury level sport at 2 years. Conclusion: Most athletes who were not playing sport at 1 year had returned to some form of sport within 2 years after ACL reconstruction, which may suggest that athletes can take longer than the clinically expected time of 1 year to return to sport. However, only 2 of every 5 athletes were playing their preinjury level of sport at 2 years after surgery. When the results of the current study were combined with the results of athletes who had returned to sport at 1 year, the overall rate of return to the preinjury level sport at 2 years was 60%. Demographics, physical function, and psychological factors were related to playing the preinjury level sport at 2 years after surgery, supporting the notion that returning to sport after surgery is multifactorial. © 2015 The Author(s).


Feller J.A.,OrthoSport Victoria
Sports Medicine and Arthroscopy Review | Year: 2012

Although tibial tuberosity (TT) transfer has for many years been the basis of many protocols for the management of patellar instability, the role of pure medial transfer in particular appears to be declining. In contrast, the greater recognition of the importance of patella alta as a predisposing factor to recurrent patellar dislocation has resulted in a resurgence in the popularity of distal TT transfer. When TT transfer is performed, the direction and amount of transfer is based on the patellar height and the lateralization of the TT relative to the trochlear groove. Patellar height is best assessed on a lateral radiograph with the knee in flexion using a ratio that uses the articular surface of the patella in relation to the height above the tibia. Assessment of lateralization of the TT relative to the trochlear groove can be made using either computed tomography or magnetic resonance imaging scans. Copyright © 2012 by Lippincott Williams & Wilkins.


Webster K.E.,La Trobe University | Feller J.A.,OrthoSport Victoria
Knee Surgery, Sports Traumatology, Arthroscopy | Year: 2016

Purpose: To investigate whether the performance of the short form-12 (SF-12) health survey is comparable with the longer version SF-36 for measuring health-related quality of life over time in patients with knee osteoarthritis who have joint replacement surgery. Methods: Four hundred and seven patients with knee osteoarthritis completed the SF-36 before surgery and at a minimum of 12 months following knee replacement. SF-12 item responses were obtained from the responses given to the SF-36 questionnaire. Correlation coefficients were calculated between SF-12 and SF-36 physical component summary (PCS) and mental component summary (MCS) scores and the respective change in scores. Sensitivity to change was determined with the standardised response mean (SRM). Results: PCS and MCS scores were highly correlated between SF-12 and SF-36 versions for both preoperative and post-operative measures (r = 0.90–0.96, p < 0.0001). Change scores (post-operative–preoperative) were also highly correlated (PCS: r = 0.88, p < 0.001; MCS: r = 0.93, p < 0.001). Sensitivity to change was large for the PCS scale (all SRMs >1.0). Correlations above 0.7 were found between change scores for each SF-36 and SF-12 subscale except General Health (r = 0.55). Conclusions: The SF-12 summary measures and component scores replicate well with the SF-36 and show similar responsiveness to change. The SF-12 appears to be an adequate alternative for use in patients with knee osteoarthritis who undergo replacement surgery, and its brevity should be attractive for both clinicians and patients. Level of evidence: I. © 2016 European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA)


McClelland J.A.,La Trobe University | Feller J.A.,OrthoSport Victoria | Menz H.B.,La Trobe University | Webster K.E.,La Trobe University
Journal of Biomechanics | Year: 2014

The aim of this study was to investigate the prevalence of abnormal knee biomechanical patterns in 40 patients with a modern TKA prosthesis, compared to 40 matched control participants when ascending and descending stairs. Fewer patients were able to ascend (65%) or descend stairs (53%) unassisted than controls (83%). Of the participants who could ascend and descend, cluster analysis classified most patients (up to 77%) as demonstrating a similar knee moment pattern as all controls. A small subgroup of patients who completed the tasks did so with distinctly abnormal biomechanics compared to other patients and controls. These findings suggest that recovery of normal stair climbing is possible. However, rehabilitation might be more effective if it were tailored to account for these differences between patients. © 2014 Elsevier Ltd.


Julian A. F.,OrthoSport Victoria
Operative Techniques in Sports Medicine | Year: 2015

Planning the management for a patient with recurrent patellar instability should be based on information gained from a thorough history and physical examination and supplemented with relevant radiological investigations. In taking the history it is important to distinguish between pain and instability and an open mind should be kept regarding the source of instability symptoms. Recurrent episodes should be distinguished from a single event and the initial episode should be well understood, particularly in relation to the degree of trauma involved and the response of the knee. Symptoms in the other knee and in other family members suggest the presence of predisposing factors.Important components of the physical examination include static and dynamic alignment, a general knee examination, and assessment of patellar height, mobility, and apprehension, as well as patellar tracking. An assessment of femoral version and tibial torsion should be made. The radiological assessment of patellar instability continues to evolve. Although plain radiographs, computerized tomography, and magnetic resonance imaging are all used, a good-quality lateral radiograph with the knee in 20°-30° flexion provides information about the 2 most important factors. -patellar height and trochlear dysplasia. The importance and role of the tibial tuberosity-trochlear groove distance has been questioned in recent research. If surgery is undertaken it should be tailored to the specific needs of the individual patient. No universally accepted algorithm exists for the planning of surgery. There appears to be a trend to use medial patellofemoral ligament reconstruction as the mainstay of surgery with an apparent reduction in the use of medial tibial tuberosity transfer. Additional procedures, particularly tibial tuberosity distalization and. -in some centers. -trochleoplasty, can be used to address predisposing factors that are felt to be significant contributors to the patient's problem. Procedures may need to be modified in the skeletally immature or individuals with hyperlaxity. Femoral and tibial osteotomies may have a role in habitual and permanent patellar dislocation. © 2015 Elsevier Inc.

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