Compliance in post-operative rehabilitation is a key factor for return to sport after revision anterior cruciate ligament reconstruction.

PURPOSE: To assess the rate of return to sport (RTS) following revision Anterior Cruciate Ligament Reconstruction (ACLR) in a rehabilitation-based cohort of patients. A secondary goal of the study was to evaluate the association between compliance in post-operative rehabilitation and RTS rate. METHODS: The study cohort included 79 sport-active patients (62 males, 17 females, 30.0 ± 10.2 years old) who underwent revision ACLR surgery and followed the same functional-oriented rehabilitation protocol. Patients were evaluated using a RTS survey: return to any kind of sport participation, return to the same pre-injury sport, return to the same sport at the same pre-injury level. With regards to compliance in post-operative rehabilitation, patients were then grouped in (1) Fully Compliant (FC), (2) Moderately Compliant (MC), (3) Scarcely Compliant (SC), and (4) Non-Compliant (NC). RESULTS: At an average follow-up of 29 ± 12 months, 86% of the patients returned to some kind of sport activity, 62% returned to the same pre-injury sport activity and 59% returned to the same pre-injury level of sport activity. While no surgical aspects were correlated with RTS, higher BMI was found to have a negative influence (p = 0.033). Regardless of the type of sport, compliance significantly affected RTS at the same pre-injury level (p = 0.006): 86% in FC, 67% in MC, 50% in SC, and 45% in NC. For each compliance goal achieved, the probability of RTS increased by 68% (OR = 1.68; p = 0.027). CONCLUSION: RTS at the same pre-injury level after revision ACLR is challenging. A higher compliance in rehabilitation significantly increases the chances of RTS. LEVEL OF EVIDENCE: IV.

Analysis of Dental Malocclusion and Neuromotor Control in Young Healthy Subjects through New Evaluation Tools.

The presence of a correlation between stomatognathic and postural systems has been investigated by different authors trying to identify a possible influence of dental occlusion on body posture and balance. The aim of this study was to evaluate the relationship between dental occlusion and neuromuscular control in a healthy young population using modern evaluation tools. 25 subjects (9 males and 16 females, aged 23 to 44) were evaluated for dental occlusion, particularly in relation to overjet and overbite parameters, anterior and posterior crossbite, scissor bite, mandibular crowding, molar and canine class, and deviation of the median dental line. Neuromotor control was assessed using two different types of stabilometric platforms in both monopodalic and bipodalic equilibriums (Prokin-B and MF-Stability, Tecnobody, Italy). All subjects were evaluated with and without cotton rolls positioned between the upper and lower arches at the premolar level in order to temporarily eliminate any pathological contact. In all 25 subjects, no statistically significant differences were revealed between the evaluations performed with and without cotton rolls in all the analyzed conditions (in static, in dynamics, with open and closed eyes). This study did not find a significant correlation between dental occlusion and neuromuscular control in a young and healthy population.

Anterior cruciate ligament reconstruction and rehabilitation: predictors of functional outcome.

UNLABELLED: Surgical reconstruction of an injured anterior cruciate ligament (ACL) leads to full recovery of function and sports activity in a high percentage of cases. The aim of the present study was to analyze variables related to the patient, the surgical technique and the post-surgical rehabilitation methods, seeking to identify predictors of outcome and recovery time after ACL reconstruction. One hundred and four patients (81 M, 23 F) undergoing a step-based rehabilitation protocol after ACL reconstruction were evaluated. 43.2% of them had an isolated ACL lesion, whereas 56.8% had one or more concurrent injuries. Data relating to personal characteristics, surgery and post-operative management were collected and analyzed for correlation. Clinical outcome was evaluated with IKDC subjective score and the Tegner score, and the time to reach full recovery was noted as well. Young patients with a higher pre-injury Tegner activity level or who practice sport at professional level, no concurrent capsular lesions and no postoperative knee bracing had better clinical results and took shorter time to recover. Also, a higher percentage of on-the-field rehabilitation sessions, and absence of significant muscle strength deficits at the first knee isokinetic test emerged as rehabilitation-related factors leading to a better post-surgical outcome. Personal, surgical and rehabilitation factors should be considered in order to optimize patient management and maximize the expected results. Further studies are needed to find the strongest factors in different patients. LEVEL OF EVIDENCE: Level IV, retrospective study.