first 72 sport exposure including participation in sport games and practice sessions. The exact reason as to why the second ACL injury occurred is not yet clear. However, it could result from early high-frequency exposure of the harvested graft tissue to excessive loads, particularly during participation in high-demand physical activities. Risk factors that may have contributed to injuring the contralateral ACL might be the continued presence of the risk factors that caused the initial ACL injury (Hewett et al., 2005), unresolved abnormal joint biomechanics, and functional limitation before returning to sport activities (Di Stasi, Hartigan, & Snyder-Mackler, 2015; Hartigan et al., 2010; Nawasreh et al., 2016; Paterno et al., 2010; Paterno, Ford, Myer, Heyl, & Hewett, 2007; Roewer et al., 2011; Schmitt et al., 2012). Multiple risk factors have been proposed as contributing factors to ipsilateral graft injury, some of which are patient-specific factors including being a youth athlete (Lind, Menhert, & Pedersen, 2012; Magnussen et al., 2012; Shelbourne et al., 2009) and a family Long-term knee joint health In addition to the second ACL injury, injuries to the intra- articular knee structures and long-term knee health also have been studied after ACL injury and surgery. Patients who fail to demonstrate knee stability after ACL injury are 12-times more likely to incur a meniscus injury that requires them to seek operative management (K. L. Dunn et al., 2016; Logerstedt, et al., 2010b), whereas patients who are managed operatively demonstrate lower risk for meniscus tear and require less subsequent knee surgery (Chalmers et al., 2014). Chondral lesions are reported as an adverse effect of knee instability after ACL injury, with the severity of the lesion increasing with longer time from injury (Logerstedt et al., 2010a). Unfortunately, meniscus and chondral lesions may continue to deteriorate, which in turn may impact knee joint health and place the knee at Psychosocial factors Following ACL injury, 60% of athletes who have been cleared for return to sport have not returned to full competition at 1 year from surgery, and half of patients are not participating in preinjury activity levels 3 to 4 years after ACL reconstruction (Kvist et al., 2005; Lentz et al., 2012; Webster et al., 2008). Despite these poor results, 90% of patients demonstrate normal or near-normal knee function when assessed using impairment- based outcomes within this same time frame (Ardern et al., 2011a). This apparent disparity may result from the influence of psychosocial factors – including fear of reinjury, decreased self-efficacy, and emotional factors – on the ability to return to preinjury activity levels. Psychological distress is frequently encountered after ACL reconstruction and typically improves over time. A study demonstrates that athletes who did not return to sport after ACL reconstruction had significantly lower preoperative motivation and less positive psychological response than those who did return (Ardern, Taylor, Feller, Whitehead, & Webster, 2013). In those who returned, those with more positive perception of their return had greater intrinsic motivation, a greater sense of autonomy, competence, and relatedness needs satisfaction (Ardern et al., 2013). Evidence also suggests that positive emotions increase and negative emotions decrease as rehabilitation progresses and upon return to sport (Everhart et al., 2013; Hartigan, Lynch, Logerstedt, Chmielewski, & Snyder- Mackler, 2013; Wu, Liu, Dines, Kelly, & Garcia, 2016). Fear of movement and reinjury decreases as rehabilitation progresses after surgery but can continue to impact function during return-to-activity time frames (Chmielewski et al., 2008). Although patient activity levels may decrease for non-knee Case study A 25-year-old woman is referred to physical therapy 1 week after left ACL reconstruction with a semitendinosus and gracilis tendon autograft. Five weeks ago, the client was injured during a soccer match when she planted her left foot during a change of direction as a defender. She heard an audible “pop” and had immediate sharp pain inside her left knee. As she attempted to
history of ACL injury (Bourke, Gordon, et al., 2012; Webster et al., 2014). Sustaining a contact mechanism of injury at the time of initial ACL injury also has been reported to associate with second ACL injury (Salmon et al., 2005). Surgical-specific risk factors included a vertical graft orientation (Bourke, Salmon, et al., 2012; Hui et al., 2011; Leys et al., 2012), small graft size and laxity (Bourke, Salmon et al., 2012; Magnussen et al., 2012; Park et al., 2013; Pinczewski et al., 2007), and using a hamstrings graft (Maletis et al., 2013). Physical activities status postoperatively has been also attributed to second ACL injury. This can include return to highly physical and pivoting sport activities (Salmon et al., 2005; Bourke, Salmon, et al., 2012; Paterno et al., 2012), with an early return to competitive sport activities increasing the rate of second ACL injury (Borchers et al., 2009; Laboute et al., 2010; Paterno et al., 2012; Webster & Feller, 2016). even higher risk of osteoarthritis (Barenius et al., 2014). Restoring passive knee stability by the reconstructive surgery did not prevent the development of knee osteoarthritis; instead, patients who were managed operatively were 3-times more likely to develop knee osteoarthritis in the reconstructed knee compared to the contralateral knee, with no difference in the knee osteoarthritis prevalence between the bone-patellar tendon- bone and hamstrings tendon autografts (Barenius et al., 2014). A systemic study indicated that the prevalence of radiological knee osteoarthritis was not different between operative and nonoperative ACL management (Chalmers et al., 2014) although another systematic review published in the same year found lower prevalence of osteoarthritis following nonoperative versus operative management (Luc et al., 2014). related life events that include decreased organized sports opportunities, occupation, education, or child care (Everhart et al., 2013), patients who have not returned to preinjury activity levels several years following ACL reconstruction demonstrate greater fear of reinjury (Kvist et al., 2005). In fact, 46% of patients had returned to preinjury activity levels, whereas 54% did not return. In those who did not return, 68% reported persistent knee symptoms, and 52% reported fear of reinjury as factors for not returning to sport (Everhart et al., 2013). Furthermore, athletes after ACL reconstruction who do not return to sports are more likely to have poor quality of life outcomes (Filbay, Crossley, & Ackerman, 2016). Self-efficacy is the judgment of one’s potential ability to carry out a task regardless of ability to perform the task or actual performance of the task (Bandura, 1977). Levels of self-efficacy are often low following ACL injury and ACL reconstruction but typically improve during the course of rehabilitation. It is important to discuss self-efficacy with patients throughout rehabilitation because poor self-efficacy can negatively affect progress toward achieving rehabilitation goals. Preoperative K-SES scores have been found to predict knee-related quality of life and return to intensity and frequency of preinjury activity levels 1 year following ACL reconstruction (P. Thomeé et al., 2008). Emotional factors such as depression may also affect patient progress following ACL injury; patients with ACL injury score higher on depression scales compared with uninjured controls (Mainwaring, Hutchison, Bisschop, Comper, & Richards, 2010). walk off the field unassisted, her knee buckled and gave way. She was then carried off the field by the athletic trainer. While on the sidelines, she noted that her left knee was swelling substantially. The client was referred by the athletic trainer to an orthopedic surgeon for consultation. The surgeon’s examination revealed gross and painful limitations in knee flexion ROM (100°
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Book Code: PTNJ0824
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