3min chapter

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Management of anterior cruciate ligament injuries with Dr Adam Culvenor

Joint Action

CHAPTER

Return to Sport and Osteoarthritis Risk

The main risk of returning to sport too early is the fact that you might re-inge your knee. We actually have very little evidence to suggest if we get quadriceps muscles stronger and if we reduce weight, whether that actually changes someone's risk. But it also sort of go back to your initial point on that is that we're trying to modify these risk factors. So actually trying to, when we change these risk factors, does that actually have an impact on osteoarthritis risk? And that's sort of a segue into a really nice study that we're doing here at the Trope.

00:00
Speaker 2
Yeah, no wonder wonderful and presumably the extension of that really is that, you know, if you want to reduce your osteoarthritis risk following the injury to maintain good strength, to keep your weight down and take advice about physical activity and return to sport. Just on the return to sport question, Adam, it's obviously great that they can get back to sport. Any advice that you give to people about the timing of that return?
Speaker 1
It varies, but there is some evidence as I suppose the main risk, so we're taking it back step. The main risk of returning to sport too early is the fact that you might re-inge your knee. If you don't have the strength around your knee to maintain the ability to jump, land, twist, pivot, then that's going to put your knee at risk of re-injuring. And then you've done a second ACL and you go and have a revision, another graft, you know, that's what we certainly don't want to happen. So historically it's been all about time, so we use time criteria, so you need to wait for nine months or 12 months and then you're able to get back to sport. But nowadays it's more around functional sort of criteria, so you have to tick off certain return to sport criteria to be able to safely return to sport. We can never prevent every single re-entry that's going to happen, but this is shown to be able to reduce that risk of re-injuring your knee. So there are things like being able to hop in different directions at least 90% compared to your un-engineered side, having quadriceps strength of at least 90% compared to other side, being able to train un-indid, you know, relatively comfortably before going back to match practice and then ultimately full competitive sport. So certainly those sort of return to sport, battery of tests are well established in literature and something that patients should absolutely be passing before they go back to sport. But it also sort of go back to your initial point on that is that we're trying to modify these risk factors. We actually have very little evidence to suggest if we get quadriceps muscles stronger and if we reduce weight, whether that actually changes someone's risk and is able to prevent or reduce the risk of osteoporitis, hypothetically because they are risk factors, absolutely. But we actually have almost no clinical trial evidence. So actually trying to, when we change these risk factors, does that actually have an impact on osteoarthritis risk? And that's sort of a segue into a really nice study that we're doing here at the Trope, which is trying to answer that exact question where we're strengthening quadriceps muscles, we're giving them the function back as best we can, we're giving them back the event losing weight and we're tracking whether these people using MRI scans, like how their target changes over time to ultimately try and say yes, if we change these things, we reduce their risk and prevent or reduce the risk of osteoarthritis moving forward. So what was the name of that study? Super knee.

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