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Background: Return to sport after stabilization surgery using the open Latarjet procedure remains challenging. Additional knowledge is needed about postoperative shoulder functional deficits in order to better design return-to-sport programs. Purpose: To investigate the effects of the dominance status of the operated shoulder on the shoulder functional profile recovery at 4.5 months after open Latarjet procedure. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A retrospective analysis of prospectively collected data was performed. All patients who underwent the open Latarjet procedure between December 2017 and February 2021 were eligible for the study. Functional assessment at 4.5 months after the surgery was performed using the following tests: maximal voluntary isometric contractions in glenohumeral internal and external rotation, upper-quarter Y balance test, unilateral seated shot-put test, and modified closed kinetic chain upper extremity stability test, leading to 10 outcome measures. Patients whose dominant side had undergone surgery and those whose nondominant side had undergone surgery were compared with a group of 68 healthy control participants. Results: A total of 72 patients who underwent an open Latarjet procedure on the dominant side and 61 patients who underwent open Latarjet on the nondominant side were compared with 68 healthy control athletes. In patients whose dominant shoulder had undergone surgery, significant deficits for the dominant side ( P < .001) and for the nondominant side ( P < .001) were found in 9 of 10 functional outcome measures. Among patients whose operations were on the nondominant shoulder, significant deficits for the nondominant side ( P < .001) and for the dominant side ( P < .001) were found in 9 and 5 of the 10 functional outcome measures, respectively. Conclusion: Regardless of dominance of the stabilized shoulder, persistent deficits in strength, stability, mobility, power, and stroke frequency were observed at 4.5 months postoperatively. Stabilization of the dominant shoulder resulted in residual surgery-related functional impairments on both sides. However, stabilization of the nondominant shoulder resulted in impairments primarily noted in the nondominant, operative shoulder. Registration: NCT05150379 (ClinicalTrials.gov identifier).

Background: The time elapsed since surgery is the primary criterion for allowing athletes to return to sport after shoulder stabilization surgery using the Latarjet procedure. The objective assessment of shoulder functional status through the return-to-sport continuum demands a scoring instrument that includes psychological and physical dimensions. This study aimed to statistically validate the Shoulder-SanTy Athletic Return To Sport (S-STARTS) score in patients who have undergone primary shoulder stabilization surgery. Hypothesis: The S-STARTS score fulfils the criteria for statistical validation for assessing return-to-sport readiness after shoulder stabilization surgery. Study Design: Diagnostic study. Level of Evidence: Level 4. Methods: Fifty patients and 50 controls completed the Shoulder Instability-Return to Sport after Injury questionnaire and performed 4 physical performance tests, from which 8 outcome measures were extracted to provide a composite score, named S-STARTS, according to a scoring procedure. The statistical validation of the S-STARTS score was based on construct validity, discriminant validity, sensitivity to change, internal consistency, reliability, agreement, and feasibility. Results: The 8 components of the S-STARTS score provided additional information (0.01 ≤ | r| ≤ 0.59). The S-STARTS score exhibited good reliability (intraclass coefficient of correlation [3,k] = 0.74), no ceiling or floor effects, and high discrimination and sensitivity to change. The S-STARTS score was significantly lower in patients than in controls (13.5 ± 3.8 points vs 16.1 ± 2.7 points, respectively; P < 0.001). A significant increase was reported between 4.5 and 6.5 months postoperatively (12.8 ± 2.3 points vs 17.2 ± 2.4 points, respectively; P < 0.001). Conclusions: The S-STARTS score meets statistical validation criteria for the assessment of shoulder functional status after shoulder stabilization surgery using the Latarjet procedure. Clinical Relevance: Using an S-STARTS score–based assessment to monitor an athlete’s progression through the return-to-sport continuum may help clinicians and strength and conditioning coaches in return-to-sport decision-making.

Background: Return to sport (RTS) to the preinjury level is the main purpose after anterior cruciate ligament (ACL) reconstruction but the factors affecting the RTS are not completely known. Knee Santy Athletic Return to Sport (K-STARTS) is a composite test designed to assess readiness for RTS after ACL reconstruction. Purpose: To determine the key factors that influence K-STARTS scores in a large cohort of patients after ACL reconstruction. Study Design: Case-control study. Level of Evidence: Level 3. Methods: A retrospective analysis of prospectively collected data was undertaken. All patients who underwent ACL reconstruction surgery between March 2016 and May 2017 and also had a K-STARTS assessment at 6 months postoperatively were included. To identify factors influencing the K-STARTS score, an analysis of variance was performed. Age, sex, sports level, delay between injury and surgery, concomitant lesions, graft type, additional lateral tenodesis procedure, and participation in the RTS program were analyzed to identify factors influencing the K-STARTS score. Results: A total of 676 patients were included in the study. The K-STARTS score was significantly higher in male patients than in female patients (13.9 vs 12.4; P < 0.001), in younger patients (those aged Conclusion: Completion of a specific RTS program, in addition to standard rehabilitation, was the most important factor influencing the K-STARTS composite functional and psychological RTS test score at 6 months after ACL reconstruction. Clinical Relevance: This study shows that the completion of a specific RTS program affects positively the RTS test score at 6 months after ACL reconstruction.

Background The Unilateral Seated Shot-Put Test (USSPT) consists of pushing an overweight ball as far as possible to assess upper extremity power unilaterally and bilateral symmetry. Literature however reports various body positions and upper limb pushing patterns to perform USSPT, demanding to provide additional guideline to achieve overweight ball push. This study therefore aimed at assessing the reliability and agreement of USSPT outcome measures when pushing an overweight ball in a horizontal direction. Methods Twenty-seven healthy male athletes performed two sessions, one week apart, of three unilateral pushes per upper limb using a 3-kg medicine ball, for which the distances were measured. The intraclass correlation coefficient (ICC), standard error of measurement (SEM), minimum detectable change at a 95 % confidence level (MDC95 %) and coefficient of variation (CV) were assessed for the pushing distances based on one, two or three trials per side to produce two outcome measures: the pushing distance per limb and USSPT Limb Symmetry Index (LSI) when dividing pushing distance of the dominant side by that of the non-dominant side. Results The most reliable pushing distance per limb was obtained when averaging three pushing distances, normalized by body mass with the exponent 0.35. The mean USSPT LSI was 1.09 ± 0.10 for the first session and 1.08 ± 0.10 for the second session, highlighting good reliability and agreement (ICC = 0.82; SEM = 0.045; MDC95 % = 0.124; CV = 5.02 %). Conclusions When the overweight ball is pushed in a horizontal direction, averaging the distances of three trials for both the dominant and non-dominant limbs is advised to provide the most reliable USSPT distance per limb and USSPT LSI.

Background: To reduce the rate of anterior cruciate ligament (ACL) graft rupture, recent surgeries have involved anterolateral ligament reconstruction (ALLR). This reconstruction procedure harvests more knee flexor muscle tendons than isolated ACL reconstruction (ACLR), but its influence on knee muscle strength recovery remains unknown. This study aimed to assess the influence of ALLR with a gracilis graft on the strength of the knee extensor and flexor muscles at 6 months postoperatively. Hypothesis: The additional amount of knee flexor harvest for ALLR would result in impairment in knee flexor muscle strength at 6 months postoperatively. Study Design: Retrospective cohort study. Level of Evidence: Level 2. Methods: A total of 186 patients were assigned to 2 groups according to the type of surgery: ACL + ALLR (graft: semitendinosus + gracilis, n = 119) or isolated ACLR (graft: semitendinosus, n = 67). The strength of the knee extensor and flexor muscles was assessed using an isokinetic dynamometer at 90, 180, and 240 deg/s for concentric and 30 deg/s for eccentric contractions and compared between groups using analysis of variance statistical parametric mapping. Results: Regardless of the surgery and the muscle, the injured leg produced significantly less strength than the uninjured leg throughout knee flexion and extension from 30° to 90° for each angular velocity (30, 90, 180, and 240 deg/s). However, the knee muscle strength was similar between the ACL + ALLR and ACLR groups. Conclusion: The addition of ALLR using the gracilis tendon during ACLR does not alter the muscle recovery observed at 6 months postoperatively. Clinical Relevance: Although more knee flexor muscle tendons were harvested in ACL + ALLR, the postoperative strength recovery was similar to that of isolated ACLR.

Objectives: Second ACL injuries (defined as a graft rupture or contralateral ACL rupture) are common after ACL reconstruction. It is postulated that this observation could reflect a premature attempt to return to sports (RTS) and that delaying RTS until certain quality indicators or rehabilitation milestones are met could reduce the risk. There is consequently considerable interest in the application of RTS criteria. Multiple authors have reported that patients who passed a battery of tests prior to RTS, had a lower risk of re-injury and an increased rate of return to sport. However, factors influencing RTS scores have not been well studied. Therefore, the aim of this study was to determine the key factors that influence RTS test scores. Methods: A retrospective analysis of consecutive patients who underwent primary ACL reconstruction between March 2016 and May 2017, who also had a documented RTS evaluation with K-STARTS, (a validated, composite psychological and functional RTS test battery (Fig 1)) at 6 months following surgery, was undertaken. All patients underwent the same standardized rehabilitation program (Table 1) but in addition to this they were offered the opportunity to participate in a separate individualized RTS program (Table 2). If patients chose to participate in the RTS program, this would occur in addition to the standard program and not instead of it. The first session would typically occur 3 months post-operatively and comprised of ten sessions that took place over a 12-week period. Demographic data and characteristics including the frequency of pre-injury sports participation, Tegner score, time from injury to surgery, graft type, the presence of meniscal lesions, whether a lateral tenodesis was performed, and whether patients participated in the specific RTS program in addition to physiotherapy were recorded. To identify factors influencing the K-STARTS score at six months postoperatively, an analysis of variances was performed. When a significant effect was found, post hoc comparisons were made using Tukey’s HSD tests with Bonferroni’s correction. Results: 676 patients were included in the study. Outcomes of the analysis of the influence of factors on the K-STARTS score is comprehensively presented in Table 3. The K-STARTS score was significantly higher in males than females (13.9 vs 12.4, pConclusions: Completion of a specific return to sports program, in addition to standard rehabilitation, was the most important factor influencing the K-STARTS composite functional and psychological return to sports test score at 6 months after ACL reconstruction.

BACKGROUND: Restoring knee muscle strength after an anterior cruciate ligament (ACL) reconstruction remains challenging. Improvement of rehabilitation program specificity demands additional knowledge on knee muscle strength deficits associated with the graft used for ACL reconstruction. PURPOSE: This study aimed to investigate the effects of graft used for ACL reconstruction on the knee muscle strength and balance assessed at six months postoperatively, based on comparisons of the isokinetic strength curves measured throughout knee extension. STUDY DESIGN: Cross-sectional study METHODS: One-hundred-and-forty-four patients were assigned into three groups according to the graft used for a primary ACL reconstruction: semitendinosus (n=47), semitendinosus+gracilis (n = 75) and patellar (n=22) tendon graft. Normalized hamstring eccentric and quadriceps concentric torques, and hamstrings-to-quadriceps torque ratio (defined as the dynamic functional ratio) were bilaterally assessed during knee extension. Statistical parametric mapping was used to compare the curves of torques and ratio from 90 ° to 30 °of knee flexion between groups. RESULTS: The uninvolved knees presented similar strength and ratio curves in the three groups. When compared involved to uninvolved knees, hamstring strength deficit was found in hamstring tendon groups throughout knee extension (p

Objectives To assess the reliability of a modified procedure for Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST). Design Intra- and intersession reliability and agreement; Setting Clinical. Participants Twenty-seven asymptomatic athletes. Main outcome measures The modifications (m-CKCUEST) in CKCUEST procedure consisted in hand spacing at one half arm-span, and to complete the three regular-series of 15 s exertion by performing a fourth 1-min series during which the number of touches was counted every 15 s. The intra- and intersession reliability and agreement were assessed for the numbers of touches in order to produce two outcome measures: m-CKCUEST score and muscular endurance index. Results The most reliable m-CKCUEST score was obtained when averaging the numbers of touches of the second and third sets (Intraclass Coefficient of Correlation(3,k); ICC = 0.92). Good reliability was found for muscular endurance index computed when dividing the one-half number of touches counted during the last 30 s of 1-min set, by the m-CKCUEST score calculated above (ICC = 0.86). Conclusions The m-CKCUEST allowed the production of two reliable outcome measures, which assessed the upper limb stability and the muscular endurance. Such outcomes may be used in a follow-up to assess performance or rehabilitation level.

Background: There is limited information on the appropriate timing of return to sports after anterior cruciate ligament (ACL) reconstruction. A composite test was developed to assess the athlete’s ability to return to sports after ACL reconstruction: the Knee Santy Athletic Return To Sport (K-STARTS) test. Hypothesis: The K-STARTS test meets validation criteria for an outcome score assessing readiness for return to sports after ACL reconstruction. Study Design: Diagnostic study. Level of Evidence: Level 3. Methods: A prospective comparative study identified 410 participants: 371 participants who had undergone ACL reconstruction and a control group of 39 healthy participants. The K-STARTS score is calculated as the sum of 7 tests (8 components), for a maximal value of 21 points. Construct validity, internal consistency, discriminant validity, and sensitivity to change were used to validate this new test. Results: The K-STARTS assessment showed a high completion rate (100%), high reproducibility (intraclass correlation coefficient, 0.87; coefficient of variation, 7.8%), and high sensitivity to change. There was moderate correlation with the ACL Return to Sports after Injury scale (ACL-RSI) and hop tests. There were no ceiling or floor effects. There was a significant difference between K-STARTS scores assessed at 6 and 8 months postoperatively (11.2 ± 2.7 vs 17.1 ± 3.2; P < 0.001). The K-STARTS score in the control group was significantly higher than that in the ACL reconstruction group (17.3 ± 2.1 and 13.7 ± 3.8, respectively; P < 0.001). Conclusion: The K-STARTS test is an objective outcome measure for functional improvement after ACL reconstruction. Clinical Relevance: It is important for the clinician to determine when return to sports is optimal after ACL reconstruction to reduce the current high risk of reinjury.

Objective To determine the key factors that influence return to sports (RTS) test scores (when using K-STARTS) in a large cohort of patients following ACL reconstruction. Design A retrospective analysis of prospectively collected data was undertaken. All patients who underwent ACL reconstruction surgery during the study period, and also had a K-STARTS assessment at 6 months post-operatively were included. In order to identify factors influencing the K-STARTS score, an analysis of variances was performed. Results A total of 676 patients were included in the study. The K-STARTS score was significantly higher in males than females (13.9 vs. 12.4, p > 0.001), in younger patients (those aged less than 30 vs older patients, 14.2 vs. 12, p > 0.001), ACL reconstructions performed with hamstring tendon autografts compared to bone-patellar tendon-bone (13.5 vs. 13.1, p = 0.03) and in those who completed a specific RTS program in addition to standard rehabilitation, compared to those who did not participate (17.1 vs. 13.1, p > 0.001). However, the only factor that significantly influenced the K-STARTS score beyond the minimal detectable change threshold was the completion of the additional RTS program. The pre-injury frequency of sports participation, whether the dominant limb was injured, time from injury to surgery, the presence of associated meniscal injuries and whether a lateral tenodesis was performed, did not significantly influence the K-STARTS score. Conclusion Completion of a specific return to sports program, in addition to standard rehabilitation, was the most important factor influencing the K-STARTS composite functional and psychological return to sports test score at 6 months after ACL reconstruction.

The aim of this study was to examine the physical performance of a successful Italian Serie A team of more than 3 consecutive seasons. Twenty-five players participated in the study and were classified into 3 playing positions: defenders (n = 9), midfielders (n = 11), and forwards (n = 5). Activities match were studied by an analysis of multiple match camera SICS throughout the competition Italian Serie A matches played at home (n = 90) for 3 consecutive seasons (first: 2004/2005; second: 2005/2006; and third: 2006/2007). Total team ball possession and time-motion characteristics were examined. Results showed that total ball possession (52.1�54.9%) and the number of points accumulated at home (40/48) improved in the past 3 seasons, whereas the final rankings at home were stable. The total distances covered by minutes of play were significantly different between the 3 seasons (118.32 ± 6.69 m·min-1 to 111.96 ± 8.05 m·min-1). Distance running and high-intensity activities were similar in the 3 seasons, whereas the distance covered in moderate-intensity running decreased in the third (p < 0.05). Variations between playing positions were found during the 3 consecutive seasons, with midfielders covering greater distances than defenders (p < 0.05) and forwards (p < 0.01). This study showed how for 3 consecutive seasons a Serie A team of successful players reduced their distances performed at submaximal speeds, and increased ball possession, while maintaining the high-intensity activities and the number of points at home. It is suggested that this is because of a better understanding of roles and tactics team organization and to act collectively and individually on these parameters to reduce energy expenditure during the game to maintain a high-level performance throughout the season.

En raison du risque eleve de rupture iterative, le choix du delai optimal pour la reprise du sport apres plastie du ligament croise anterieur (LCA) s’avere souvent epineux en pratique quotidienne. Par ailleurs, la litterature fait etat d’un manque de criteres objectifs pour autoriser ce retour au sport. Les auteurs rapportent un test composite d’evaluation des capacites de retour au sport apres plastie du LCA : le test K-STARTS. Le K-STARTS est un test sur 21 points comprenant 7 items cotes sur 3 points chacun. L’objectif de l’etude etait de valider ce test comme score d’evaluation des capacites de retour au sport apres plastie du LCA. Il s’agissait d’une etude prospective comparative incluant 410 participants repartis en 2 groupes : un groupe de 371 patients operes d’une plastie du LCA et un groupe temoin de 39 sujets sains. La validation du test etait basee sur la validite de construction, la consistance interne, la validite discriminante et la sensibilite au changement. L’evaluation du K-STARTS a montre un excellent taux de remplissage (100 %), une forte reproductibilite (coefficient de correlation intra-classe : 0,87 ; coefficient de variation : 7,8 %) et une forte sensibilite au changement. Il existait une correlation moderee ou faible entre chacun des items du test et le score final. Il n’existait pas d’effet plafond ou plancher. Il existait une difference significative entre les scores au test K-STARTS a 6 et 8 mois postoperatoires dans le groupe des patients operes (11,2 ± 2,7 vs 16,8 ± 3,2, p > 0,001). Le score au test K-STARTS etait significativement meilleur dans le groupe temoin que dans le groupe des patients operes (17,3 ± 2,1 vs 13,7 ± 3,8, p > 0,001). En conclusion, le test K-STARTS est un outil d’evaluation des capacites fonctionnelles apres plastie du LCA objectif et reproductible.

Anterior Cruciate Ligament (ACL) injury is one of the most frequent injury type in individuals who participate in pivoting sports, with an annual incidence of more than 200,000 cases according to the American Academy of Orthopaedic Surgeons (2007).This has motivated numerous studies on risk factors and prevention strategies (see Griffin et al., 2000 for review), as well as on ACL reconstructiontechnics (see Spindler et al., 2004 as an example). The most prevalent complications after ACL reconstruction are quadriceps weakness, flexion contracture, and patellofemoral pain (Sachs et al., 1989).Patellofemoral Pain Syndrome (PFPS) is characterised by pain around the patella mainly at activities that load the patellofemoral joint like bending knees, walking stairs or kneeling. The origin of the complaints is not fully understood although weakness and/or tightness of the extensor muscles, changes in medial and lateral quadriceps muscle reflex time, patellar laxity and increased navicular drop are suggested to be associated with PFPS (Boling et al., 2009; Witvrouw et al., 2000). This study therefore aimed at comparing the isokinetic profile in female athletes with and without PFPSto gain further understanding in characteristics and prognosis of PFPS after ACL reconstruction.

The purpose of this study was to analyse the activity profile of players in a top-class team in the Italian national football league over the course of a season (n=388). The effect of playing position and the two halves on the number and duration of short, intense bursts of effort and recovery phases was studied. The main results show that midfielders cover significantly more distance than players in other positions (p