Study Design: Case report. Background: To present the rehabilitative course, decision-making, and clinical milestones that allowed a top-level professional soccer player to return to full competitive activity 90 days after surgery. Case Description: The patient was a 35-year-old forward player who sustained an isolated complete tear of the left anterior cruciate ligament (ACL) in the midst of the competitive 2001-2002 season. He was in contention for a position on the Italian World Cup Team that was to be played 135 days after his injury, only if he demonstrated that he could return to play at the highest level before the team was selected. The patient underwent an arthroscopically assisted ACL reconstruction with a double-loop semitendinosus-gracilis autograft 4 days after the injury. Eight days after surgery he began rehabilitation at a rate of 2 sessions a day, 5 days a week, plus 1 session every Saturday morning. These sessions were performed in a pool for aquatic exercises, in a gymnasium for flexibility, coordination, and strength exercises, and on a soccer field for recovery of technical and tactical skills, with continuous monitoring of training intensity. Outcomes: The surgical technique and the progressive rehabilitation program allowed the patient to play for 20 minutes in an official First Division soccer game 77 days after surgery and to play a full game 90 days after surgery. Eighteen months postsurgery, the player had participated in 62 First Division matches, scoring 26 times, and had received no further treatment for his knee. Discussion: This case report suggests that early return to high-level competition after ACL reconstruction is possible in some instances. Some factors that may have favored the early return include optimal physical fitness before surgery, a strong psychological determination, an isolated ACL lesion, a properly placed and tensioned graft, a personalized progression of volume and intensity of exercise loads, and an appropriate density of rehabilitative training consisting of a mix of gymnasium, pool, and field exercises.

J Orthop Sport Phys Ther. 2005;35(2):52-66. doi: 10.2519/jospt.2005.1583

Key Words: ACL, knee, rehabilitation, semitendinosus

Study Design: Random allocation of subjects into a placebo-controlled, crossover study. Objectives: To investigate the effect of changing thoracic and scapular posture on shoulder flexion and scapular plane abduction range of motion in asymptomatic subjects, and in subjects with subacromial impingement syndrome. Background: Changes in upper body posture and concomitant imbalance of the muscle system have been proposed as one of the etiological mechanisms leading to subacromial impingement syndrome. Although clinicians commonly assess posture and devise rehabilitation programs to correct posture, there is little evidence to support this practice. Methods and Materials: Selected postural, range of movement, and pain measurements were investigated in 60 asymptomatic subjects and 60 subjects with subacromial impingement syndrome, prior to and following thoracic and scapular taping intended to change their posture. Results: Changing posture had an effect on all components of posture measured (P<.001) and these changes were associated with a significant increase (P<.001) in the range of motion in shoulder flexion and abduction in the plane of the scapula. Changing posture was not found to have a significant effect on the intensity of pain experienced by the symptomatic subjects, although the point in the range of shoulder elevation at which they experienced their pain was significantly higher (P<.001). Conclusions: The findings of this investigation suggest that changing 1 or more of the components of posture may have a positive effect on shoulder range of movement and the point at which pain is experienced.

J Orthop Sport Phys Ther. 2005;35(2):72-87. doi: 10.2519/jospt.2005.1578

Key Words: pain, scapula, taping, thorax

Study Design: Systematic literature review. Objective: To compare the effectiveness of conventional treatment complemented by supervised rehabilitation training (supervised exercises) with conventional treatment alone for the rehabilitation of acute lateral ankle sprains. Background: Conventional treatment is advocated as a preferable treatment strategy. Whether supervised exercises should complement conventional treatment is unclear. Methods and Measures: We searched 5 computerized databases from 1966 to March 2004, checked the reference lists of all studies that fulfilled our eligibility criteria, and searched for nonindexed journals available on the Internet. Three reviewers independently selected randomized controlled trials (RCTs), and controlled clinical trials (CCTs), comparing conventional treatment alone with conventional treatment combined with supervised exercises for treating patients with an acute lateral ankle sprain. Two reviewers independently assessed the methodological quality of each included study. Two reviewers extracted data regarding outcomes, interventions, and results. Follow-up measurements were grouped as (a) immediate term, (b) short term, (c) intermediate term, and (d) long term. A best-evidence synthesis was conducted, weighting the studies with respect to their internal validity and statistical significance of the outcomes. Results: Seven RCTs were included. The quality assessment resulted in 1 high quality and 6 low-quality studies. There is limited evidence that the addition of supervised exercises to a conventional treatment approach results in greater reduction in swelling and faster return to work. Studies reporting a lack of difference between treatment approaches did not report statistical power, making interpretation of those results difficult. Conclusions: The retrieved data failed to demonstrate a clearly superior treatment approach, although preliminary support exists for supervised exercises. Additional high-quality RCTs are needed that are appropriately designed and reported.

J Orthop Sports Phys Ther. 2005;35(2):95-105. doi: 10.2519/jospt.2005.1314

Key Words: calcaneofibular ligament, exercise, physical therapy, talofibular ligament