Journal of Orthopaedic & Sports Physical Therapy - Mario Bizzini, PT, PhD

Suggestions From the Field for Return to Sports Participation Following Anterior Cruciate Ligament Reconstruction: Soccer

Fri, 30 Mar 2012 00:00:00 EST

Mario Bizzini, Dave Hancock, Franco Impellizzeri

SYNOPSIS: Successful return to play remains a challenge for a soccer player after anterior cruciate ligament reconstruction. In addition to a successful surgical intervention, a soccer-specific functional rehabilitation program is essential to achieve this goal. Soccer-like elements should be incorporated in the early stages of rehabilitation to provide neuromuscular training specific to the needs of the player. Gym-based and, later, field-based drills are gradually intensified and progressed until the player demonstrates the ability to return to team practice. In addition to the recovery of basic attributes such as mobility, flexibility, strength, and agility, the surgically repaired knee must also regain soccer-specific neuromuscular control and conditioning for an effective return to sports. The individual coaching of the player by the sports physiotherapist and compliance with the training program by the player are key factors in the rehabilitation process. To minimize reinjury risk and to maximize the player’s career, concepts of soccer-specific injury prevention programs should be incorporated into the training routine during and after the rehabilitation of players post–ACL reconstruction. LEVEL OF EVIDENCE: Therapy, level 5.

J Orthop Sports Phys Ther 2012;42(4):304-312. doi:10.2519/jospt.2012.4005

KEY WORDS: ACL, football/soccer, functional training, injury prevention

Lateral Meniscus Repair in a Professional Ice Hockey Goaltender: A Case Report With a 5-Year Follow-up

Mon, 05 Feb 2007 09:45:00 EST

Mario Bizzini, Mark Gorelick, Thomas Drobny

Study Design: Case report of a professional ice hockey goaltender who underwent an arthroscopically assisted lateral meniscus repair. Background: Rehabilitation of isolated meniscal repairs is not well documented in the literature. There is little knowledge about the healing time and the choice of rehabilitation exercises to be applied to a repaired meniscus. The objective of this case report is to describe a criterion-based, supervised, sport-specific rehabilitation protocol for a high-level athlete with a lateral meniscus repair from the first postoperative day until return to competitive sport, including a 5-year follow-up. Case Description: The criterion-based protocol used with this athlete was based on a sport-specific neuromuscular rehabilitation approach. Data collected included range of motion, strength, neuromuscular control, and magnetic resonance images. Outcomes: This high-level athlete was able to return to sport 103 days after surgery and no reinjury of the lateral meniscus occurred up to 5 years after surgery. Discussion: The sport-specific, criterion-based, supervised rehabilitation program described in this case report showed a safe return to sport and a good long-term outcome.

J Orthop Sports Phys Ther. 2006;36(2):89-100. doi:10.2519/jospt.2006.2015

Key Words: knee, meniscal repair, surgery

Systematic Review of the Quality of Randomized Controlled Trials for Patellofemoral Pain Syndrome

Thu, 07 Dec 2006 00:00:00 EST

Mario Bizzini, John D. Childs, Sara R. Piva, Anthony Delitto
Study Design: Systematic review of the literature. Objectives: To develop a grading scale to judge the quality of randomized clinical trials (RCTs) and conduct a systematic review of the published RCTs that assess nonoperative treatments for patellofemoral pain syndrome (PFPS). Background: Systematic reviews of the quality and usefulness of clinical trials allow for efficient synthesis and dissemination of the literature, which should facilitate clinicians’ efforts to incorporate principles of evidence-based practice in the clinical decision-making process. Methods and Measures: Using a scale based on criteria in the Cochrane Collaboration Handbook, we sought to critically appraise the methodology used in RCTs related to the nonoperative management of PFPS, synthesize and interpret our results, and report our findings in a user-friendly fashion. A scale to assess the methodological quality of trials was designed and pilot tested for its content and reliability. Published RCTs identified during a literature search were then selected and rated by 6 raters. We used predefined cutoff scores to identify specific weaknesses in the clinical research process that need to be improved in future clinical trials. Results: The quality scale we developed was demonstrated to be sufficiently reliable to warrant interpretation of the reviewers’ findings. The percentage of trials that met a minimum level of quality for each specific criterion ranged from a low of 25% for the adequacy of the description of the randomization procedure to a high of 95% for the description and standardization of the intervention. Conclusions: Based on the results of trials exhibiting a sufficient level of quality, treatments that were effective in decreasing pain and improving function in patients with PFPS were acupuncture, quadriceps strengthening, the use of a resistive brace, and the combination of exercises with patellar taping and biofeedback. The use of soft foot Orthotics in patients with excessive foot pronation appeared useful in decreasing pain. In addition, at a short-term follow-up, patients who received exercise programs were discharged earlier from physical therapy. Unfortunately, most RCTs reviewed contained qualitative flaws that bring the validity of the results into question, thus diminishing the ability to generalize the results to clinical practice. These flaws were primarily in the areas of randomization procedures, duration of follow-up, control of cointerventions, assurance of blinding, accountability and proper analysis of dropouts, number of subjects, and the relevance of outcomes. Also, given the limited number of high-quality clinical trials, recommendations about supporting or refuting specific treatment approaches may be premature and can only be made with caution.

J Ortho Sports Phys Ther. 2003;33(1):4-20.

Keywords: bias, decision making, evidence, grading, methodology