Recovery of Soccer Players After Anterior Cruciate Ligament Reconstruction.

Study Overview
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Brief Summary
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The purpose of this CRT study is to compare clinical and functional outcomes of three graft types ( Quadriceps tendon with bone versus Hamstring tendon versus Quadriceps tendon without bone) for reconstration of anterior cruciate ligament among football players.

Detailed Description
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In the previous studies patellar tendon and hamstring tendon were the most investigated graft types. While quadriceps tendon has been investigated a fewer times. And to our knowledge there is no control study that compare quadriceps tendon-patellar bone autograft with Quadriceps Autograft and Hamstring Autograft as control randomized study. All of the patients will be examined before of the surgery and 3, 6, 12, 24 months after the surgery to compare the outcome of differnt graft types. While a secand aim of this study is to examen the effect of rehabilitation protocol on the short and long term within all of the clinical and the functional outcomes. The rehabilitation protocol will contain one phase before the surgery and four phases after the surgery.The goal of the first phase will be pain and inflammation control, increase ROM and muscle strength will be during the second and the third phases.In the last phase all of the players have to achieve maximum muscle strength and neuromuscular control.

Official Title
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Recovery of Soccer Players After Anterior Cruciate Ligament Reconstruction.

Conditions
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Knee Injuries and Disorders

Intervention / Treatment
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* Procedure: ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION WITH QUADRICEPS TENDON WITH BONE GRAFT
* Procedure: ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION WITH HAMSTRING TENDON GRAFT
* Procedure: ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION WITH QUADRICEPS TENDON WITHOUT BONE GRAFT
* Other: Rehabilitation protocol


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients with ACL injury susceptible to receive a surgical reconstruction. Autograft with Hamstring tendon ,quadriceps tendon or quadriceps tendon with patellar bone. Soccer player for more than 3 years. Between 16 and 40 years old. Exclusion Criteria: Patient with previous joint injury. Patient with previous surgery on the affected knee. patient with previous musculoskeletal injury (4 weeks) Patient with untreated chronic injury.

Ages Eligible for Study
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Minimum Age: 16 Years
Maximum Age: 40 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Arm 1 QUADRICEPS TENDON WITH BONE GRAFT<br>Quadriceps tendon with bone will be used as graft for the surgery. | Procedure: ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION WITH QUADRICEPS TENDON WITH BONE GRAFT<br>* Quadriceps tendon with pattlar bone will used for grating<br>Other: Rehabilitation protocol<br>* All patients will receive six months rehabilitation program which aim to recover the strength and function<br>|
| Experimental: Arm 2 HAMSTRING TENDON GRAFT<br>Hamstring tendon with bone will be used as graft for the surgery | Procedure: ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION WITH HAMSTRING TENDON GRAFT<br>* Hamstring tendon with will used for grating<br>Other: Rehabilitation protocol<br>* All patients will receive six months rehabilitation program which aim to recover the strength and function<br>|
| Experimental: Arm 3. QUADRICEPS TENDON WITHOUT BONE GRAFT<br>Quadriceps tendon without bone will be used as graft for the surgery. | Procedure: ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION WITH QUADRICEPS TENDON WITHOUT BONE GRAFT<br>* Quadriceps tendon without pattlar bone will used for grating<br>Other: Rehabilitation protocol<br>* All patients will receive six months rehabilitation program which aim to recover the strength and function<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| change of Isokinetic strenght test | the assessment will be made with GENU 3 dynamometer (GENU 3, Easytech, Firenze, Italy), using isokinetic parameters at angular velocities of 60°/sec (3 repetitions), 180°/sec (5 repetitions) and 300°/sec (15 repetitions) with 30 seconds of rest among these. To determine the height of the chair, the lateral femoral condyle was aligned with the rotational axis of the dynamometer. The peak torque, average torque and flexor-extensor torque rate value. Patients will be warm up in a cycle ergometer previously (5 min) and them performing mobilization exercises and stretching in lower limbs (5 min). | Patients will be examined before , after 3 , 6 12 and 24 month of the surgery | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Visual Analogical Scale | the participants will be completed a visual analogue scale (0-10 points) to assess the presence of knee pain. | Patients will be examined before , after 3 , 6 12 and 24 month of the surgery | 
| Pressure Pain Thresholds | We will use an electronic algometer (Somedic AB, Farsta, Sweden) over 6 points: epicondyle (1), at the midpoint between the greater trochanter and the lateral condyle of the femur on the external (2), at three centimeters above the patella in the vastus medialis (3), at the midpoint between the lower pole of the patella and the anterior tuberosity of the tibia (4), at 3 cm above the patella in midline of the thigh (5) and at the inclusion of the goose leg. The mean of 3 trials will be used for the main analysis. | Patients will be examined before , after 3 , 6 12 and 24 month of the surgery | 
| MUSCLE ARQUITECTURE | an ultrasound device (MyLab™ 25, Esaote Medical Systems,Genova, Italy) and a 12 MHz linear probe will be used in this study. The depth and width of quad tendon and articular cartilage of femoral trochlea will be captured. | Patients will be examined before , after 3 , 6 12 and 24 month of the surgery | 
| ANTEROPOSTERIOR LAXITY | it will be measured using the KT-2000 TM arthrometer (MEDmetric, Sn Diego, CA, USA) | Patients will be examined before , after 3 , 6 12 and 24 month of the surgery | 
| Tegner questionnaire | It is a subjective satisfaction index of on a scale of 0 to 100 | Patients will be examined before , after 3 , 6 12 and 24 month of the surgery | 
| Single-legged hop test | The patient is placed standing on one leg and must jump as far as possible landing on the same leg. | Patients will be examined before , after 3 , 6 12 and 24 month of the surgery | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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ACLR, Quadricepses tendon graft, hamstring tendon graft