Fatigue induced alterations on lower limb after anterior cruciate ligament reconstruction - Implications in safe return to sport ; Impacto da fadiga no membro inferior após reconstrucção do ligamento cruzado anterior - implicações na retoma desportiva

Trabalho Final do Mestrado Integrado em Medicina apresentado à Faculdade de Medicina ; AbstractIntroduction: Anterior cruciate ligament (ACL) injuries are multifactorial in nature and its recurrence rates after anterior cruciate ligament reconstruction (ACLR) are unsatisfactory, underlying the need to redefine the decision criteria to return to sport (RTS). Fatigue is a factor proposed to adversely impact lower limb biomechanics and task performance, therefore contributing to reinjury numbers. The main purpose of this systematic review is to determine how fatigue alters lower limb biomechanics and task performance. Secondly, understand whether these changes constitute a risk factor for subsequent reinjury and whether fatigue should be incorporated into rehabilitation test batteries in order to enhance RTS protocols and reduce reinjury rates. Our aim is to improve safety when returning to sport. Methods: A systematic review of the literature using PubMed and Cochrane was performed. The studies deemed suitable for this Systematic Review were published between 2014 and 2023, in Portuguese or English language. The inclusion criteria according to PICO (Population, intervention, comparison, outcome) model involved patients who underwent ACLR (Population), in whom a fatigue protocol was applied (Intervention), and compared with a non-fatigated state (Comparison). The outcomes evaluated were kinetics/ kinematics of the lower limb or task performance (Outcomes). These outcomes were then discussed in order to understand if fatigue really induced higher injury risk. Results: 10 articles published between 2014 and 2023 were included in the synthesis. A total of 160 participants were involved, with a mean age of 25.14 years. Two studies used a peripheral fatigue protocol, and 8 studies used a central fatigue protocol. The outcome measures varied between kinetics or kinematics alterations, task performance variation or specific scores. Conclusions: Alterations seen in fatigued state generally constitute risk of injury but ...