Description
Objectives:
The majority of anterior cruciate ligament reconstruction (ACLr) patients wish to return to sport. Nonetheless, final clinical evaluations after ACLr often do not include physical testing, making it difficult to determine the patient’s readiness to return to sport. Thus, it would be helpful for clinicians to identify easily assessable factors associated with physical function in ACLr patients that could inform the planning of patients’ return to sport.
This study sought to evaluate the associations between physical test performance in ACLr patients and known ACL injury risk factors, knee laxity and patient-reported outcomes at one-year follow-up.
Methods:
The cohort included ACLr patients who underwent surgery between 2009-2014. The inclusion criteria were as follows: isolated primary ACLr and recorded data on single-hop, triple-hop or strength performance at one-year follow-up.
ACLr patients were invited to an extended one-year visit to clarify their readiness to return to sport. An extended test battery was performed, including clinical evaluation (sagittal knee laxity, pivot shift test), three patient-reported outcomes (Knee Injury and Osteoarthritis Outcome Score sport (KOOSsport), International Knee Documentation Committee (IKDC), Single Assessment Numeric Evaluation (SANE)) and three physical tests (single- and triple-hop and leg extension strength test, from which the Leg Symmetry Index (LSI) was calculated).
Multivariate regression analyses were performed for each of the three physical tests, including known risk factors, clinical outcomes (laxity <3 mm and a pivot shift grade of 0 were applied as cut-off values for good vs. poor status) and patient-reported outcomes (KOOSsport>75, IKDC>75.9 and SANE>92.7 were applied as cut-off values for good vs. poor status).
Results:
A total of 480 ACLr patients were included in the study. Sagittal laxity <3 mm had a negative impact on the single-hop LSI, whereas a pivot shift grade of 0 or IKDC>75.9 had a positive impact on the single-hop LSI. Age<20, a pivot shift grade of 0 and KOOSsport>75 were positively associated with the triple-hop LSI. Finally, age<20 and IKDC>75.9 were positively associated with the leg extension strength LSI.
Conclusion:
Age, sagittal laxity, pivot shift and patient-reported outcomes were associated with physical test performance one year after ACLr. However, the associations were not completely uniform and strong, so information on age, sagittal laxity, pivot shift and patient reported-outcomes cannot replace a return-to-sport functional test battery in determining when it is safe to return to sport after ACLr.
