Menzer Heather, Slater Lindsay V, Diduch David, Miller Mark, Norte Grant, Goetschius John, Hart Joseph M
Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA.
Shirley Ryan AbilityLab, Neuromechanics of Impaired Locomotion Lab, Chicago, Illinois, USA.
Orthop J Sports Med. 2017 Dec 18;5(12):2325967117744758. doi: 10.1177/2325967117744758. eCollection 2017 Dec.
Many clinicians release patients to return to activity after anterior cruciate ligament reconstruction (ACLR) based on time from surgery despite deficits in muscle strength and function. It is unclear whether symmetry or unilateral performance is the best predictor of subjective outcomes after ACLR.
To determine physical performance predictors of patient-reported outcomes after reconstruction.
Cross-sectional study; Level of evidence, 3.
A total of 88 participants (49 males, 39 females; mean ± SD height, 174.0 ± 9.6 cm; weight, 76.1 ± 18.5 kg; age, 19.4 ± 3.7 years) who underwent primary, unilateral ACLR volunteered for this study. Participants had undergone reconstruction a mean of 6.9 ± 1.8 months (range, 5.0-14.1 months) before the study. All participants underwent strength testing as well as hop testing and then completed the International Knee Documentation Committee (IKDC) and Knee injury and Osteoarthritis Outcome Score (KOOS) questionnaires. Stepwise linear regression models were used for symmetry and unilateral performance to identify the proportion of variance explained in the IKDC score, KOOS total score, KOOS-sport subscale, and time from surgery, as well as receiver operating characteristic (ROC) curve analyses on those variables that explained the most variance in patient-reported outcomes to determine cutoff thresholds.
No significant correlations were found between time from surgery and objective performance. The only significant predictors of IKDC score were single-hop limb symmetry index (LSI) and age ( = 0.177) and unilateral triple-hop performance and age ( = 0.228). The cutoff for single-hop symmetry was 0.92 (area under the curve [AUC], 0.703; = .012), and the cutoff for normalized triple-hop distance was 3.93 (AUC, 0.726; = .005). When stratified by age, the cutoff for single-hop symmetry was 0.81 (AUC, 0.721; = .051) for younger patients (age <19.1 years) and was not significant for older patients (age ≥19.1 years). The cutoff for normalized triple-hop distance was 3.85 (AUC, 0.832; = .005) in older patients and was not significant for younger patients. The only significant predictors of KOOS-sport subscale were single-hop LSI ( = 0.140) and normalized knee extensor power at 180 deg/s ( = 0.096). When subjective outcomes were predicted based on KOOS-sport subscale, the cutoff for single-hop symmetry was 0.85 (AUC, 0.692; = .018).
Hopping performance is the most predictive functional variable of subjective outcomes after reconstruction. Single-hop symmetry was most important for younger patients and unilateral triple-hop distance was most important for older patients. Clinicians should consider hopping performance when making return-to-activity decisions after ACLR.
许多临床医生在进行前交叉韧带重建术（ACLR）后，尽管患者存在肌肉力量和功能缺陷，但仍根据手术时间让患者恢复活动。目前尚不清楚对称性或单侧表现是否是ACLR后主观结果的最佳预测指标。
确定重建后患者报告结果的身体表现预测指标。
横断面研究；证据等级，3级。
共有88名接受初次单侧ACLR的参与者（49名男性，39名女性；平均±标准差身高，174.0±9.6厘米；体重，76.1±18.5千克；年龄，19.4±3.7岁）自愿参加本研究。参与者在研究前平均6.9±1.8个月（范围，5.0 - 14.1个月）接受了重建手术。所有参与者均接受了力量测试以及单腿跳测试，然后完成了国际膝关节文献委员会（IKDC）和膝关节损伤与骨关节炎结局评分（KOOS）问卷。采用逐步线性回归模型对对称性和单侧表现进行分析，以确定IKDC评分、KOOS总分、KOOS运动亚量表以及手术时间中可解释的方差比例，同时对那些在患者报告结果中解释方差最多的变量进行受试者工作特征（ROC）曲线分析，以确定临界阈值。
手术时间与客观表现之间未发现显著相关性。IKDC评分的唯一显著预测指标是单腿跳肢体对称指数（LSI）和年龄（=0.177）以及单侧三级跳表现和年龄（=0.228）。单腿跳对称性的临界值为0.92（曲线下面积[AUC]，0.703；=0.012），标准化三级跳距离的临界值为3.93（AUC，0.726；=0.005）。按年龄分层时，年轻患者（年龄<19.1岁）单腿跳对称性的临界值为0.81（AUC，0.721；=0.051），而老年患者（年龄≥19.1岁）则无显著差异。老年患者标准化三级跳距离的临界值为3.85（AUC，0.832；=0.005），年轻患者则无显著差异。KOOS运动亚量表的唯一显著预测指标是单腿跳LSI（=0.140）和180度/秒时的标准化膝关节伸肌力量（=0.096）。当根据KOOS运动亚量表预测主观结果时，单腿跳对称性的临界值为0.85（AUC，0.692；=0.018）。
跳跃表现是重建后主观结果最具预测性的功能变量。单腿跳对称性对年轻患者最重要，单侧三级跳距离对老年患者最重要。临床医生在ACLR后做出恢复活动的决定时应考虑跳跃表现。
