Nielsen Torsten Grønbech, Dalgas Ulrik, Lind Martin
Department of Orthopaedic Surgery Aarhus University Hospital Aarhus Denmark.
Department of Physiotherapy and Occupational Therapy Aarhus University Hospital Aarhus Denmark.
J Exp Orthop. 2024 Jul 17;11(3):e12071. doi: 10.1002/jeo2.12071. eCollection 2024 Jul.
The majority of anterior cruciate ligament reconstruction (ACLr) patients wish to return to sport. 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 to identify easily assessable factors associated with physical function in ACLr patients that could inform 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 1-year follow-up.
The cohort included isolated primary ACLr patients operated between 2009 and 2014. Patients were invited to a 1-year visit to clarify their readiness to return to sport. A test battery was performed, including clinical evaluation, patient-reported outcomes and three physical tests, from which the Leg Symmetry Index (LSI) was calculated. Multivariate regression analyses were performed for each of the physical tests, including known risk factors, clinical outcomes and patient-reported outcomes. Laxity <3 mm, pivot shift = 0, Knee Injury and Osteoarthritis Outcome Score (KOOS) sport >75, International Knee Documentation Committee (IKDC) >75.9, and Single Assessment Numeric Evaluation (SANE) >92.7 were applied as cut-off values for good versus poor status.
A total of 480 ACLr patients were included in the study. Laxity <3 mm had a negative impact on the single-hop LSI, whereas a pivot shift = 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.
Age, sagittal laxity, pivot shift and patient-reported outcomes were associated with physical test performance 1 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.
Level III.
大多数前交叉韧带重建（ACLr）患者希望恢复运动。ACLr后的临床评估通常不包括体能测试，因此难以确定患者是否准备好恢复运动。因此，识别ACLr患者中与身体功能相关的易于评估的因素，有助于为患者恢复运动的计划提供参考。本研究旨在评估ACLr患者体能测试表现与已知的ACL损伤风险因素、膝关节松弛度以及1年随访时患者报告的结果之间的关联。
该队列包括2009年至2014年间接受单纯原发性ACLr手术的患者。邀请患者进行1年随访，以明确其恢复运动的准备情况。进行了一系列测试，包括临床评估、患者报告的结果和三项体能测试，并据此计算腿对称指数（LSI）。对每项体能测试进行多因素回归分析，包括已知风险因素、临床结果和患者报告的结果。将松弛度<3mm、轴移试验为0、膝关节损伤和骨关节炎疗效评分（KOOS）运动功能>75、国际膝关节文献委员会（IKDC）评分>75.9以及单项评估数值评定（SANE）>92.7作为区分良好与不良状态的临界值。
本研究共纳入480例ACLr患者。松弛度<3mm对单腿跳LSI有负面影响，而轴移试验为0或IKDC评分>75.9对单腿跳LSI有正面影响。年龄<20岁、轴移分级为0以及KOOS运动功能>75与双腿跳LSI呈正相关。最后，年龄<20岁和IKDC评分>75.9与伸腿力量LSI呈正相关。
年龄、矢状面松弛度、轴移试验和患者报告的结果与ACLr术后1年的体能测试表现相关。然而，这些关联并不完全一致且强度不大，因此在确定ACLr后何时安全恢复运动时，年龄、矢状面松弛度、轴移试验和患者报告的结果信息不能替代恢复运动功能测试。
三级。
