Padanilam Simon J, Dayton Steven R, Jarema Ryan, Boctor Michael J, Tjong Vehniah K
Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Northwestern University, Evanston, Illinois, USA.
Video J Sports Med. 2021 Oct 12;1(5):26350254211040510. doi: 10.1177/26350254211040510. eCollection 2021 Sep-Oct.
Functionality testing following anterior cruciate ligament (ACL) reconstruction can benefit clinicians and patients in determining readiness for return to sport. While a component of a multifactorial decision, inability to perform well on these tests predicts increased risk of reinjury. As of 2013, only 41% of orthopaedic surgeons report using strength or functionality testing in evaluating patients for return to sport (RTS).
In the intermediate to late stages of their rehabilitation program, patients may undergo these tests to determine readiness and safety to return to sport.
The tests described in this video include the single and triple hop for distance, triple crossover hop, single and double vertical leg jump tasks, drop jump landing task, and isokinetic and isometric strength testing.
Clinicians who incorporate these tests into patient rehabilitation programs may reduce patient risk of ACL reinjury by 75% to 84%. The limb symmetry index (LSI) is a reliable calculated measure for these tests, with a strong reliability for the hop tests. The limb symmetry index can be calculated for each test and represents the ratio of measured performance of the involved, or post-ACL reconstruction, leg when compared against the uninvolved leg. The commonly used limb symmetry index threshold for passing each hop test is 90%. Patients who score 90% or greater on each of these tests are less likely to experience knee reinjury.
DISCUSSION/CONCLUSION: The ability of knee strength and functionality tests in determining RTS following ACL reconstruction has been highlighted as a tool in potentially reducing risk of knee reinjury. Other isometric and isokinetic testing can be used in addition to the described functionality tests but may not be possible in certain practices due to equipment and funding limitations. Usage of these strength and functionality tests, in conjunction with clinician evaluation, may lead to more optimal outcomes for patients and lower rates of reinjury. Psychological assessment may aid in evaluating patient readiness for return to sport. Importantly, further sport-specific testing is still recommended and will optimize patient outcomes.
前交叉韧带（ACL）重建术后的功能测试有助于临床医生和患者确定恢复运动的准备情况。虽然这是多因素决策的一部分，但在这些测试中表现不佳预示着再次受伤的风险增加。截至2013年，只有41%的骨科医生报告在评估患者恢复运动（RTS）时使用力量或功能测试。
在康复计划的中后期阶段，患者可进行这些测试以确定恢复运动的准备情况和安全性。
本视频中描述的测试包括单腿和双腿跳远距离、双腿交叉跳、单腿和双腿垂直跳任务、跳落着地任务以及等速和等长力量测试。
将这些测试纳入患者康复计划的临床医生可将患者ACL再次受伤的风险降低75%至84%。肢体对称指数（LSI）是这些测试的可靠计算指标，对跳跃测试具有很强的可靠性。可针对每项测试计算肢体对称指数，它表示ACL重建术后患侧腿与未受累腿的测量表现之比。每项跳跃测试通过的常用肢体对称指数阈值为90%。在这些测试中每项得分达到或超过90%的患者再次发生膝盖损伤的可能性较小。
讨论/结论：ACL重建术后膝盖力量和功能测试在确定RTS方面的能力已被视为一种潜在降低膝盖再次受伤风险的工具。除了所描述的功能测试外，还可使用其他等长和等速测试，但由于设备和资金限制，某些机构可能无法进行。将这些力量和功能测试与临床医生评估相结合，可能会为患者带来更理想的结果并降低再次受伤率。心理评估可能有助于评估患者恢复运动的准备情况。重要的是，仍建议进行进一步的特定运动测试，这将优化患者的治疗效果。
