Knee strength symmetry at 4 months is associated with criteria and rates of return to sport after anterior cruciate ligament reconstruction - 12/02/22
, Clémence Ferrandez 2, Antoine Gauthier 3, Henri Guermont 4, César Praz 5, Emmanuel Reboursière 6, Christophe Hulet 7Cet article a été publié dans un numéro de la revue, cliquez ici pour y accéder
Highlights |
• | Younger age and higher level of sport were associated with better symmetry at 4 months after anterior cruciate ligament reconstruction (ACLR). |
• | Longer tourniquet duration and bone-patellar tendon-bone graft were associated with lower symmetry at 4 months. |
• | We identified cut-off values for strength symmetry at 4 months after ACLR. |
• | Achieving these cut-offs was associated with higher return-to-performance rates. |
• | Early identification of patients at risk of unsuccessful return to performance could help with ACLR follow-up. |
Abstract |
Background |
Strength limb symmetry index (LSI) is a useful criterion to help in return-to-sport performance (RTP) after anterior cruciate ligament reconstruction (ACLR).
Objectives |
We aimed to assess whether knee extensor and flexor LSI values at 4 months after ACLR are associated with those recommended at 8 months after ACLR for RTP (80%, 85% and 90%) and with successful RTP after 2 years.
Methods |
This was prospective cohort study of 113 participants who underwent primary ACLR. Personal factors such as demographic and sport information, injury and surgery characteristics were collected at 6 weeks after surgery. Isokinetic strength LSI (60°/s) was calculated at 4 months (LSI[4m]) and 8 months (LSI[8m]) for knee extensors (Q-LSI) and flexors (H-LSI). Participants were followed at 2 years after ACLR to determine their self-reported RTP. Multiple linear regression analysis was used to determine associations between personal factors and LSI at 4 and 8 months. Associations between passing the optimal cut-off thresholds and RTP were tested with chi-square tests and odds ratios (ORs) with effect sizes (ES).
Results |
Among the 113 participants (mean age 25.2 [SD 9.7] years; 42% females), extended tourniquet time and lower level of pre-injury sport were associated with lower Q-LSI[4m] and H-LSI[4m]. Bone-patellar tendon-bone graft was associated with lower Q-LSI[4m] and Q-LSI[8m], and older age was associated with lower Q-LSI[4m]. For knee extensors, Q-LSI[4m] >59% was associated with Q-LSI[8m] >80% (OR= 31.50, p <0.001, large ES) and increased odds of successful RTP (60% vs 31%, OR= 3.45, p= 0.003, medium ES). For knee flexors, H-LSI[4m] >72% was associated with H-LSI[8m] >90% (OR= 6.03, p <0.001, large ES) and increased odds of successful RTP (53% vs 23%, OR= 3.76, p= 0.013, small-to-medium ES).
Conclusions |
After primary ACLR, 4-month post-operative strength symmetry was negatively associated with age, pre-injury sport and tourniquet time and bone-patellar tendon-bone graft. Four-month post-operative LSI was associated with 8-month post-operative LSI, and Q-LSI[4m] >59% or H-LSI[4m] >72% was associated with increased RTP rates after 2 years.
ClinicalTrials.gov |
: NCT04071912
Le texte complet de cet article est disponible en PDF.Key words : ACL reconstruction, isokinetic testing, strength, limb symmetry index
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