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Isokinetic quadriceps symmetry helps in the decision to return to running after anterior cruciate ligament reconstruction - 05/08/22

Doi : 10.1016/j.rehab.2021.101543 
Marc Dauty a, b, c, Pascal Edouard d, e, Pierre Menu a, b, c, Olivier Mesland a, c, Alban Fouasson-Chailloux a, b, c,
a Physical medicine and rehabilitation center, university hospital of Nantes, CHU Nantes, Nantes, France 
b Service de médecine du sport, university hospital of Nantes, CHU Nantes, Nantes, France 
c Inserm UMR U1229/RMeS, regenerative medicine and skeleton – Nantes university, Nantes, France 
d Inter-university laboratory of human movement science (LIBM EA 7424), university of Lyon, university Jean-Monnet, 42023 Saint-Étienne, France 
e Department of clinical and exercise physiology, sports medicine unit, faculty of medicine, university hospital of Saint-Etienne, Saint-Étienne, France 

Corresponding author. MPR locomotrice et respiratoire, hôpital St Jacques, CHU de Nantes, 85, rue Saint-Jacques, 44093 Nantes cedex 1, France.MPR locomotrice et respiratoire, hôpital St Jacques, CHU de Nantes85, rue Saint-JacquesNantes cedex 144093France

Highlights

Sensitivity and specificity of the Quadriceps Limb Symmetry Index (LSI) at 60% were 83% and 70%, respectively.
20% of the patients did not return to running despite a Quadriceps LSI60%.
Multivariate model identified hamstring strand as associated with a return to running.

Le texte complet de cet article est disponible en PDF.

Abstract

Background

After anterior cruciate ligament reconstruction (ACLR), the decision to allow a return to running is empirical, and the post-operative delay is the most-used criterion. The Quadriceps isokinetic-strength Limb Symmetry Index (Quadriceps LSI), with a cutoff of 60%, could be a useful criterion.

Objective

To determine the association between a Quadriceps LSI60% and return to running after ACLR.

Methods

Over a 10-year period, we retrospectively included 470 patients who underwent ACLR. Four months after ACLR, participants performed an isokinetic test; quadriceps concentric peak torque was used to calculate the Quadriceps LSI at 60̊/s. With a Quadriceps LSI60%, a return to running was suggested. At 6 months after ACLR, participants were clinically evaluated for a return to sport and post-operative middle-term complications. A multivariable predictive model was built to assess the efficiency diagnosis of this cutoff in order to consider cofounding factors. Quadriceps LSI cutoff60% was assessed with sensitivity, specificity and the area under the receiver operating characteristic curve (AUC).

Results

According to our decision-making process with the 60% Quadriceps LSI cutoff at 60̊/s, 285 patients were authorized to return to running at 4 months after ACLR and 185 were not, but 21% (n=59) and 24% (n=45), respectively, were not compliant with the recommendation. No iterative autograft rupture or meniscus pathology occurred at 6 months of follow-up. On multivariable logistic regression analysis, a return to running by using the 60% Quadriceps LSI cutoff was associated with undergoing the hamstring strand procedure (odds ratio 2.60, 95% confidence interval [CI] 1.75–3.84; P<0.0001) and the absence of knee complications (1.18, 1.07–1.29; P=0.001) at 4 months. The sensitivity and specificity of the 60% Quadriceps LSI cutoff were 83% and 70%, respectively. The AUC was 0.840 (95% CI 0.803–0.877).

Conclusions

Using the 60% cutoff of the isokinetic Quadriceps LSI at 4 months after ACLR could help in the decision to allow a return to running.

Le texte complet de cet article est disponible en PDF.

Keywords : Anterior cruciate ligament reconstruction, Running, Prediction, Isokinetic, Limb symmetry index, Quadriceps


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Vol 65 - N° 4

Article 101543- juin 2022 Retour au numéro
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