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Knee strength symmetry at 4 months is associated with criteria and rates of return to sport after anterior cruciate ligament reconstruction - 05/08/22

Doi : 10.1016/j.rehab.2022.101646 
Joffrey Drigny a, , Clémence Ferrandez b, Antoine Gauthier c, Henri Guermont d, César Praz e, Emmanuel Reboursière f, Christophe Hulet g
a Service de Médecine Physique et de Réadaptation, Service de Médecine du Sport, CHU de Caen Normandie, Normandie Univ, UNICAEN, INSERM, COMETE, GIP CYCERON, Caen 14000, France 
b Service de Médecine Physique et de Réadaptation, Service de Médecine du Sport, CHU de Caen Normandie, Caen 14000, France 
c Normandie Univ, UNICAEN, INSERM, COMETE, GIP CYCERON, Caen 14000, France 
d Service de Médecine du Sport, CHU de Caen Normandie, Caen 14000, France 
e Département d'orthopédie et de traumatologie, Normandie Univ, UNICAEN, CHU de Caen Normandie, Caen 14000, France 
f Service de Médecine du Sport, CHU de Caen Normandie, Caen 14000, France 
g Département d'orthopédie et de traumatologie, Normandie Univ, UNICAEN, INSERM, COMETE, GIP CYCERON, Caen 14000, France 

Corresponding author.

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.

Le texte complet de cet article est disponible en PDF.

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[4 m]) and 8 months (LSI[8 m]) 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.

Keywords : ACL reconstruction, Isokinetic testing, Strength, Limb symmetry index


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Vol 65 - N° 4

Article 101646- juin 2022 Retour au numéro
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