1
|
Pedersen M, Grindem H, Berg B, Engebretsen L, Axe MJ, Snyder-Mackler L, Risberg MA. Four Distinct 5-Year Trajectories of Knee Function Emerge in Patients Who Followed the Delaware-Oslo ACL Cohort Treatment Algorithm. Am J Sports Med 2022; 50:2944-2952. [PMID: 35975945 PMCID: PMC9442772 DOI: 10.1177/03635465221116313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Impairments and dysfunction vary considerably after anterior cruciate ligament (ACL) injury, and distinct subgroups may exist. PURPOSE (1) To identify subgroups of patients with ACL injury who share common trajectories of patient-reported knee function from initial presentation to 5 years after a treatment algorithm where they chose either ACL reconstruction (ACLR) plus rehabilitation or rehabilitation alone. (2) To assess associations with trajectory affiliation. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS We included 276 patients with a acute first-time complete unilateral ACL injury. All patients underwent a 5-week neuromuscular and strength training program before a shared decision-making process about treatment. Within their latest attended follow-up, 62% of patients had undergone early ACLR (<6 months after the 5-week program), 11% delayed ACLR (>6 months after the 5-week program), and 27% progressive rehabilitation alone. Patients completed the International Knee Documentation Committee Subjective Knee Form (IKDC-SKF) at inclusion, after the 5-week program, and at 6 months, 1 year, 2 years, and 5 years after ACLR or completion of the 5-week program (patients treated with rehabilitation alone). We used group-based trajectory modeling to identify trajectories of IKDC-SKF and multinomial logistic regression to assess associations with trajectory affiliation. RESULTS Four distinct trajectories of IKDC-SKF were identified: Low (n = 22; 8.0% of the cohort), Moderate (n = 142; 51.4%), High (n = 105; 38.0%), and High Before Declining (n = 7; 2.5%). The High trajectory had higher scores at inclusion than the Moderate trajectory, but both improved considerably within 1 year and had thereafter stable high scores. The High Before Declining trajectory also started relatively high and improved considerably within 1 year but experienced a large deterioration between 2 and 5 years. The Low trajectory started low and had minimal improvement. New knee injuries were important characteristics of the High Before Declining trajectory, concomitant meniscal injuries were significantly associated with following the Low (vs Moderate) trajectory, and early/preoperative quadriceps strength and hop symmetry (measured at inclusion) were significantly associated with following the High (vs Moderate) trajectory. CONCLUSION We identified 4 distinct 5-year trajectories of patient-reported knee function, indicating 4 subgroups of patients with ACL injury. Importantly, 88% of the patients who followed our treatment algorithm followed the Moderate and High trajectories characterized by good improvement and high scores. Due to eligibility criteria and procedures in our cohort, we can only generalize our model to athletes without major concomitant injuries who follow a similar treatment algorithm. Concomitant meniscal injuries and new knee injuries were important factors in the unfavorable Low and High Before Declining trajectories. These associations were exploratory but support the trajectories' validity. Our findings can contribute to patient education about prognosis and underpin the importance of continued secondary injury prevention.
Collapse
Affiliation(s)
- Marie Pedersen
- Department of Sports Medicine,
Norwegian School of Sport Sciences, Oslo, Norway,Marie Pedersen, PT, MS, Department of Sports Medicine, Norwegian
School of Sport Sciences, PB 4014 Ullevaal stadion, 0806 Oslo, Norway (
) (Twitter: @MariePeders)
| | - Hege Grindem
- Oslo Sport Trauma Research Center,
Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo,
Norway,Stockholm Sports Trauma Research
Center, Department of Molecular Medicine and Surgery, Karolinska Institutet,
Stockholm, Sweden
| | - Bjørnar Berg
- Division of Orthopedic Surgery, Oslo
University Hospital, Oslo, Norway,Faculty of Medicine, Department of
Interdisciplinary Health Sciences, University of Oslo, Oslo, Norway
| | - Lars Engebretsen
- Oslo Sport Trauma Research Center,
Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo,
Norway,Division of Orthopedic Surgery, Oslo
University Hospital, Oslo, Norway,Institute of Clinical Medicine,
University of Oslo, Oslo, Norway
| | - Michael J. Axe
- Department of Physical Therapy,
University of Delaware, Newark, Delaware, USA,First State Orthopaedics, Newark,
Delaware, USA
| | - Lynn Snyder-Mackler
- Department of Physical Therapy,
University of Delaware, Newark, Delaware, USA,Graduate Program in Biomechanics and
Movement Science, University of Delaware, Newark, Delaware, USA
| | - May Arna Risberg
- Department of Sports Medicine,
Norwegian School of Sport Sciences, Oslo, Norway,Division of Orthopedic Surgery, Oslo
University Hospital, Oslo, Norway
| |
Collapse
|