Réentraînement à l'effort entre le quatrième et le sixième mois après ligamentoplastie de genou au DIDT : comparaison de la pratique de la bicyclette et de la pratique du footing avec un groupe témoin non réentraîné

Reintroduction of running after ACL reconstruction with a hamstring graft: can we predict short-term success?

CONTEXT

Return to running (RTR) after anterior cruciate ligament reconstruction (ACL-R) is a crucial milestone. However, there is uncertainty on how and when to start a running program.

OBJECTIVE

To explore the feasibility of a structured program to reintroduce running after ACL-R and to evaluate the predictive value of potential predictors of short-term success.

DESIGN

Longitudinal cohort study.

SETTING

Local Research Center / participant's home.

PATIENTS

Thirty-five participants were recruited after ACL-R.

INTERVENTION

Program with a progression algorithm to reintroduce running (10 running sessions in 14 days).

MAIN OUTCOME MEASURES

The criterion for short-term success was no exacerbation of symptoms. Potential predictors included: (i) the International Knee Document Committee (IKDC) subjective knee form; (ii) ACL Return to Sport after Injury questionnaire; (iii) quadriceps and hamstring strength; (iv) Step-Down Endurance test; and (v) the modified Star Excursion Balance test. Descriptive statistics were performed to study the feasibility of the RTR program and Poisson regression analysis was used to evaluate predictors of success.

RESULTS

Of the 34 participants included, 33 completed the RTR program. Sixteen participants experienced some temporary exacerbation of symptoms, but only one had to stop the RTR program. Initial IKDC score was the only significant predictor of a successful RTR with an Area under the ROC curve of 80.4%. An ICKD cut-off of 63.7/100 differentiated responders and non-responders with the highest sensitivity and specificity (77.8% and 75.0%, respectively). There was a 3-fold greater chance of success with an IKDC score above this threshold.

CONCLUSIONS

Our results confirm the feasibility of our RTR program and progression algorithm after ACL-R. Clinicians should use an IKDC score of >64 as a criterion to reintroduce running after ACL-R to increase the likelihood of short-term success.

Effects of running retraining after knee anterior cruciate ligament reconstruction

OBJECTIVE

The aim of this study was to analyze the effect of running retraining on the recovery of the knee's functional and muscular properties after anterior cruciate ligament (ACL) reconstruction.

METHODS

Eighty-five athletes who had undergone ACL reconstruction surgery were selected randomly to receive, or not to receive, controlled running training based on interval training and speed exercises. The effect of retraining was measured by the evolution of the knee's isokinetic strength deficit and progress (at angular speeds of 60 and 180 degrees /s), the knee laxity parameters and the score on the Lysholm Knee Scale from the 4th to the 6th month after the surgery. Forty subjects were retrained and compared with 40 control-group subjects. The effect of the retraining program was studied in terms of the type of ACL reconstruction and the effect of time.

RESULTS

After retraining, no difference was found for isokinetic knee strength deficit and progress, knee laxity and Lysholm Knee Score. The isokinetic strength deficit was influenced mainly by the type of ACL reconstruction.

CONCLUSION

It would seem that running retraining has an insufficient effect on the muscular and functional recovery after ACL reconstruction, despite the fact that this type of training is well-tolerated.

[Return to pivot-contact sports after anterior cruciate ligament reconstruction: patellar tendon or hamstring autografts]

PURPOSE OF THE STUDY

The purpose of this study was to compare outcome at 12 months and return of pivot-contact sports in male subjects having undergone anterior cruciate ligament reconstruction using a patellar tendon or four-strand hamstring autografts.

MATERIAL AND METHODS

Sixty male athletes underwent arthroscopic ligament reconstruction using either a patellar graft or a hamstring graft. The two groups were comparable for age (25+/-6 years), height (177+/-5cm), weight (74+/-8kg), pivot-contact sports, and level of sports activity. The two groups were reviewed at four, six and 12 months. The Lysholm and Tegner scores were noted and isokinetic tests were performed (60 and 180 degrees /s). The comparison was completed at twelve months with the single-legged hop test, instrumental laximetry (KT-1000) and the Arpege and IKDC 2000 scores. Return to pivot-contact sports at the same level was assessed at last follow-up after having been encouraged at the nine-month check-up.

RESULTS

At twelve months, the function scores (IKDC 2000, Lysholm: 99.4+/-5 versus 98+/-5, Tegner: 6.8+/-1 versus 6.5+/-1) and single-legged hop test (94+/-5% versus 95+/-7%) were comparable. Instrumental laxity measurements however demonstrated greater laxity with the hamstring graft (2.7+/-0.4mm versus 1.8+/-0.3mm, p=0.02). A knee extension deficit was observed for the patellar technique (10+/-8%, p<0.01). A knee flexion deficit was observed for the hamstring technique (11+/-14%, p<0.01). Return to pivot-contact sports at the same level was comparable and concerned 53% [95%CI 41-66] of the knees after hamstring ligament reconstruction and 56.6% [44-68] of the knees after patellar ligamentoplasty.

CONCLUSION

The two techniques of anterior cruciate ligament reconstruction were found to be equivalent in terms of return to pivot-contact sports at the same level. It was noted however that this resumed sports activity was possible for only one out of two subjects despite the systematic medical and surgical surveillance and selection of subjects free of any complication.