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Lundgaard-Nielsen M, Herzog RB, Warming S, Rathcke MW, Magnusson SP, Krogsgaard MR. Good physical function but reduced quality of life in children 3 years after ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2024; 32:1725-1733. [PMID: 38666741 DOI: 10.1002/ksa.12211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 03/30/2024] [Accepted: 04/09/2024] [Indexed: 07/21/2024]
Abstract
PURPOSE To assess children's physical function and subjective knee status 1 and 3 years after anterior cruciate ligament (ACL) reconstruction. It was hypothesised that there was no difference between the operated and normal legs in relation to physical strength and function, that there was <-2 mm side-to-side difference in knee laxity, and that the subjective knee function was better 3 years after ACL reconstruction compared to 1 year after. METHODS Children (<16 years of age) who had an ACL reconstruction had follow-up with physical function tests (four hop tests and strength measurement in a power rig [PR]), anterior knee laxity (measured using a Rolimeter) and patient-reported outcome measures (Pedi-International Knee Documentation Committee [IKDC] and Knee injury and Osteoarthritis Outcome Score [KOOS]-Child) 1 and 3 years postoperatively. Changes from 1- to 3-year follow-up were evaluated with a paired t test. RESULTS Out of 148 ACL reconstructed children, 60 had all measures. The four hop tests and the PR all yielded a Limb Symmetry Index >90% at both follow-ups. There was a significant improvement from 1- to 3-year follow-up in two-hop tests (6 m on time and crossover hop). Side-to-side knee laxity was >2 mm in four children at 1- and 3-year tests. Pedi-IKDC scores increased, and KOOS-Child improved significantly from 1 to 3 years in two of the five domains: 'Sport' and 'Quality of life', but scores were lower than in a cohort of normal children. CONCLUSION The children had good objective physical function 1 and 3 years after ACL reconstruction. However, scores from the KOOS-Child sport-specific function and quality of life domains were lower than in normal children. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Mathilde Lundgaard-Nielsen
- Department of Physical and Occupational Therapy, Copenhagen University Hospital, Bispebjerg-Frederiksberg, Copenhagen, Denmark
| | - Robert Bennike Herzog
- Department of Physical and Occupational Therapy, Copenhagen University Hospital, Bispebjerg-Frederiksberg, Copenhagen, Denmark
| | - Susan Warming
- Department of Physical and Occupational Therapy, Copenhagen University Hospital, Bispebjerg-Frederiksberg, Copenhagen, Denmark
| | - Martin Wyman Rathcke
- Section for Sports Traumatology M51, Copenhagen University Hospital, Bispebjerg-Frederiksberg, Copenhagen, Denmark
| | - Stig Peter Magnusson
- Department of Physical and Occupational Therapy, Copenhagen University Hospital, Bispebjerg-Frederiksberg, Copenhagen, Denmark
- Department of Orthopedic Surgery, Institute of Sports Medicine Copenhagen, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Michael Rindom Krogsgaard
- Section for Sports Traumatology M51, Copenhagen University Hospital, Bispebjerg-Frederiksberg, Copenhagen, Denmark
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Al-Gburi M, Kristiansen JB, Christensen KB, Krogsgaard MR. Functional performance tests, clinical measurements, and patient-reported outcome measures do not correlate as outcomes 1 year after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2023; 31:5905-5912. [PMID: 37947829 PMCID: PMC10719130 DOI: 10.1007/s00167-023-07648-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 10/24/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE The results after anterior cruciate ligament reconstruction (ACLR) are evaluated by laxity measures, functional tests, and patients' perception by patient-reported outcome measures (PROMs). It is not known, if one of these evaluation instruments is representative or if outcome scores from all must be reported to obtain a full evaluation of the condition. The aim was to study the correlations between these three types of outcomes 1 year after primary ACLR. METHOD All adult patients (range 18-45 years) who had an ACLR between 1.1.2019 and 31.12.2021 were offered 1-year follow-up by an independent observer. Preoperative information about knee laxity and peroperative information about the condition of menisci and cartilage were registered. At 1-year follow-up clinical and instrumented knee stability and function assessed by four different hop tests were registered. Patients completed four PROMs (the Subjective International Knee Documentation Committee (IKDC) score, the Knee Numeric-Entity Evaluation Score (KNEES-ACL), the Knee injury and Osteoarthritis Outcome Score (KOOS) and the Lysholm score) and Tegner activity scale and answered anchor questions regarding satisfaction and willingness to repeat the operation. RESULTS A total of 190 adults attended the 1-year follow-up and 151 had all assessments. There were only a few positive and weak correlations between performance tests and PROMS and between clinical measurements and PROMS (r = 0.00-0.38), and the majority were of negligible strength. Tegner score had in general the highest correlation (low to moderate). The highest correlation was 0.53 (moderate) between the anchor question about patient satisfaction and Lysholm/IKDC scores. There was no difference in the correlations depending on meniscal condition. CONCLUSIONS In ACLR patients there was no clinically relevant correlation between scores obtained by PROMs, a battery of functional performance tests and instrumented laxity of the knee at 1-year follow-up. Therefore, one type of outcome cannot represent the others. This is an argument for always to include and report all three types of outcomes, and conclusions based on one type of outcome may not be sufficient. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Mustafa Al-Gburi
- Sections for Sports Traumatology, Department of Orthopedic Surgery, Copenhagen University Hospital Bispebjerg, Copenhagen Ø, Denmark.
- Department of Physiotherapy, Copenhagen University Hospital Bispebjerg, Copenhagen Ø, Denmark.
- Section for Biostatistics, Copenhagen University, Copenhagen K, Denmark.
| | - Jakob Bredahl Kristiansen
- Sections for Sports Traumatology, Department of Orthopedic Surgery, Copenhagen University Hospital Bispebjerg, Copenhagen Ø, Denmark
- Department of Physiotherapy, Copenhagen University Hospital Bispebjerg, Copenhagen Ø, Denmark
- Section for Biostatistics, Copenhagen University, Copenhagen K, Denmark
| | - Karl Bang Christensen
- Sections for Sports Traumatology, Department of Orthopedic Surgery, Copenhagen University Hospital Bispebjerg, Copenhagen Ø, Denmark
- Department of Physiotherapy, Copenhagen University Hospital Bispebjerg, Copenhagen Ø, Denmark
- Section for Biostatistics, Copenhagen University, Copenhagen K, Denmark
| | - Michael Rindom Krogsgaard
- Sections for Sports Traumatology, Department of Orthopedic Surgery, Copenhagen University Hospital Bispebjerg, Copenhagen Ø, Denmark
- Department of Physiotherapy, Copenhagen University Hospital Bispebjerg, Copenhagen Ø, Denmark
- Section for Biostatistics, Copenhagen University, Copenhagen K, Denmark
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Kuenze C, Weaver A, Grindstaff TL, Ulman S, Norte GE, Roman DP, Giampetruzzi N, Lisee CM, Birchmeier T, Triplett A, Farmer B, Hopper H, Sherman DA, Ness BM, Collins K, Walaszek M, Baez SE, Harkey MS, Tulchin-Francis K, Ellis H, Wilson PL, Chang ES, Wilcox CL, Schorfhaar A, Shingles M, Hart JM. Age-, Sex-, and Graft-Specific Reference Values From 783 Adolescent Patients at 5 to 7 Months After ACL Reconstruction: IKDC, Pedi-IKDC, KOOS, ACL-RSI, Single-Leg Hop, and Thigh Strength. J Orthop Sports Phys Ther 2023; 53:194-201. [PMID: 36688716 DOI: 10.2519/jospt.2023.11389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE: To describe age-, sex-, and graft source-specific reference values for patient-reported, physical function, and strength outcome measures in adolescents at 5 to 7 months after anterior cruciate ligament reconstruction. DESIGN: Cross-sectional study. METHODS: Data were collected at 3 universities and 2 children's hospitals. The participants completed at least one of the International Knee Documentation Committee (IKDC) Subjective Evaluation Form, Pediatric IKDC (Pedi-IKDC), Knee Injury and Osteoarthritis Outcomes Score (KOOS), and Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) Scale. Participants also completed single-leg hop tests and/or isokinetic quadriceps and hamstrings strength assessments (at 60°/s). Reference values were summarized using descriptive statistics and stratified for age, sex, and graft source. RESULTS: Reference values were reported for common patient-reported outcomes and measures of physical function and strength from 783 participants (56% females, age = 16. 4 ± 2.0 years) who were in early adolescence (12-14 years, N = 183, 52% females), middle adolescence (15-17 years, N = 456, 58% females), or late adolescence (18-20 years, N = 144, 55% females). Three hundred seventy-nine participants (48.4%) received a bone-patellar tendon-bone autograft, 292 participants (37.3%) received hamstring tendon autograft, and 112 participants (14.3%) received autograft or allograft from an alternative source. CONCLUSION: Reference values for common patient-reported outcomes and measures of physical function and strength differed depending on a patient's age, sex, and graft source. Using patient-specific reference values, in addition to previously described age-appropriate cutoff values, may help clinicians monitor and progress patients through rehabilitation and return to physical activity after anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther 2023;53(4):1-8. Epub: 23 January 2023. doi:10.2519/jospt.2023.11389.
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Alkjaer T, Zebis MK, Herzog RB, Lundgaard-Nielsen M, Skovgaard LT, Krogsgaard MR, Warming S. Evaluation of hop performance in children with anterior cruciate ligament reconstruction using healthy reference data: A cross-sectional study. Knee 2023. [PMID: 36863117 DOI: 10.1016/j.knee.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
BACKGROUND Hop performance evaluation in children after anterior cruciate ligament (ACL) reconstruction may benefit from comparison to healthy controls. Thus, the purpose was to investigate the hop performance in children one year after ACL reconstruction with a comparison to healthy controls. METHODS Hop performance data from children with ACL reconstruction one year post-surgery and healthy children were compared. Four one-legged hop test data were analyzed: 1) single hop (SH), 2) 6 m timed hop (6 m-timed), 3) triple hop (TH), and 4) cross-over hop (COH). Outcomes were the best result (longest/fastest hop) from each leg and limb asymmetry. Differences in hop performance between-limbs (operated versus non-operated) and between-groups were estimated. RESULTS 98 children with ACL reconstruction and 290 healthy children were included. Few statistically significant group differences were observed. Girls with ACL reconstruction outperformed healthy controls in two tests on the operated leg SH, COH) and in three tests on the non-operated leg (SH, TH, COH). However, the girls performed 4-5% worse on the operated leg when compared to the non-operated leg in all hop tests. No statistically significant between-group differences in the limb asymmetry were found. CONCLUSION The hop performance in children with ACL reconstruction one year post-surgery was largely comparable to the level of healthy controls. Despite this, we cannot exclude that neuromuscular deficits exist among the children with ACL reconstruction. The inclusion of a healthy control group for evaluating hop performance evoked complex findings regarding the ACL reconstructed girls. Thus, they may represent a selected group.
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Affiliation(s)
- T Alkjaer
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark; The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.
| | - M K Zebis
- Department of Midwifery, Physiotherapy, Occupational Therapy and Psychomotor Therapy, University College Copenhagen, Copenhagen, Denmark; Institute of Sports Medicine Copenhagen, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - R B Herzog
- Department of Physical and Occupational Therapy, Copenhagen University Hospital, Bispebjerg-Frederiksberg, Copenhagen, Denmark
| | - M Lundgaard-Nielsen
- Department of Physical and Occupational Therapy, Copenhagen University Hospital, Bispebjerg-Frederiksberg, Copenhagen, Denmark
| | - L T Skovgaard
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - M R Krogsgaard
- Section for Sports Traumatology M51, Copenhagen University Hospital, Bispebjerg-Frederiksberg, Copenhagen, Denmark
| | - S Warming
- Department of Physical and Occupational Therapy, Copenhagen University Hospital, Bispebjerg-Frederiksberg, Copenhagen, Denmark
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Warming S, Herzog RB, Lundgaard-Nielsen M, Rathcke MW, Krogsgaard MR. No correlation between performance tests, clinical measurements and data from patient-reported outcome measures (PROM) in children reconstructed for anterior cruciate ligament injury. Knee Surg Sports Traumatol Arthrosc 2022; 31:2386-2393. [PMID: 36149469 DOI: 10.1007/s00167-022-07174-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 09/15/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE To investigate if patient-reported outcome measures (PROMs), functional tests and clinical measures correlate well in children after reconstruction of the anterior cruciate ligament (ACL). It was hypothesized that these outcomes correlate, so it is sufficient to report only one of them. METHODS A consecutive group of children (< 16 years old) who had an ACL reconstruction, were prospectively followed and assessed after 1-year with Pedi-IKDC and KOOS-Child, instrumented laxity measurement, range of motion, extension strength and four performance tests. Relations between the different outcomes were calculated by partial correlation coefficient analysis, controlling for gender, age, height, and weight. RESULTS Outcomes were available for 141 of 163 children. There were only few positive and weak correlations between performance tests and PROM scores and between clinical measurements and PROM scores. There were weak to strong correlations between the scores from Pedi-IKDC and the scores from each of the five domains of KOOS-Child and a weak to moderate correlation between the different domains of KOOS-Child. Similar correlations were found between the different performance tests. CONCLUSION For children who had their ACL reconstructed there was no clinically important correlation between scores obtained by PROMs, a battery of functional performance tests and instrumented laxity of the knee at 1-year follow-up. This is an argument for always to include and report all three types of outcomes. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Susan Warming
- Department of Physical and Occupational Therapy, Copenhagen University Hospital, Bispebjerg-Frederiksberg, Denmark.
| | - Robert Bennike Herzog
- Department of Physical and Occupational Therapy, Copenhagen University Hospital, Bispebjerg-Frederiksberg, Denmark
| | - Mathilde Lundgaard-Nielsen
- Department of Physical and Occupational Therapy, Copenhagen University Hospital, Bispebjerg-Frederiksberg, Denmark
| | - Martin Wyman Rathcke
- Section for Sports Traumatology M51, Copenhagen University Hospital, Bispebjerg-Frederiksberg, Denmark
| | - Michael Rindom Krogsgaard
- Section for Sports Traumatology M51, Copenhagen University Hospital, Bispebjerg-Frederiksberg, Denmark
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Hirohata K, Aizawa J, Ohmi T, Ohji S, Mitomo S, Ohara T, Koga H, Yagishita K, Jinno T, Okawa A. Reactive strength index during single-limb vertical continuous jumps after anterior cruciate ligament reconstruction: cross-sectional study. BMC Sports Sci Med Rehabil 2022; 14:150. [PMID: 35918729 PMCID: PMC9344617 DOI: 10.1186/s13102-022-00542-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 07/26/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND The association of the reactive strength index (RSI) during single-limb vertical continuous jumps (SVCJs) with single-limb hop tests in athletes after anterior cruciate ligament reconstruction (ACLR) is unclear. Thus, this study aimed to confirm the measurement properties of the RSI during SVCJs in athletes with ACLR at the phase of determining the timing of their return to sport. METHODS RSI during SVCJs and single-limb hop (single, triple, and crossover) tests were measured for post-ACLR and healthy athletes. The limb symmetry index (LSI) was calculated using the measurements of each parameter. For each test, patients were divided into two subgroups according to their LSI score (≥ 90%, satisfactory; < 90%, unsatisfactory). Fisher's exact test was used to examine the association of single-limb hop tests with RSI during the SVCJs. RESULTS A total of 21 post-ACLR and 17 healthy athletes completed all the tests. RSI during SVCJs was significantly lower on the involved limb than on the uninvolved limb in post-ACLR athletes (P < 0.001). The LSI of RSI during SVCJs of post-ACLR athletes was significantly lower than that of the healthy athletes (P < 0.01). Among the post-ACLR athletes, < 30% of those with LSIs > 90% in the single-limb hop tests had an LSI > 90% of the RSI during SVCJs. CONCLUSIONS RSI during SVCJs of post-ACLR athletes was significantly lower on the involved limb than on the uninvolved limb, and the asymmetry was more remarkable in the SVCJs than in the single-limb hop tests.
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Affiliation(s)
- Kenji Hirohata
- Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
| | - Junya Aizawa
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo, Japan.,Department of Rehabilitation Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takehiro Ohmi
- Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Shunsuke Ohji
- Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Sho Mitomo
- Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Toshiyuki Ohara
- Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Hideyuki Koga
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazuyoshi Yagishita
- Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Tetsuya Jinno
- Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Atsushi Okawa
- Department of Orthopaedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Fares MY, Khachfe HH, Salhab HA, Bdeir A, Fares J, Baydoun H. Physical Testing in Sports Rehabilitation: Implications on a Potential Return to Sport. Arthrosc Sports Med Rehabil 2022; 4:e189-e198. [PMID: 35141551 PMCID: PMC8811492 DOI: 10.1016/j.asmr.2021.09.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 09/29/2021] [Indexed: 10/26/2022] Open
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