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General Orthopaedics

POSTOPERATIVE LAXITY, FUNCTIONAL PERFORMANCE, AND QUALITY OF LIFE FOLLOWING ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

The Canadian Orthopaedic Association (COA) and The International Combined Orthopaedic Research Societies (ICORS) Meeting, Montreal, Canada, June 2019. Part 2.



Abstract

The aim of an anterior cruciate ligament (ACL) reconstruction is to regain functional stability of the knee following ACL injury, ideally allowing patients to return to their pre-injury level of activity. The purpose of this study was to assess clinical, functional and patient-reported outcomes following primary ACL reconstruction with hamstring autograft.

A prospective case-series design (n=1610) was used to gather data on post-operative ACL graft laxity, functional testing performance and scores on the ACL quality of life (ACL-QOL) questionnaire. Demographic data were collected for all patients. Post-operative ACL laxity assessment using the Lachman and Pivot-shift tests was completed independently on each patient by a physiotherapist and an orthopaedic surgeon at the 6-, 12- and 24-months post-operative appointments. A battery of functional tests was also assessed including single leg Bosu balance, and 4 single-leg hop tests. The hop tests provided a comparative assessment of limb-to-limb function. Patients completed the ACL-QOL at all time points. The degree and frequency of post-operative laxity was calculated. A Spearman's rank correlation matrix was undertaken to assess for relationships between post-operative laxity, functional test performance, and the ACL-QOL scores. A linear regression model was used to assess for relationships between the ACL-QOL scores, as well as the functional testing results, and patient demographic factors.

ACLR patients were 55% male, with a mean age of 29.7 years (SD=10.4), mean BMI of 25 (SD=3.9), and mean Beighton score of 3.3 (SD=2.5). At clinical assessment 2-years post-operatively, 20.6% of patients demonstrated a positive Lachman test and 7.7% of patients demonstrated a positive Pivot-shift test. The mean ACL-QOL score was 28.6/100 (SD=13.4) pre-operatively, 58.2/100 (SD=17.6) at 6-months, 71.8/100 (SD=18.1) at 12-months, and 77.4/100 (SD=19.2) at 24-months post-operative. Functional tests assessing operative to non-operative limb performance demonstrated that patients were continuing to improve up to the 24-month mark, with limb symmetry indices ranging from 96.6–103.1 for the single-leg hop tests. Spearman's correlation coefficient demonstrated a significant relationship between the presence of ACL graft laxity and ACL-QOL score at 12- and 24-months post-operative (p < 0 .05). Functional performance on the single leg balance and single-leg hop tests demonstrated significant correlations to the 6-, 12- and 24-month ACL-QOL scores (p < 0 .05). There was no statistically significant correlation between the functional testing results and the presence of ACL graft laxity.

This study demonstrated that up to 20.6% of patients had clinically measurable graft laxity 2-years after ACLR. In this cohort, patients with graft laxity demonstrated lower ACL-QOL scores, but did not demonstrate lower functional testing performance. Patient-reported ACL-QOL scores improved significantly at each time point following ACLR, and functional performance continued to improve up to 2-years after surgery. The ACL-QOL score was strongly correlated to the patient's ability to perform single-limb functional tests, indicating that the ACL-QOL score accurately predicted level of function.


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