Objectively Measured Physical Activity in Patients After Anterior Cruciate Ligament Reconstruction

Abstract

Background Returning to a healthy level of physical activity is among the most commonly discussed clinical goals for patients recovering from anterior cruciate ligament reconstruction (ACLR). However, physical activity has not been objectively measured in this population. Purpose To investigate differences in the mean time (min/d) spent in moderate-to-vigorous physical activity (MVPA) as well as the daily step count (steps/d) between patients who underwent ACLR and matched controls. A second purpose was to investigate relationships between MVPA and objective assessments of the daily step count and Tegner and Marx activity scales. Study Design Cross-sectional study; Level of evidence, 3. Methods Physical activity was assessed using ActiGraph accelerometers in 33 participants with a history of primary unilateral or bilateral ACLR (mean time from surgery, 27.8 ± 17.5 months; range, 6–67 months) as well as in 33 healthy controls (matched on age, sex, and activity level). Participants wore the accelerometer for 7 days and completed the International Knee Documentation Committee subjective form and the Tegner and Marx activity scales. Independent t tests were used to determine differences in each dependent variable per group. Results Patients who underwent ACLR spent less time in MVPA (ACLR: 79.37 ± 23.95 min/d; control: 93.12 ± 23.94 min/d; P = .02) and had a lower daily step count (ACLR: 8158 ± 2780 steps/d; control: 9769 ± 2785 steps/d; P = .02) compared with healthy matched controls. However, the Marx (ACLR median: 11.0 [interquartile range (IQR), 7–14]; control median: 12.0 [IQR, 8–13]; P = .85) and Tegner (ACLR median: 6.0 [IQR, 5–8]; control median: 7.0 [IQR, 6–8]; P = .12) scores did not differ between the groups, and no relationships were observed between objectively measured physical activity and scale measures (P > .05), except for a moderate relationship between the Tegner score and daily step count in the ACLR group (r = 0.36, P = .04). Only 24% of patients who underwent ACLR met the guideline of 10,000 steps per day compared with 42% of controls. Conclusion Patients who underwent ACLR spent less time in MVPA and had a lower daily step count compared with highly matched controls (age, sex, and activity level) with no history of knee injuries. This was true despite being similar in activity levels, which brings into question the utility of the Tegner and Marx activity scales.

The Effect of ACL Reconstruction on Involved and Contralateral Limb Vastus Lateralis Morphology and Histology: A Pilot Study

“…The implications of an unloaded leg can lead to an avoidance of physical activity, potentially leading to later health complications from a sedentary lifestyle. 24 Skeletal muscle fiber type percentage remained the same between legs following reconstruction, although the crosssectional area was significantly decreased in the ACLR limb. This observation may also be influenced by neurological processes, as evident from previous literature, where leg asymmetries within patients are seen in gait, muscular strength, and use of the injured leg.…”

The Relationship Between Musculoskeletal Injury and Objectively Measured Physical Activity Levels: A Critically Appraised Topic

“…After a review of the abstracts, 45 studies were excluded as they did not meet the inclusion criteria for this CAT. Four studies [5][6][7][8] were included, 3 case-control studies and 1 cross-sectional study.…”

“…None of the included articles [6][7][8] discussed any efforts to address sources of potential bias. Bell et al, 6 Hubbard-Turner and Turner, 8 and Glaviano et al 5 did not provide a proper description of the setting, locations, or relevant dates of the study. Also, Hubbard-Turner and Turner 8 did not provide a hypothesis or explain how their study size was arrived at.…”

“…2 It is important that adults reach these recommendations, as physical activity can aid in the prevention of coronary heart disease, type 2 diabetes, and different types of cancer as well as prevent recurring or chronic injuries. 4 One factor that may cause adults to participate in less physical activity is musculoskeletal injury including injuries to the knee [5][6][7] and ankle. 8 Most often subjective measures of physical activity have been utilized in these populations, including the Tegner activity scale 9 and the Marx activity scale.…”

“…These findings are pertinent to patient care, as an understanding of how these injuries may affect a person's physical activity can help clinicians educate their patients on the importance of participating in physical activity to reduce the risk of chronic disease development associated with physical inactivity. 4,[6][7][8] Therefore, the purpose of this critically appraised topic (CAT) was to synthesize and critically appraise the current research that examines objectively measured physical activity levels in patients who have a history of ankle or knee injury compared with healthy controls.…”