Outcome measurement in the ACL deficient knee — what's the score?

Abstract.[Purpose] The aim of this study was to determine the functional level of activity and postural control after rehabilitation of anterior cruciate ligament reconstructed knees and compare them with nonoperated limbs and healthy limbs in control subjects.[Subjects] Twenty-seven patients participated in the study: 17 had undergone reconstruction with a bone-patellar tendon-bone and 10 with a semitendinosus graft technique. The same rehabilitation protocol was used for all of the patients. Besides the patients, 18 healthy volunteers participated as a control group. [Results] There were no significant differences for the eyes open static stabilometry test between operated and non-operated limbs of the patients. On the other hand, there were statistically significant differences for the closed eyes static balance test between the operated and non-operated limbs at 3 and 6 months after surgery. There were significant differences for the eyes open static balance test between the 3rd and 6th, and 6th and 12th months and for the eyes closed test of non-operated limbs between the same months as well. No statistically significant differences were noted in the dynamic balance tests between the patients and the control group. Lysholm scores of the patients obtained at 6 and 12th months after surgery were significantly better than those at 3 months after surgery. Different operation techniques revealed no significant differences in any test performed at any time.[Conclusions] Performing a postoperative sportive rehabilitation including specific proprioceptive training sessions has positive effects both on clinical status and postural control of the patients.

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“…Lysholm knee scoring 23) was performed for the patients to determine their functional status at 3, 6 and 12 months after surgery.…”

Section: Methodsmentioning

confidence: 99%

Effect of Proprioceptive Rehabilitation on Postural Control Following Anterior Cruciate Ligament Reconstruction

2010

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“…The actual value of both methods is evaluated in various tests, mostly combining objective measurements and subjective patient opinions [2,20,[23][24][25]. The most commonly used tests are the Single Assessment Numeric Evaluation Score, Lysholm Score, International Knee Documentation Committee Score and Knee Injury and Osteoarthritis Outcome Score [12]. Some authors, however, consider that conventional evaluation of ACL reconstruction with these tests is not good enough, as they cannot imitate the situations in modern sports that are extremely demanding of the knee.…”

Section: Introductionmentioning

confidence: 99%

Electromyographic analysis of the knee using fixed-activation threshold after anterior cruciate ligament reconstruction

Kasović

Mejovšek

Matković

et al. 2010

International Orthopaedics (SICOT)

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The aim of this study was to establish whether there are any electromyographic (EMG) differences after two different surgical techniques in two years follow-up after anterior cruciate ligament (ACL) reconstruction. Study participants were divided into three groups. The control group included healthy athletes (C), the first study group (E1) consisted of injured athletes who were treated by ACL reconstruction using patellar tendon graft and the second study group (E2) comprised injured athletes treated by gracilis and semitendinosus tendon graft. The threshold of muscle activity was defined as 30% of maximum amplitude of EMG signal medial envelope of individual muscles in the control group. Two years after reconstruction, the E2 group achieved the maximum amplitude of biceps femoris muscle signal in the takeoff phase statistically significantly later than the E1 group (0.0166, p=0.05 and 0.015152, p=0.05/3= 0.016), whereas the rectus femoris muscle in the flight phase in the E2 group improved statistically significantly earlier than in the C group (0.0393, p=0.05 and 0.025974, p=0.05/3= 0.016). The results of this study show particularly statistically significant differences between observed surgery techniques, which led to the change of the neuromuscular pathway during simple and controlled knee movements even two years after ACL reconstructions in athletes who returned to active training. These disturbances of muscle work coordinations in the knee joint could be tied to the function and location from which the graft was taken rather than the quality of the transplant itself. This may result in an increased risk of repeated knee injury, including potential permanent health consequences in athletes. Based on the results of this research, we were unable to establish which of the presented ACL reconstruction techniques is more appropriate. This study may be useful for athletes and their coaches, who could plan, programme and adequately adjust their training process, thereby improving knee function in the best possible way, which in turn would maintain and extend athletes' respective sports careers.

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“…However, they are limited in their ability to address the other aspects of functional limitation and participation restriction associated with ACL injury. For this reason, there has been a trend towards assessing the patient's perception of function and outcome (Johnson & Smith, 2001;Pantano et al, 2001;Wang et al, 2010). With a greater demand on patient specific outcomes and a lack of correlation between clinical testing and patient satisfaction, patient reported outcomes have emerged as a simple and cost effective method that allows the patient to quantify their level of impairment or function in relation to quality of life and satisfaction (Barenius, Forssblad, Engstrom, & Eriksson, 2013;Johnson & Smith, 2001;Roos, 2001;Tanner, Dainty, Marx, & Kirkley, 2007;Wright, 2009).…”

Section: Single Leg Hop Testsmentioning

confidence: 99%

“…However, a lack of rigor in the development and evaluation has seen the majority of these measures receive limited use (Johnson & Smith, 2001;Risberg, Holm, Steen, et al, 1999;Tanner et al, 2007;Wang et al, 2010;Wright, 2009 (Collins, Misra, Felson, Crossley, & Roos, 2011;Johnson & Smith, 2001;Neeb, Aufdemkampe, Wagener, & Mastenbroek, 1997;Risberg, Holm, Steen, et al, 1999;Sernert et al, 1999;Wang et al, 2010;Wright, 2009). …”

Section: Patient Reported Outcome Measuresmentioning

confidence: 99%

“…Recognised as the first adequately tested patient reported outcome measure, the Lysholm score has been widely used in the evaluation of ACL injury and intervention (Irrgang et al, 2001;Johnson & Smith, 2001;Risberg, Holm, Steen, et al, 1999;Wright, 2009 (Collins et al, 2011;Lysholm & Gillquist, 1982;Tegner & Lysholm, 1985). Although not officially reported, the estimated time to complete the questionnaire based on clinical experience is between five and 10 minutes and scoring can be completed in less than five minutes.…”

Section: Lysholm Scorementioning

confidence: 99%

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Graft tensioning in anterior cruciate ligament reconstruction

Kirwan¹

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BackgroundAnterior cruciate ligament reconstruction (ACLR) is an effective procedure for restoring stability and function. Being a technically demanding procedure, patient outcomes are highly dependent on numerous surgical factors, which are critical for success. The application of tension to the graft prior to tibial fixation is one such factor and is considered essential for the restoration of joint stability, normal knee biomechanics, graft revascularisation and patient function. In applying tension, a key factor is the amount of force applied to the graft. However, the method of applying the tension, position of the knee during tensioning, properties of the graft material, tunnel placement and graft fixation device can all influence the effect that graft tension has on outcomes. Despite the reported importance of graft tension there has been limited empirical evidence defining the best tensioning practice for restoring patient outcome post ACLR. AimsThe goal of this program of research was to explore the effect that different aspects of graft tensioning has on patient function post ACLR. To address the aims of the thesis, three studies were conducted. The first study was a systematic review aimed at examining if a particular amount of tension results in better functional outcomes post ACLR. The second study aimed to compare the effect of two methods of applying graft tension on patient function post ACLR. The study used a prospective randomised controlled trial to compare manual tensioning with the use of a tensioning device. The third study aimed to define current graft tensioning practices and explore the factors that influence surgical decision making. A national survey of Australian orthopaedic surgeons was conducted to achieve the aims of the study. ResultsThe systematic review (study one) revealed that a medium graft tension of 79N to 90N produced the least side-to-side difference (STSD) in anterior posterior (AP) tibial translation as measured by a KT-1000 when compared to tensions <79 or >90N. However, the heterogeneous use of functional outcomes inhibited the ability to draw conclusions on other patient specific functional outcomes.Furthermore, the review highlighted the lack of high quality studies, which also failed to discuss other aspects of graft tension such as the method of applying tension.iii Building on the findings of study one, the second study undertook a RCT to compare the functional outcomes of applying 80N of force with a tensioning device (TD) (n=10) to a manual tensioning method (MT) (n=13) using an estimated force described as a sustained maximum one handed pull.Patients were assessed at pre-surgery and two weeks, three months, six months and 12 months post Based on the findings of study one, tensioning between 79N and 90N appeared to improve the restoration of joint stability, when compared to higher and lower tensions. However, no effect on patient function within 24 months post surgery was apparent. Furthermore, study two observed that tension did not appear to have an...

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Outcome measurement in the ACL deficient knee — what's the score?

Cited by 119 publications

References 49 publications

Effect of Proprioceptive Rehabilitation on Postural Control Following Anterior Cruciate Ligament Reconstruction

Effect of Proprioceptive Rehabilitation on Postural Control Following Anterior Cruciate Ligament Reconstruction

Electromyographic analysis of the knee using fixed-activation threshold after anterior cruciate ligament reconstruction

Graft tensioning in anterior cruciate ligament reconstruction

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