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Factors Associated with Excellent Early Functional and Isokinetic Test Results Following ACL Reconstruction
Aaron J. Krych, MD Jessica A. Woodcock, MD
Joseph A. Morgan, MD Bruce A. Levy, MD
Michael J. Stuart, MD Diane L. Dahm, MD
Department of Orthopedic Surgery and Sports Medicine Mayo Clinic
Rochester, MN
Background • The incidence of ACL tear has been reported at 81
ruptures per 100,000 people 2
• Only 2/3 of athletes return to preinjury level of activities following ACL reconstruction 1
• Average return to moderate sports was at 5.8 months 3
• Average return to strenuous sports was at 8.1 months 3
• To identify factors associated with excellent functional and isokinetic testing results at six months following ACL reconstruction surgery.
Purpose
• 352 primary ACL reconstructions by single surgeon 1998-2005
• All patients were given option of Allograft vs. Autograft
• Retrospective review • -Factors: • -Age -Graft type • -Gender -Quad activation • -BMI -IKDC/Tegner scores • -Intraarticular concomitant injuries
• -Functional and Isokinetic Testing at 6 months.
Methods
• Criteria for testing at 6 months • Absence of Effusion • No patellofemoral pain or pain with weightbearing • Objective stability on exam
• Functional Testing • Single hop • Vertical jump • Triple jump • Satisfactory result = >90% of opposite limb
• Isokinetic Testing • Maximal torque of hamstrings and quads were measured at
60o/s and 180o/s and recorded • Satisfactory result = >85% of opposite limb
Methods Functional and Isokinetic Testing
Results • Study Group
• 224 Primary ACL reconstructions • Mean age 26 (12-59) • Mean BMI 25.8 (17-44) • 162 Autografts
• 134 BTB • 28 Hamstrings
• 62 Allografts
• Excellent Performance Group • Patients who performed
satisfactorily in at least 6 of 7 of categories (3 functional tests and 4 strength tests).
Performance Groups
0 20 40 60 80
100 120 140 160 180
Excellent Not Cleared
52
172
Patie
nts (
#)
Results
22.5
23
23.5
24
24.5
25
25.5
26
26.5
27
27.5
Excellent Not Cleared
Age Age
Excellent Performance
Group
Not Cleared
P-Value
Age* 24.1 ± 12.1 27.1 ± 11.7
0.01 *
Gender 25 (48.1%) m 27 (51.9%) f
68 (39.5%) m 104 (60.5%) f
0.27
BMI*
24.5 ± 3.8
26.2 ± 4.8 0.03 *
Articular Damage *
15 (28.8%) 76 (44.2%) 0.048 *
Age
P = 0.01*
Results
23.5
24
24.5
25
25.5
26
26.5
Excellent Not cleared
BM
I
BMI
24.5*
26.2*
P = 0.03*
Articular Damage
01020304050607080
Pat
ient
s
Excellent Not cleared
CartilageDegeneration
BMI
P = 0.048*
Results Allograft vs. Autograft Excellent Outcome Group Not Cleared P-Value
PT autograft HS autograft PT allograft
28 (53.8%) 10 (19.2%) 15 (28.8%)
107 (62.2%) 17 (9.9%) 47 (27.3%)
0.29
Allograft vs Autograft
37 (71.2%) 15 (28.8%)
124 (72.1%) 48 (27.9%)
0.90
0
10
20
30
40
50
<18 18-30 >30
Exe
llent
Out
com
e %
Age
Allograft Autograft
P=0.66 P=0.75 P=0.047*
0
0.1
0.2
0.3
0.4
10 20 30 40 50 60 Age
Estimated probability of excellent outcome
Patients > 30 years old Allograft vs. Autograft
0
5
10
15
20
25
30
35
40
Allograft Autograft
Excellent Not Cleared
P=.047*
1
13
Results
• Younger age, lower BMI, and minimal cartilage degeneration is significantly associated with excellent functional and isokinetic test results at 6 months post operatively.
• Patients over 30, who underwent Allograft reconstruction were more likely to exhibit excellent test results at 6 months.
• The safety of returning patients with an Allograft reconstruction to sport at 6 months has not been established.
Conclusion
1. Biau DJ, Tournoux C, Katsahian S, Schranz P, Nizard R. ACL reconstruction: a meta-analysis of functional scores. Clin Orthop Relat Res. 2007 May;458:180-7.
2. Frobell RB, Lohmander LS, Roos HP. Acute rotational trauma to the knee: poor agreement between clinical assessment and magnetic resonance imaging findings. Scand J Med Sci Sports. 2007 Apr;17(2):109-14.
3. Harner CD, Fu FH, Irrgang JJ, Vogrin TM. Anterior and posterior cruciate ligament reconstruction in the new millennium: a global perspective. Knee Surg Sports Traumatol Arthrosc 2001;9(6):330-6.
4. Lyman S, Koulouvaris P, Sherman S, Do H, Mandl LA, Marx RG. Epidemiology of anterior cruciate ligament reconstruction: trends, readmissions, and subsequent knee surgery. J Bone Joint Surg Am. 2009 Oct;91(10):2321-8
References