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Strength and functional symmetry is associated with post-operative rehabilitation in patients following anterior cruciate ligament reconstruction

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To investigate strength and functional symmetry during common tests in patients after anterior cruciate ligament reconstruction (ACLR), and its association with post-operative rehabilitation.

Methods

At a median 11.0 months post-surgery (range 10–14), 111 ACLR patients were assessed. A rehabilitation grading tool was employed to evaluate the duration and supervision of rehabilitation, as well as whether structured jumping, landing and agility exercises were undertaken. Patients completed the Noyes Activity Score (NSARS), maximal isokinetic knee extensor and flexor strength assessment, and a 4-hop test battery. Limb Symmetry Indices (LSIs) were calculated, presented for the entire group and also stratified by activity level. ANOVA evaluated differences between the operated and unaffected limbs across all tests. Correlations were undertaken to assess the relationship between post-operative rehabilitation and objective test LSIs.

Results

The unaffected limb was significantly better (p < 0.0001) than the operated limb for all tests. Only 52–61 patients (47–55%) demonstrated LSIs ≥ 90% for each of the hop tests. Only 34 (30.6%) and 61 (55.0%) patients were ≥ 90% LSI for peak quadriceps and hamstring strength, respectively. Specifically in patients actively participating in jumping, pivoting, cutting, twisting and/or turning sports, 21 patients (36.8%) still demonstrated an LSI < 90% for the single hop for distance, with 37 patients (65.0%) at < 90% for peak knee extension strength. Rehabilitation was significantly associated with the LSIs for all tests.

Conclusion

Rehabilitation was significantly correlated with limb symmetry, and lower limb symmetry was below recommended criterion for many community-level ACLR patients, including those already engaging in riskier activities. It is clear that many patients are not undertaking the rehabilitation required to address post-operative strength and functional deficits, and are being cleared to return to sport (or are returning on their own accord) without appropriate evaluation and further guidance.

Level of evidence

IV.

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Authors and Affiliations

  1. School of Human Sciences (M408), The University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia

    Jay R. Ebert, Peter Edwards, Luke Yi & Timothy Ackland

  2. HFRC, 117 Stirling Highway, Nedlands, WA, 6009, Australia

    Jay R. Ebert, Peter Edwards & Brendan Joss

  3. Perth Orthopaedic and Sports Medicine Centre, 31 Outram Street, West Perth, WA, 6005, Australia

    Richard Carey-Smith & Jens-Ulrich Buelow

  4. School of Surgery (Orthopaedics), University of Western Australia, Crawley, WA, 6009, Australia

    Richard Carey-Smith

  5. Sir Charles Gairdner Hospital (Orthopaedic Surgery Department), Nedlands, WA, 6009, Australia

    Richard Carey-Smith

  6. Orthology, Suite 1, 48 Outram Street, West Perth, WA, 6005, Australia

    Ben Hewitt

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  1. Jay R. Ebert
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Correspondence to Jay R. Ebert.

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Conflict of interest

The authors declare that they have no conflict of interest.

Funding

A small independent Grant (Hollywood Private Hospital Research Foundation, RF070) was awarded to assist with data collection.

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Ethics approval was obtained by the Hollywood Private Hospital (HPH382).

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Ebert, J.R., Edwards, P., Yi, L. et al. Strength and functional symmetry is associated with post-operative rehabilitation in patients following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 26, 2353–2361 (2018). https://doi.org/10.1007/s00167-017-4712-6

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  • DOI: https://doi.org/10.1007/s00167-017-4712-6

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