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Few young athletes meet newly derived age- and activity-relevant functional recovery targets after ACL reconstruction

Abstract

Purpose

National registry data have established Knee injury and Osteoarthritis Outcome Score (KOOS) functional recovery target values for adults after anterior cruciate ligament (ACL) reconstruction. However, the specificity of these target values for young athletes after ACL reconstruction is unclear. The purpose of this analysis was to (1) derive age- and activity-relevant KOOS functional recovery target values from uninjured young athlete data and (2) determine clinical measures at the time of RTS clearance associated with meeting the newly-derived functional recovery target values in young athletes following ACLR.

Methods

Two hundred and twenty-two young athletes (56 uninjured controls, 17.2 ± 2.4 years, 73% female; 166 after ACL reconstruction, 16.9 ± 2.2 years, 68% female) were included in this cross-sectional analysis from a larger cohort study. Uninjured control participants completed the KOOS, and functional recovery target values were defined as the lower bound of the 95% confidence interval for KOOS subscales. ACL reconstruction participants completed testing within 4 weeks of return-to-sport clearance, including the KOOS, single-leg hop tests, and isometric quadriceps strength. In ACL reconstruction participants, logistic regression was used to determine predictors of meeting all KOOS functional recovery target values (primary outcome) among demographic/injury, hop, and strength data (α ≤ 0.05).

Results

KOOS functional recovery target values for each subscale from uninjured athlete data were: Pain ≥ 94, Symptoms ≥ 92, Activities of Daily Living ≥ 97, Sport ≥ 92, and Quality-of-Life ≥ 92. At the time of return-to-sport clearance, ACL reconstruction participants met the KOOS functional recovery targets in the following proportions: Pain, 63%; Symptoms, 42%; Activities of Daily Living, 80%; Sport, 45%; Quality-of-Life, 24%; overall functional recovery (met all subscale targets), 17%. In ACL reconstruction participants, significant predictors of overall functional recovery (primary outcome) were: younger age, hamstring graft, pediatric ACL reconstruction, quadriceps strength limb-symmetry index > 90%, single-hop limb-symmetry index > 90%, and crossover-hop limb-symmetry index > 90%.

Conclusions

KOOS functional recovery target values derived from uninjured young athletes were higher than those previously reported. Small proportions of young athletes following recent RTS clearance after ACLR met these newly-derived functional recovery target values, and factors associated with meeting functional recovery target values included younger age, hamstring autograft and pediatric ACLR, and having > 90% LSI for quadriceps strength and single-leg hop tests.

Level of evidence

I.

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Acknowledgements

We would like to thank the staff of the Division of Sports Medicine and the Sports and Orthopaedic Team in the Division of Occupational Therapy and Physical Therapy for their contribution to this work.

Funding

This study was funded by support from the National Institutes of Health grant F32-AR055844 and the National Football League Charities Medical Research Grants 2007, 2008, 2009, and 2011. The funding agencies had no role in the study design, collection, analysis, nor interpretation of the data presented. Additionally, the funding agencies had no involvement in the writing of the manuscript, nor the decision to submit the manuscript for publication.

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Authors

Contributions

The conception and design of the study, or acquisition of data, or analysis and interpretation of data: MPI, BB, ST, MVP, LCS. Drafting the article or revising it critically for important intellectual content: MPI, BB, ST, MVP, LCS. Final approval of the version to be submitted: MPI, BB, ST, MVP, LCS. All authors take responsibility for the integrity of the work as a whole.

Corresponding author

Correspondence to Laura C. Schmitt.

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We have no competing interests or conflicts of interest to declare for this study.

Ethical approval of research on humans

The Institutional Review Board at Cincinnati Children’s Hospital Medical Center (Cincinnati, Ohio, USA) approved the protocol for this study (Project 2008-0514).

Informed consent

All participants provided written informed consent or parental permission/assent (when younger than 18 years old) prior to participating in the study.

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Ithurburn, M.P., Barenius, B., Thomas, S. et al. Few young athletes meet newly derived age- and activity-relevant functional recovery targets after ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 30, 3268–3276 (2022). https://doi.org/10.1007/s00167-021-06769-4

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Keywords

  • ACL reconstruction
  • Functional recovery
  • Hop tests
  • Quadriceps strength