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Functional tests should be accentuated more in the decision for ACL reconstruction

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

Abstract

A high pre-injury activity level, the desire of the patient to continue pivoting sports and fear of future give-way episodes are considered the most significant factors affecting the decision to perform anterior cruciate ligament reconstruction. However, since the functional status of the knee at the time of surgery affects the final outcome, assessments of knee function should be considered in the decision making for surgery. Individuals with anterior cruciate ligament injury can be classified as potential copers or non-copers from an existing screening examination. The purpose of this study was to investigate whether the functional tests incorporated in the original screening examination could contribute to explain those who later go through anterior cruciate ligament reconstruction and to examine whether changes to the content or the time of conducting the screening examination (before or after ten sessions of exercise therapy) could improve its explanatory value. One-hundred and forty-five individuals were included and prospectively followed for 15 months, after where 51% had gone through anterior cruciate ligament reconstruction and 49% were managed non-operatively. The only significant baseline differences between those who later went through anterior cruciate ligament reconstruction and those who were non-operatively treated were that those who had surgery were younger and had a higher activity level (P < 0.05). Regression analyses revealed that the explanatory value for those who later went through anterior cruciate ligament reconstruction significantly improved when the original screening examination was considered compared to only age, activity level and give-way episodes. Changes to the content further improved the explanatory value, with quadriceps muscle strength as the single variable with the highest impact. Finally, conducting the screening examination after ten sessions of progressive exercise therapy gave the overall highest explanatory values, suggesting that the screening examination should be conducted subsequent to a short period of rehabilitation to inform decision making for anterior cruciate ligament reconstruction.

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Acknowledgments

This study received research grants from the South-Eastern Norway Regional Health Authority and NIH grant RO1 HD37985-04, RO1 HD37985-05 and RO1 HD37985-06.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. NAR, Department of Orthopaedics, Oslo University Hospital and Hjelp24NIMI, NAR/Hjelp24NIMI Ullevaal, PB 3842 Ullevaal Stadion, 0705, Oslo, Norway

    Ingrid Eitzen

  2. NAR, Norwegian School of Sport Sciences, Hjelp24NIMI and Department of Orthopaedics, Oslo University Hospital, Oslo, Norway

    Håvard Moksnes & May Arna Risberg

  3. Department of Physical Therapy, University of Delaware, Newark, DE, USA

    Lynn Snyder-Mackler

  4. NAR, Department of Orthopaedics, Oslo University Hospital, Norwegian School of Sport Sciences and University of Oslo, Oslo, Norway

    Lars Engebretsen

Authors
  1. Ingrid Eitzen
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  2. Håvard Moksnes
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  3. Lynn Snyder-Mackler
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  4. Lars Engebretsen
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  5. May Arna Risberg
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Correspondence to Ingrid Eitzen.

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Eitzen, I., Moksnes, H., Snyder-Mackler, L. et al. Functional tests should be accentuated more in the decision for ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 18, 1517–1525 (2010). https://doi.org/10.1007/s00167-010-1113-5

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  • DOI: https://doi.org/10.1007/s00167-010-1113-5

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