Analysis of subjective, objective and functional examination tests after anterior cruciate ligament reconstruction

Abstract

This study included 527 patients (178 female and 349 male) with unilateral anterior cruciate ligament (ACL) rupture who underwent arthroscopic ACL reconstruction using bone-patellar tendon-bone autograft and interference screw fixation. The follow-up examination was performed by independent observers at a median of 38 (21-68) months after the index operation. At the follow-up, the Lysholm score was 86 (14-100) points, the Lysholm instability subscore was 22 (0-25) points and the Lysholm pain subscore was 19 (0-25) points. The Tegner activity level was 6 (1-10). The one-leg-hop test was 91 (0-167)% of the non-injured knee. The difference in the anterior side-to-side laxity as measured with the KT-1000 arthrometer at 89 Newton (N) was 1.5 (-5-13) mm and the total KT-1000 side-to-side difference at 89 N was 2 (-7-11) mm. Using the International Knee Documentation Committee (IKDC) evaluation system, 177 (33.6%) patients were classified as normal (group A), 211 (40%) as nearly normal (group B), 109 (20.7%) as abnormal (group C) and 30 (5.7%) as severely abnormal (group D). The highest correlation coefficients were recorded between the IKDC evaluation system and the Lysholm score (p = 0.66), the patients' subjective evaluation (p = 0.53), the Tegner activity level (p = 0.34), all the laxity tests (p > or = 0.34) and the one-leg-hop test (p = 0.28). The resumption of sporting activities and work as evaluated by the Tegner activity level correlated with the patients' subjective evaluation (p = 0.34) but did not correlate with the laxity tests, i.e., the manual Lachman test (p = -0.06) and the total and anterior KT-1000 tests (p = -0.06). Furthermore, none of the laxity tests correlated with the functional tests or the patients' subjective evaluation. We conclude that the IKDC evaluation system is a reliable and useful tool for evaluating the post-operative outcome after an ACL reconstruction.

A comparison of quadruple semitendinosus and patellar tendon grafts in reconstruction of the anterior cruciate ligament

“…14 Other authors have also noted a lower percentage of 'normal' or 'nearly normal' results when using the IKDC system compared with other rating systems. 10,15,16 Our final IKDC, VAS and Lysholm values were also comparable with a previous study of reconstruction using patellar tendon grafts. 17 In our study significant improvement in knee function, activity level and IKDC and Lysholm scores was found in both groups.…”

“…42 There were no correlations between values for laxity and outcome scores, which has been reported previously. 16 It seems as if a certain degree of anteroposterior laxity can be tolerated as long as there is no giving-away. We interpreted the high correlation between the patellofemoral pain score and Lysholm score as well as the IKDC score to mean that pain and discomfort, rather than instability, characterise most patients with suboptimal results.…”

Rehabilitation After Anterior Cruciate Ligament Reconstruction: Criteria-Based Progression Through the Return-to-Sport Phase

“…Though mechanical stability may be restored via surgical reconstruction, the patient may continue to experience functional instability (giving-way episodes or perceived instability) or functional impairments. 34,80,85 Return to high-level sports is a high-risk period for athletes during the first year postreconstruction. 68,78,87 Return of a patient to high-level sports before functional stability is achieved may increase the potential for poor outcome.…”

Development and Validation of a New Evaluation System for Patients With a Floor-based Lifestyle: The Korean Knee Score

“…In recent years, there has been wide acceptance and recognition of the importance of patient-reported outcome measures in the evaluation of patients' health status after treatment [9,10,18]. This is because functional status and quality of life are best described by patients rather than by physicians.…”

“…From clinical examination to imaging studies, numerous methods of evaluation have been introduced and used. Although objective measures of outcomes such as ROM, static instability grade, and muscle strength are commonly used, they reportedly only weakly correlate with patient function, general status, and health-related quality of life (HRQOL) [9,10,18].…”