Tracking Patient Outcomes after Anterior Cruciate Ligament Reconstruction

Abstract

Purpose: To model how patients' knee range of motion (ROM), pain, and self-reported lower-extremity (LE) functional status change over the first 26 weeks following anterior cruciate ligament (ACL) reconstruction and to estimate the test-retest reliability of these measurements. Methods: Patients were assessed weekly over 26 weeks following ACL reconstruction. Outcomes were knee ROM, LE functional status measured by the Lower Extremity Functional Scale (LEFS), and pain measured by the 4-item pain intensity measure (P4). A nonlinear model was applied to describe change for each outcome. Intra-class correlation coefficients and standard errors of measurement were applied to estimate test-retest reliability and minimal detectable change. Key Words: knee; outcome assessment; prognosis; reproducibility of results. RÉ SUMÉObjet: Modé liser comment l'amplitude du mouvement (ADM) du genou des patients, la douleur et l'é tat fonctionnel autodé claré des membres infé rieurs (MI) changent au cours des 26 premiè res semaines suivant la reconstruction du ligament croisé anté rieur (LCA) et estimer la fiabilité de test-retest de ces mesures. Mé thodes: On a é valué les patients une fois par semaine pendant les 26 semaines qui ont suivi une reconstruction du LCA. L'ADM du genou, l'é tat fonctionnel des MI mesuré en fonction de l'é chelle fonctionnelle des membres infé rieurs (EFMI) et la douleur mesuré e par le questionnaire sur l'intensité de la douleur à quatre questions (P4) ont constitué les ré sultats. Nous avons appliqué un modè le non liné aire pour dé crire le changement de chaque ré sultat. Nous avons aussi appliqué des coefficients de corré lation intra-classe et les erreurs de mesure types pour estimer la fiabilité de test-retest et le changement dé tectable minimal. Ré sultats: Un modè le non liné aire a produit les valeurs suivantes d'adaptation du modè le (R 2 ): P4 ¼ 0,71, ADM extension ¼ 0,51, ADM flexion ¼ 0,99, EFMI ¼ 0,97. Dans le cas de la douleur et de l'ADM, les valeurs maximales ont é té atteintes vers la 12 e semaine suivant la reconstruction et les valeurs EFMI ont continué d'augmenter jusqu'à 26 semaines. Les coefficients de fiabilité de test-retest ont varié de 0,85 à 0,95. Conclusions: L'amé lioration la plus importante s'est produite au cours des huit semaines suivant l'intervention chirurgicale. Le ré tablissement é tait presque complet à 12 semaines en ce qui a trait à la douleur et à l'ADM, mê me si l'é tat fonctionnel des membres infé rieurs a continué de s'amé liorer durant toute la pé riode d'é tude. Les ré sultats de toutes les mesures ont dé montré de la fiabilité , ce qui appuie leur utilisation avec des patients particuliers.Understanding patients' clinical course following anterior cruciate ligament (ACL) reconstruction is of interest to physical therapists working in orthopaedics in general and with athletic injuries specifically. 1 The term clinical course refers to how patients change over the course of treatment with respect to outcomes that are of interest to both patients a...

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