The impact of graft type on rehabilitation outcomes following ACL reconstruction: Bone patellar tendon bone versus quadriceps tendon grafts.

OBJECTIVE: The aims of this study were to 1) compare the dosage of physical therapy provided for patients following an anterior cruciate ligament reconstruction (ACL-R) with either quadriceps or bone-patellar tendon-bone (BPTB) graft type and their resulting outcomes and 2) investigate the frequency therapists documented surgical graft type. DESIGN: Retrospective observational. SETTING: Outpatient orthopedics. PARTICIPANTS: Data was collected from the electronic medical records of 212 patients: BPTB (41) and quadriceps tendon (33) were analyzed. Forty-eight cases were other graft types and 90 were unspecified. MAIN OUTCOME MEASURE: An independent samples t-test was used to compare differences in knee range of motion (ROM) and Knee Functional Status (FS) between BPTB and quadriceps grafts. RESULTS: There were no differences in knee flexion (p = 0.148) or extension (p = 0.305) ROM between groups at discharge. The quadriceps group achieved greater improvement in functional outcomes (p < 0.001). The quadriceps group received more sessions (p = 0.021) and a longer duration of care (p = 0.007). CONCLUSIONS: The significant difference in treatment dosage makes it difficult to conclude which graft is superior. It is unknown if the frequent omission of graft type in the patient chart is an indication of poor documentation practice or a lack of perceived importance in knowing the graft type for PT.

Identification of Latent Classes of Motor Performance in a Heterogenous Population of Adults.

OBJECTIVE: To determine classes of motor performance based on community deployable motor impairment and functional tests in a heterogeneous adult population. DESIGN: Sixteen tests of limb-specific and whole-body measures of motor impairment and function were obtained. Linear regression analysis was used to dichotomize performance on each test as falling within or outside the age- and sex-predicted values. Latent class analysis was used to determine 3 classes of motor performance. The chi-square test of association and the Fisher exact test were used for categorical variables, and analysis of variance and the Kruskal-Wallis test were used for continuous variables to evaluate the relationship between demographic characteristics and latent classes. SETTING: General community. PARTICIPANTS: Individuals (N=118; 50 men) participated in the study. Quota sampling was used to recruit individuals who self-identified as healthy (n=44) or currently living with a preexisting chronic health condition, including arthritis (n=19), multiple sclerosis (n=18), Parkinson disease (n=17), stroke (n=18), or low functioning (n=2). INTERVENTION: Not applicable. MAIN OUTCOME MEASURE: Latent classes of motor performance. RESULTS: Across the entire sample, 3 latent classes of motor performance were determined that clustered individuals with motor performance falling: (1) within predicted values on most of the tests (expected class), (2) outside predicted values on some of the tests (moderate class), and (3) outside predicted values on most of the tests (severe class).The ability to distinguish between the respective classes based on the percent chance of falling outside predicted values was achieved using the following community deployable motor performance tests: 10-meter walk test (22%, 80%, and 100%), 6-minute walk test (14.5%, 37.5%, and 100%), grooved pegboard test (23%, 38%, and 100%), and modified physical performance test (3%, 54%, and 96%). CONCLUSIONS: In this heterogeneous group of adults, we found 3 distinct classes of motor performance, with the sample clustering into an expected test score group, a moderate test score deficiency group, and a severed test score deficiency group. Based on the motor performance tests, we established that community deployable, easily administered testing could accurately predict the established clusters of motor performance.