Persistent Early Knee Osteoarthritis Symptoms in the First Two Years After ACL Reconstruction.

CONTEXT: Early identification of knee osteoarthritis (OA) symptoms after anterior cruciate ligament reconstruction (ACLR) could enable timely interventions to improve long-term outcomes. However, little is known about the change in early OA symptoms from 6 to 12 months following ACLR. OBJECTIVE: To evaluate the change over time in meeting classification criteria for early knee OA symptoms from 6 to 12 months following ACLR. DESIGN: Prospective Cohort Study. SETTING: Research laboratory. PATIENTS OR OTHER PARTICIPANTS: 82 participants aged 13-35 years who underwent unilateral primary ACLR. On average, participants' 1st and 2nd visits were 6.2 and 12.1 months post-ACLR. MAIN OUTCOME MEASURES: Early OA symptoms were classified using generic (Luyten Original) and patient population-specific (Luyten PASS) thresholds on Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales. Changes in meeting early OA criteria were compared between an initial and follow-up visit at an average of 6 and 12 months post-ACLR, respectively. RESULTS: Twenty-two percent of participants exhibited persistent early OA symptoms across both visits using both the Luyten Original and PASS criteria. From initial to follow-up visit, 18-27% had resolution of early OA symptoms while 4-9% developed incident symptoms. In total, 48-51% had no early OA symptoms at either visit. There were no differences between change in early OA status between adults and adolescents. CONCLUSIONS: Nearly one quarter of participants exhibited persistent early knee OA symptoms based on KOOS thresholds from 6 to 12 months post-ACLR. Determining if this symptom persistence predicts worse long-term outcomes could inform the need for timely interventions after ACLR. Future research should examine if resolving persistent symptoms in this critical window improves later outcomes. Tracking early OA symptoms over time may identify high-risk patients who could benefit from early treatment.

Age-, Sex-, and Graft-Specific Reference Values From 783 Adolescent Patients at 5 to 7 Months After ACL Reconstruction: IKDC, Pedi-IKDC, KOOS, ACL-RSI, Single-Leg Hop, and Thigh Strength.

OBJECTIVE: To describe age-, sex-, and graft source-specific reference values for patient-reported, physical function, and strength outcome measures in adolescents at 5 to 7 months after anterior cruciate ligament reconstruction. DESIGN: Cross-sectional study. METHODS: Data were collected at 3 universities and 2 children's hospitals. The participants completed at least one of the International Knee Documentation Committee (IKDC) Subjective Evaluation Form, Pediatric IKDC (Pedi-IKDC), Knee Injury and Osteoarthritis Outcomes Score (KOOS), and Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) Scale. Participants also completed single-leg hop tests and/or isokinetic quadriceps and hamstrings strength assessments (at 60°/s). Reference values were summarized using descriptive statistics and stratified for age, sex, and graft source. RESULTS: Reference values were reported for common patient-reported outcomes and measures of physical function and strength from 783 participants (56% females, age = 16. 4 ± 2.0 years) who were in early adolescence (12-14 years, N = 183, 52% females), middle adolescence (15-17 years, N = 456, 58% females), or late adolescence (18-20 years, N = 144, 55% females). Three hundred seventy-nine participants (48.4%) received a bone-patellar tendon-bone autograft, 292 participants (37.3%) received hamstring tendon autograft, and 112 participants (14.3%) received autograft or allograft from an alternative source. CONCLUSION: Reference values for common patient-reported outcomes and measures of physical function and strength differed depending on a patient's age, sex, and graft source. Using patient-specific reference values, in addition to previously described age-appropriate cutoff values, may help clinicians monitor and progress patients through rehabilitation and return to physical activity after anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther 2023;53(4):1-8. Epub: 23 January 2023. doi:10.2519/jospt.2023.11389.

Quadriceps Strength and Knee-Related Symptom State 6 Months After Anterior Cruciate Ligament Reconstruction.

CONTEXT: Isometric quadriceps strength metrics and patient-reported outcomes are commonly used in return-to-sport assessments in those with anterior cruciate ligament reconstruction (ACLR). Patients may experience clinical knee-related symptoms aggravating enough to seek additional medical care after ACLR. In addition to seeking additional medical care, these patient-reported clinical knee-related symptoms may also influence function after ACLR. However, whether an association exists between these common quadriceps metrics and the patient-reported clinical knee-related symptom state is unknown. OBJECTIVE: To determine if meeting isometric quadriceps strength and symmetry criteria is associated with acceptable clinical knee-related symptoms at 5 to 7 months post-ACLR. DESIGN: Cross-sectional study. SETTING: Laboratories. PATIENTS OR OTHER PARTICIPANTS: We classified individuals at 5 to 7 months post-ACLR based on their isometric ACLR and uninvolved-limb quadriceps strength or quadriceps strength symmetry. We also dichotomized participants based on the Englund et al criteria for unacceptable clinical knee-related symptoms. MAIN OUTCOME MEASURE(S): Quadriceps strength variables were compared between groups using analysis of covariance, and the relative risk of a participant in each quadriceps strength group reporting acceptable clinical knee-related symptoms was determined using binary logistic regression. RESULTS: A total of 173 individuals participated. The isometric quadriceps strength and limb symmetry index were different (P < .001) between quadriceps strength groups. Those categorized as both strong and symmetric had a 1.28 (95% CI = 0.94, 1.74) and individuals categorized as symmetric only had a 1.29 (95% CI = 0.97, 1.73) times greater relative risk of reporting acceptable clinical knee-related symptoms compared with the neither strong nor symmetric group. CONCLUSIONS: The majority of individuals (85%) recovering from ACLR failed to meet either the clinical quadriceps strength or symmetry criteria at 5 to 7 months post-ACLR. Quadriceps strength and quadriceps strength symmetry are clinically important but may not be primary determinants of the clinical knee-related symptom state within the first 6 months post-ACLR.

Gender Differences in Psychological Responses to Recovery After Anterior Cruciate Ligament Reconstruction Before Return to Sport.

CONTEXT: Female patients with anterior cruciate ligament reconstruction (ACLR) are less likely to return to sport than males. Psychological readiness predicts successful return to sport, but it is unclear if psychological experiences differ between males and females during recovery. OBJECTIVE: To explore gender differences in psychological readiness factors of return to sport after ACLR. DESIGN: Qualitative study. SETTING: Laboratory. PATIENTS OR OTHER PARTICIPANTS: A total of 12 male (months since surgery = 6.2 ± 1.2) and 13 female (months since surgery = 6.4 ± 1.3) high school athletes with a history of ACLR. DATA COLLECTION AND ANALYSIS: Participants were interviewed before physician clearance to return to activity. Transcribed interviews were analyzed using deductive thematic coding of 5 themes identified from previous research (psychological distress, self-efficacy, locus of control, athletic identity, and fear of reinjury) and inductive secondary subthematic coding. Gender comparisons were generated within primary themes and secondary subthemes. RESULTS: All deductive themes were consistently reinforced. Male and female participants reported fear of movement, loss of athletic identity, and motivational mindsets for return to sport and self-improvement. Males reported a stronger sense of internal locus of control using positive internal reinforcement, whereas females described balancing internal and external control and valuing external support systems. Male participants described mood changes influenced by physical and social limitations. Female participants closely monitored their emotions throughout recovery and were influenced by rehabilitation fluctuations. CONCLUSIONS: Male and female high school athletes described different psychological factors related to return to sport and locus of control as well as psychological distress. Gender-specific psychological interventions may be warranted to overcome psychological barriers after ACLR.

Sex differences in quadriceps rate of torque development within 1 year of ACL reconstruction.

OBJECTIVES: To investigate the effect of sex on measures of quadriceps strength, rate of torque development, and knee function during the first year following ACLR. DESIGN: Cross-sectional; SETTING: University community; PARTICIPANTS: Sixty individuals (29 men) with unilateral ACLR in the last 12 months. MAIN OUTCOME MEASURES: Participants completed bilateral knee extension maximal voluntary isometric contraction (MVIC, Nm/kg) strength assessments. Rates of torque development (Nm*kg-1*s-1) were assessed from contraction initiation to 100 ms (RTD100) and from 100 ms to 200 ms after contraction initiation (RTD200). The effects of sex MVIC strength, RTD, and limb symmetry were assessed using separate ANCOVAs. RESULTS: Women displayed weaker involved limb (Men = 2.72 ±â€¯0.72 Nm*kg-1, Women = 2.01 ±â€¯0.50 Nm*kg-1, p < 0.001) and contralateral limb (Men = 3.15 ±â€¯0.52 Nm*kg-1, Women = 2.66 ±â€¯0.58 Nm*kg-1, p < 0.001) MVIC, and slower involved limb RTD100 (Men = 8.36 ±â€¯3.16 Nm*kg-1*s-1, Women = 6.50 ±â€¯2.41 Nm*kg-1*s-1, p = 0.01) and RTD200 (Men = 9.49 ±â€¯3.45 Nm*kg-1*s-1, Women = 9.49 ±â€¯3.45 Nm*kg-1*s-1, p < 0.001) when compared to men. CONCLUSIONS: Within the first year after ACLR, women displayed bilateral quadriceps weakness and slower involved limb quadriceps RTD when compared to men. Specific focus on facilitating quadriceps hypertrophy and improving neural drive to the quadriceps is indicated when treating female patients attempting to make a return to sport after ACLR.

Perceptions of Rehabilitation and Return to Sport Among High School Athletes With Anterior Cruciate Ligament Reconstruction: A Qualitative Research Study.

BACKGROUND: Adolescent athletes struggle to return to sport following anterior cruciate ligament reconstruction (ACLR) for physical and psychosocial reasons. The ability to integrate contextual evidence obtained directly from patients with the growing body of quantitative rehabilitation research may aid clinicians in taking an evidence-based approach to rehabilitation and return to sport within the adolescent population. OBJECTIVES: To assess perceived barriers to return to sport, as well as positive and negative factors influencing recovery, among high school athletes with recent history of ACLR. METHODS: This phenomenographic cross-sectional study included a sample of 10 high school-aged individuals (7 female, 3 male; mean ± SD age, 16.8 ± 1.1 years; time since surgery, 5.5 ± 1.4 months) who underwent ACLR and had not returned to sports. Participants completed a semi-structured interview focused on attitudes related to return to sport, perceived physical or psychosocial barriers to physical activity and return to sport, and rehabilitation characteristics that may facilitate or hinder return to sport. RESULTS: Participants reported psychosocial barriers to return to sport with greater consistency than physical barriers. Consistently reported barriers included the feeling that sport-based activities were now associated with injury, a persistent sense of uncertainty regarding full recovery, and the sense that comparison to others with ACLR by parents or coaches hindered their ability to make progress in rehabilitation. CONCLUSION: Early identification of athletes at risk for persistent psychosocial barriers, such as fear of reinjury and uncertainty regarding full recovery, and establishment of peer mentoring groups to facilitate psychosocial support throughout the rehabilitation process may be key components of a gradual, patient-centered approach to improving mental and physical readiness for return to sport. J Orthop Sports Phys Ther 2018;48(12):951-959. Epub 22 Jun 2018. doi:10.2519/jospt.2018.8277.

The Relationship Between Tibial Tubercle-Trochlear Groove Distance and Noncontact Anterior Cruciate Ligament Injuries in Adolescents and Young Adults.

PURPOSE: To determine differences in tibial tubercle-trochlear groove (TT-TG) distance between patients with a history of noncontact anterior cruciate ligament (ACL) injury and an uninjured control group. METHODS: MRI studies of 60 patients (age range, 14 to 25 years) with ACL-deficient (ACLD) knees were compared with 60 intact-ACL controls. All patients underwent MRI after a noncontact sports injury. TT-TG distances were measured on proton density-weighted axial images. Independent t-tests were used to determine differences in TT-TG distance between the ACLD and control groups. RESULTS: The mean TT-TG distance in the ACLD group was 12.07 mm (95% confidence interval [CI], 11.11 to 13.02), compared with 10.44 mm (95% CI, 9.64 to 11.24) in the control group. The mean TT-TG distance in the male ACLD group was 12.95 mm (95% CI, 11.39 to 14.51), compared with 10.87 mm (95% CI, 9.52 to 12.21) in the male control group. The mean TT-TG distance in the female ACLD group was 11.48 mm (95% CI, 10.24 to 12.71), compared with 10.04 mm (95% CI, 9.06 to 11.02) in the female control group. There were statistically significant differences in TT-TG distance between the ACLD and control groups (P = .011) and between the male ACLD and control groups (P = .041). CONCLUSIONS: In adolescents and young adults, the TT-TG distance was statistically larger in knees with noncontact ACL tears than in intact-ACL control knees. When the groups were stratified on the basis of sex, only the male patients showed a statistical difference, with a 2.08 mm increase in TT-TG distance between the ACLD and intact-ACL patients. No difference in TT-TG distance was found between the ACLD and control groups for female patients. Despite the findings of this study, the clinical significance of an increased TT-TG distance as an isolated risk factor for noncontact ACL injury remains unanswered. LEVEL OF EVIDENCE: Level III, case-control study.