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Patient Characteristics and Predictors of Return to Sport at 12 Months After Anterior Cruciate Ligament Reconstruction: The Importance of Patient Age and Postoperative Rehabilitation

BACKGROUND: Preventing and mitigating the risk of reinjury after anterior cruciate ligament reconstruction (ACLR) rest on variables including age, surgical restoration of knee stability, adequate physical function, and thorough and complete postoperative rehabilitation, but to what degree these fact...

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Autores principales: Edwards, Peter K., Ebert, Jay R., Joss, Brendan, Ackland, Timothy, Annear, Peter, Buelow, Jens-Ulrich, Hewitt, Ben
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6149022/
https://www.ncbi.nlm.nih.gov/pubmed/30263898
http://dx.doi.org/10.1177/2325967118797575
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author Edwards, Peter K.
Ebert, Jay R.
Joss, Brendan
Ackland, Timothy
Annear, Peter
Buelow, Jens-Ulrich
Hewitt, Ben
author_facet Edwards, Peter K.
Ebert, Jay R.
Joss, Brendan
Ackland, Timothy
Annear, Peter
Buelow, Jens-Ulrich
Hewitt, Ben
author_sort Edwards, Peter K.
collection PubMed
description BACKGROUND: Preventing and mitigating the risk of reinjury after anterior cruciate ligament reconstruction (ACLR) rest on variables including age, surgical restoration of knee stability, adequate physical function, and thorough and complete postoperative rehabilitation, but to what degree these factors influence return to sport is unclear. PURPOSE: To investigate factors predictive of return to sport 12 months after ACLR. The factors specifically evaluated were strength, hop function, self-reported knee function, patient age, and quality of postoperative rehabilitation. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: This study evaluated 113 patients approximately 12 months after ACLR using a rehabilitation grading tool, the subjective International Knee Documentation Committee (IKDC) form, and a return-to-sport battery consisting of maximal isokinetic quadriceps and hamstring strength and 4 functional hop tests. Mann-Whitney U tests and chi-square analyses were used to determine differences between patients who had or had not returned to sport. A subsequent binary logistic hierarchical regression determined the factors predictive of a patient’s return to sport. In those patients who had returned to sport, relationships between either age or level of rehabilitation and passing the return-to-sport battery were also investigated. RESULTS: Complete rehabilitation (adjusted odds ratio [OR], 7.95; P = .009), age ≤25 years (adjusted OR, 3.84; P = .024), and higher IKDC scores (P < .001) were predictive of return to sport at 12 months. In participants who had returned to sport, 21% passed the return-to-sport battery compared with only 5% who did not. Of those who had returned to sport, 37% who underwent complete rehabilitation passed the return-to-sport battery as opposed to 5% who underwent incomplete rehabilitation. In patients aged ≤25 years, only 48% underwent complete rehabilitation, despite having returned to sport. Additionally, in this group of patients, 40% underwent complete rehabilitation and passed the physical performance battery as opposed to only 4% who did not undergo complete rehabilitation. CONCLUSION: Younger patients and higher subjective IKDC scores were predictive of return to sport. Patients who completed 6 months of rehabilitation incorporating jumping and agility tasks had a higher rate of return to sport, suggesting that postoperative rehabilitation is important in predicting return to sport. Specialists and physical therapists alike should stress the importance of thorough postoperative rehabilitation and adequate neuromuscular strength and function to patients whose goals are to return to sport.
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spelling pubmed-61490222018-09-27 Patient Characteristics and Predictors of Return to Sport at 12 Months After Anterior Cruciate Ligament Reconstruction: The Importance of Patient Age and Postoperative Rehabilitation Edwards, Peter K. Ebert, Jay R. Joss, Brendan Ackland, Timothy Annear, Peter Buelow, Jens-Ulrich Hewitt, Ben Orthop J Sports Med Article BACKGROUND: Preventing and mitigating the risk of reinjury after anterior cruciate ligament reconstruction (ACLR) rest on variables including age, surgical restoration of knee stability, adequate physical function, and thorough and complete postoperative rehabilitation, but to what degree these factors influence return to sport is unclear. PURPOSE: To investigate factors predictive of return to sport 12 months after ACLR. The factors specifically evaluated were strength, hop function, self-reported knee function, patient age, and quality of postoperative rehabilitation. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: This study evaluated 113 patients approximately 12 months after ACLR using a rehabilitation grading tool, the subjective International Knee Documentation Committee (IKDC) form, and a return-to-sport battery consisting of maximal isokinetic quadriceps and hamstring strength and 4 functional hop tests. Mann-Whitney U tests and chi-square analyses were used to determine differences between patients who had or had not returned to sport. A subsequent binary logistic hierarchical regression determined the factors predictive of a patient’s return to sport. In those patients who had returned to sport, relationships between either age or level of rehabilitation and passing the return-to-sport battery were also investigated. RESULTS: Complete rehabilitation (adjusted odds ratio [OR], 7.95; P = .009), age ≤25 years (adjusted OR, 3.84; P = .024), and higher IKDC scores (P < .001) were predictive of return to sport at 12 months. In participants who had returned to sport, 21% passed the return-to-sport battery compared with only 5% who did not. Of those who had returned to sport, 37% who underwent complete rehabilitation passed the return-to-sport battery as opposed to 5% who underwent incomplete rehabilitation. In patients aged ≤25 years, only 48% underwent complete rehabilitation, despite having returned to sport. Additionally, in this group of patients, 40% underwent complete rehabilitation and passed the physical performance battery as opposed to only 4% who did not undergo complete rehabilitation. CONCLUSION: Younger patients and higher subjective IKDC scores were predictive of return to sport. Patients who completed 6 months of rehabilitation incorporating jumping and agility tasks had a higher rate of return to sport, suggesting that postoperative rehabilitation is important in predicting return to sport. Specialists and physical therapists alike should stress the importance of thorough postoperative rehabilitation and adequate neuromuscular strength and function to patients whose goals are to return to sport. SAGE Publications 2018-09-20 /pmc/articles/PMC6149022/ /pubmed/30263898 http://dx.doi.org/10.1177/2325967118797575 Text en © The Author(s) 2018 http://creativecommons.org/licenses/by-nc-nd/4.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License (http://www.creativecommons.org/licenses/by-nc-nd/4.0/) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Article
Edwards, Peter K.
Ebert, Jay R.
Joss, Brendan
Ackland, Timothy
Annear, Peter
Buelow, Jens-Ulrich
Hewitt, Ben
Patient Characteristics and Predictors of Return to Sport at 12 Months After Anterior Cruciate Ligament Reconstruction: The Importance of Patient Age and Postoperative Rehabilitation
title Patient Characteristics and Predictors of Return to Sport at 12 Months After Anterior Cruciate Ligament Reconstruction: The Importance of Patient Age and Postoperative Rehabilitation
title_full Patient Characteristics and Predictors of Return to Sport at 12 Months After Anterior Cruciate Ligament Reconstruction: The Importance of Patient Age and Postoperative Rehabilitation
title_fullStr Patient Characteristics and Predictors of Return to Sport at 12 Months After Anterior Cruciate Ligament Reconstruction: The Importance of Patient Age and Postoperative Rehabilitation
title_full_unstemmed Patient Characteristics and Predictors of Return to Sport at 12 Months After Anterior Cruciate Ligament Reconstruction: The Importance of Patient Age and Postoperative Rehabilitation
title_short Patient Characteristics and Predictors of Return to Sport at 12 Months After Anterior Cruciate Ligament Reconstruction: The Importance of Patient Age and Postoperative Rehabilitation
title_sort patient characteristics and predictors of return to sport at 12 months after anterior cruciate ligament reconstruction: the importance of patient age and postoperative rehabilitation
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6149022/
https://www.ncbi.nlm.nih.gov/pubmed/30263898
http://dx.doi.org/10.1177/2325967118797575
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