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J Knee Surg 2023; 36(10): 1060-1068
DOI: 10.1055/s-0042-1748824
Original Article

Are 6-Month Functional and Isokinetic Testing Measures Risk Factors for Second Anterior Cruciate Ligament Injuries at Long-T Follow-Up?

Erick M. Marigi
1   Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
,
Rena F. Hale
1   Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
,
Christopher D. Bernard
1   Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
,
Nathaniel Bates
1   Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
,
Michael J. Stuart 
1   Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
,
Timothy E. Hewett
1   Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
,
Aaron J. Krych
1   Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
› Author Affiliations Funding This work was supported by the National Institutes of Health (NIH) National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) Musculoskeletal Grant R01AR055563 and UL1 TR002377 from the National Center for Advancing Translational Sciences (NCATS). The contents of this study are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.
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Abstract

Introduction Second anterior cruciate ligament (SACL) injuries are a devastating complication following return to sport (RTS). Appropriate and safe RTS criteria that reduce the risk of SACL injuries are needed. The goal of this study was to investigate the relationship between functional and isokinetic testing at 6 months following primary ACL reconstruction (ACLR) as risk factors for SACL injuries.

Methods Patients with primary ACLR from 1990 to 2010 were identified. Those with 6-month postoperative functional and isokinetic testing and a minimum of 2-year follow-up were included. Functional testing included vertical jump, single-leg hop, and single-leg triple hop. Isokinetic testing included concentric quadriceps and hamstrings (HSs) strength at 60 and 180 degree/s speeds. Statistical analysis evaluated the significance of the various tests between those with and without a secondary tear.

Results In total, 344 patients with a mean age of 26.0 ± 9.8 years at an average time of 9.1 ± 3.5 years of follow-up were analyzed. Fifty-nine patients (17%) experienced SACL injuries at an average time of 4.8 years following ACLR with 34 (58%) ipsilateral graft ruptures and 25 (43%) contralateral tears. Several isokinetic measures were significantly different between the NO SACL and the SACL groups: quadriceps 60 degree/s limb symmetry index (LSI) (75 vs. 82% p = 0.01), HS 60 degree/s LSI (92 vs. 97%, p = 0.04), quadriceps 180 degree/s involved/body weight (BW) (41 vs. 47%, p = 0.04), and HS 180 degree/s involved/BW (30 vs. 34%, p = 0.04). Patients with involved limb peak quadriceps torque value greater than 65 or 50% of BW (60 and 180 degree/s) had a 2.2 and 3.1 times higher risk of an SACL injury.

Conclusions Patients with certain elevated isokinetic scores in the injured limb at 6 months after ACLR experienced a higher rate of subsequent ACL injuries than those who had lower peak torque. Although a quantitative only analysis may not be sufficient to determine RTS criteria, clinicians should caution high-performing patients about the risk of subsequent ACL injury.

Level of Evidence Cohort study; 3.

Keywords

ACL injury - return to sport - isokinetic testing - functional testing - ACL reconstruction

Note

IRB: ID: 15-000601 Knee Biologic Preservation: Functional and Clinical Outcome.




Publication History

Received: 13 March 2021

Accepted: 18 March 2022

Article published online:
10 June 2022

© 2022. Thieme. All rights reserved.

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