PMID- 31756121
OWN - NLM
STAT- MEDLINE
DCOM- 20200902
LR  - 20200902
IS  - 1552-3365 (Electronic)
IS  - 0363-5465 (Linking)
VI  - 48
IP  - 1
DP  - 2020 Jan
TI  - How Much Time Is Needed Between Serial "Return to Play" Assessments to Achieve 
      Clinically Important Strength Gains in Patients Recovering From Anterior Cruciate 
      Ligament Reconstruction?
PG  - 70-77
LID - 10.1177/0363546519886291 [doi]
AB  - BACKGROUND: Pass rates for return-to-play evaluations are alarmingly low for 
      patients after anterior cruciate ligament reconstruction (ACLR). Since timing of 
      return to play is a complicated decision, it is important that patients be given 
      optimal time to realize meaningful improvements in strength that warrant 
      additional testing. PURPOSE: To (1) compare outcomes among patients assessed at 
      different time points after ACLR, (2) determine strength gains indicative of 
      improvements in subjective function, and (3) determine the amount of time 
      necessary to achieve meaningful strength gains. STUDY DESIGN: 
      Cross-sectional/case-control study; Level of evidence, 3. METHODS: A total of 293 
      patients participated in the study after ACLR (mean +/- SD, 23.2 +/- 10.1 years old; 
      n = 142 female participants; 6.4 +/- 0.9 months after ACLR). Participants were 
      stratified on the month of their evaluation after ACLR: 5 to 6 months (n = 122), 
      6 to 7 months (n = 102), 7 to 8 months (n = 43), and 8 to 9 months (n = 26). The 
      International Knee Documentation Committee (IKDC) subjective form and knee 
      extensor and flexor torque and symmetry, as assessed through an isokinetic 
      dynamometer, were compared among groups. Forty patients (20 female participants, 
      20.4 +/- 7.1 years old) were referred for subsequent testing (2.14 +/- 0.78 months 
      after initial visit). Subjective improvement between visits was defined as a 
      >/=9-point change of the IKDC score. Thresholds of knee extensor torque and 
      symmetry indicative of subjective improvement and the time between assessments 
      needed to achieve these strength improvements were determined. RESULTS: Patients 
      between 5 and 6 months (IKDC, 79.7; interquartile range [IQR], 70.1-88.5) had 
      lower subjective function compared to patients between 6 and 7 months (IKDC, 
      83.9; IQR, 74.5-92.0; P = .019) and 8 and 9 months after ACLR (IKDC, 89.1; IQR 
      75.8-92.3; P = .026). Patients between 5 and 6 months (1.41 N.m/kg; IQR, 
      1.16-1.73 N.m/kg]) had lower knee extensor torque compared to patients 6 and 7 
      months (1.59 N.m/kg; IQR, 1.23-1.95 N.m/kg; P = .013) and 7 and 8 months after 
      ACLR (1.62 N.m/kg; IQR, 1.30-1.86 N.m/kg; P = .046). Patients between 5 and 6 
      months (66.4%; IQR, 54.2-78.6) had lower symmetry compared to patients between 6 
      and 7 months (71.8%; IQR,61.1-82.9; P = .019) and 8 and 9 months afterACLR 
      (75.2%; IQR, 66.6-87.7; P = .014). Of the 40 patients that completed follow-up 
      assessments, an increase in knee extensor torque of 0.22 N.m/kg and symmetry of 
      5.75% discriminated patients that achieved subjective improvement. A period of 
      1.97 months between assessments discriminated those that achieved the established 
      symmetry threshold. CONCLUSION: Patients demonstrate increasing subjective and 
      quadriceps function when tested at later time points from surgery; however, the 
      observed values are low, suggesting that at 9 months patients are demonstrating 
      deficits that may be improving. Approximately 2 months is needed to observe 
      clinically meaningful improvements.
FAU - Bodkin, Stephan G
AU  - Bodkin SG
AD  - Department of Kinesiology, University of Virginia, Charlottesville, Virginia, 
      USA.
FAU - Rutherford, Margaret H
AU  - Rutherford MH
AD  - Department of Kinesiology, University of Virginia, Charlottesville, Virginia, 
      USA.
FAU - Diduch, David R
AU  - Diduch DR
AD  - Department of Orthopaedic Surgery, University of Virginia, Charlottesville, 
      Virginia, USA.
FAU - Brockmeier, Stephen F
AU  - Brockmeier SF
AD  - Department of Orthopaedic Surgery, University of Virginia, Charlottesville, 
      Virginia, USA.
FAU - Hart, Joe M
AU  - Hart JM
AD  - Department of Kinesiology, University of Virginia, Charlottesville, Virginia, 
      USA.
AD  - Department of Orthopaedic Surgery, University of Virginia, Charlottesville, 
      Virginia, USA.
LA  - eng
PT  - Journal Article
DEP - 20191122
PL  - United States
TA  - Am J Sports Med
JT  - The American journal of sports medicine
JID - 7609541
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Anterior Cruciate Ligament Injuries/*surgery
MH  - Anterior Cruciate Ligament Reconstruction/*statistics & numerical data
MH  - Case-Control Studies
MH  - Cross-Sectional Studies
MH  - Female
MH  - Humans
MH  - Male
MH  - Return to Sport/*statistics & numerical data
MH  - Young Adult
OTO - NOTNLM
OT  - anterior cruciate ligament
OT  - knee ligaments
OT  - limb symmetry
OT  - outcome
OT  - quadriceps
OT  - sport clearance
EDAT- 2019/11/23 06:00
MHDA- 2020/09/04 06:00
CRDT- 2019/11/23 06:00
PHST- 2019/11/23 06:00 [pubmed]
PHST- 2020/09/04 06:00 [medline]
PHST- 2019/11/23 06:00 [entrez]
AID - 10.1177/0363546519886291 [doi]
PST - ppublish
SO  - Am J Sports Med. 2020 Jan;48(1):70-77. doi: 10.1177/0363546519886291. Epub 2019 
      Nov 22.