Self-reported Knee Function Can Identify Athletes Who Fail Return to Activity Criteria up to 1 Year after Anterior Cruciate Ligament Reconstruction. A Delaware-Oslo Cohort Study
Logerstedt D, Di Stasi S, Grindem H, Lynch A, Eitzen I, Engebretsen L, Risberg MA, Axe MJ, Synder-Mackler L. Journal of Orthopaedic & Sports Physical Therapy. 2014. Epub ahead of print, Octoer 27, 2014.
Take Home Message: The subjective IKDC-2000 form can be used to determine when a participant may be ready to be functionally assessed for a possible return to play. The participants who have IKDC-2000 scores that are lower than normative data have a high likelihood of failing a battery of functional tests.
Outcomes post-anterior cruciate ligament (ACL) surgery vary by individual. Despite having ACL reconstruction, 20 to 35% of patients do not return to play, or have prolonged pain or functional impairments. While functional screening for return to play can often be easily deployed, they can be time consuming and may be inappropriate for some patients (e.g., patients with fear of reinjury or functional impairments). It would be helpful if a simple questionnaire could help clinicians identify who may be ready for a functional assessment. The authors of this prospective cohort study aimed to identify whether International Knee Documentation Committee Subcommittee (IKDC)-2000 Subjective form could identify patients who would pass a battery of functional assessment tests after an ACL reconstruction. All participants had an ACL reconstruction and prior to their injury participated in activities requiring jumping, pivoting, and hard cutting (Level I) or activities that required less jumping and hard cutting but still require lateral cutting (Level 2). Participants were assessed at 6 months and then at 12 months post ACL surgery with three subjective questionnaires, a series of hop testing, and quadriceps strength testing. Of the 158 young and active participants who were re-assessed at the 6 month time period, approximately 48% were classified as having knee function below normal ranges for the IKDC-2000, and within this group, 90% of them failed the functional tests. On the other hand, among the 52% of participants who had IKDC-2000 scores within a normal range only 48% of these participants passed the functional assessment. At 6 months post surgery, self-reported knee function had a sensitivity of approximately 62% and a specificity of 85%. At the 12 month assessment, 22% of the participants were classified as having below normal ranges for the IKDC-2000, and within this group, 81% failed the functional tests. Self-reported knee function had a sensitivity of approximately 37% and a specificity of 92% at 12 month re-assessments.
This study provides support for the use of IKDC-2000 to identify people who may pass a functional assessment for return to activity after an ACL reconstruction. Individuals with low IKDC-2000 scores are very likely to fail functional testing and measurements. However, the authors highlighted that many people who reported normal IKDC-2000 scores also failed the return to functional activities assessment. Hence, the IKDC can be valuable in determining when an individual should be tested with functional assessments. However, this assessment should only inform the functional assessment and testing process, and should not be the only criteria to determine return to activity. It would be interesting to see sub-analyses of this cohort to determine if these results are consistent in different age groups and among athletes in level 1 or 2 activities. Ultimately, the IKDC can inform when we should assess our patients for return to activity. If the patient has a score below normal then we may want to hold off on conducting a functional assessment for return to activity.
Questions for Discussion: Do you use the IKDC-2000 clinically? How do you decide when it is appropriate to put a patient though a battery of tests for functional and strength assessment for return to normal physical activities?
Written by: Nicole Cattano
Reviewed by: Jeffrey Driban
Factors Used to Determine Return to Unrestricted Sports Activities After Anterior Cruciate Ligament Reconstruction