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
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.
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.
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.
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.
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?
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
by: Nicole Cattano
Reviewed
by: Jeffrey Driban
by: Jeffrey Driban
Related Post:
Logerstedt, D., Di Stasi, S., Grindem, H., Lynch, A., Eitzen, I., Engebretsen, L., Risberg, M., Axe, M., & Snyder-Mackler, L. (2014). 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 ACL Cohort Study Journal of Orthopaedic & Sports Physical Therapy, 1-27 DOI: 10.2519/jospt.2014.4852
I think that this is a great starting point for RTP in people with ACL-R, however it should not be the only thing we base our criteria on. Allowing a clinician to have a form like the IKDC 2000 can give a subjective outcome, to understand where the patient stands and when they are ready to proceed to the next phase. It can be an indicator of what the patient needs improvement on as well. Using this form, along with other outcome measures, like strength, confidence, and overall readiness to RTP. Implementing this more and more will assist us in getting better at RTP protocols for ACL injuries.
Sandra – you make some great points! I think it is important to utilize this only one factor in the big picture regarding RTP. Thanks for your comment!