Correlation of Y Balance with Clinical Scores and Functional Tests after Anterior Cruciate Ligament Reconstruction in Young and Middle-Aged Patients

Background@#Criteria for return to sports (RTS) following anterior cruciate ligament (ACL) reconstruction have been extensively studied. But there is no consensus among investigators regarding which factors are most important in determining a safe RTS. @*Methods@#Sixty-one patients who underwent ACL reconstruction were included. Subjective knee scoring systems (International Knee Documentation Committee [IKDC] score and Lysholm score), functional performance tests (carioca test and single-leg hop for distance [SLHD] test), and isokinetic knee strength test were used for assessment and analyzed for association with the limb symmetry index (LSI) of the Y-balance test for lower quarter (YBT-LQ). @*Results@#The LSI of the YBT-LQ was significantly correlated with Lysholm score, IKDC score, Carioca, LSI for the SLHD, and extensor strength deficit at 6 months after ACL reconstruction. At 12 months, Lysholm score, IKDC score, LSI for the SLHD, and extensor strength deficit were significantly correlated with the LSI of the YBT-LQ. @*Conclusions@#The YBT-LQ test could be used conveniently as an additional tool to assess the patient’s functional performance results after ACL reconstruction in outpatient clinics.

Functional Effects of Single Semitendinosus Tendon Harvesting in Anatomic Anterior Cruciate Ligament Reconstruction: Comparison of Single versus Dual Hamstring Harvesting

BACKGROUND: This study aimed to determine the effects of single semitendinosus tendon (ST) harvesting for anterior cruciate ligament (ACL) reconstruction by comparing outcomes of single ST and semitendinosus-gracilis tendon (ST-G) harvesting. METHODS: ACL reconstruction with ST-G harvesting (D group, n = 60) or single ST harvesting (S group, n = 60) were included according to inclusion criteria. Subjective assessments included subjective International Knee Documentation Committee score, Lysholm score, and Tegner activity scale score. Objective assessments included isokinetic strength and functional tests. These tests were completed at 36 months of follow-up. Magnetic resonance imaging (MRI) and second-look arthroscopy findings were evaluated. In the S group, regeneration properties were assessed by serial ultrasonography (US). RESULTS: The S group showed significantly less deep flexor strength deficit than the D group (p < 0.001). Deep flexor power deficits showed significant correlation with the shift of musculotendinous junction of the ST. There was significant difference in the cocontraction test between the groups (p = 0.012), and the S group tended to show better results in other functional tests at the last follow-up. There were no significant differences in graft tension and synovial coverage on second-look arthroscopy between the groups. In the S group, the regeneration rates assessed by US at the joint line and distal insertion were 81.7% and 80%, respectively at 6 months of follow-up. CONCLUSIONS: The S group showed significantly less deficit in deep flexor strength and tended to show better clinical results at the last follow-up than the D group. In the S group, more than 80% showed good regeneration at the 6-month follow-up. Hence, single ST harvesting is effective in minimizing flexor weakness and functional deficits and shows great potential for regeneration.

Correlation between Hamstring Flexor Power Restoration and Functional Performance Test: 2-Year Follow-Up after ACL Reconstruction Using Hamstring Autograft

PURPOSE: To evaluate the restoration of the flexor power and the correlation between the flexor power and functional performance tests (FPTs) after anterior cruciate ligament (ACL) reconstruction with hamstring autograft. MATERIALS AND METHODS: Twenty-three men, who underwent ACL reconstruction with hamstring autograft, were evaluated using Lysholm, Subjective IKDC, Tegner activity score, isokinetic flexion and hyperflexion power test, and the FPTs at 1 and 2-year follow-up. We analyzed the mean change from 1 to 2 year and the correlation between both the flexion and hyperflexion power deficit with the FPTs at each follow-up. RESULTS: Mean age of the patients was 30.9 years (range, 19 to 44). Tegner activity score was significantly increased from 5.7 to 6.3 (p=.010). Hyperflexion power of the involved knee deficits significantly decreased at 2 year follow-up compared with 1 year (p<.001). There was a correlation between the flexor power deficit and the co-contraction, carioca, and involved one-legged hop test at each follow-up. However, no significant correlations were revealed between the hyperflexion power deficit and the FPTs. CONCLUSIONS: Hyperflexion power deficit after ACL reconstruction with the hamstring autograft decreased at 2 year follow-up compared to 1 year and does not affect the results of the FPTs.

Validation of Functional Performance Tests after Anterior Cruciate Ligament Reconstruction

PURPOSE: To validate the functional performance tests (FPTs) after anterior cruciate ligament (ACL) reconstruction. MATERIALS AND METHODS: Thirty men in their third decade after ACL reconstruction at 6 month follow-up and thirty healthy subjects were selected. Lysholm knee score, International Knee Documentation Committee (IKDC) subjective score, Tegner activity score, KT-2000 arthrometer test, isokinetic strength test, functional performance tests (one leg hop test, co-contraction test, shuttle run test, carioca test) were performed in two groups. We evaluated the test-retest reliability of FPTs in healthy group and the between FPTs and other parameters in ACL reconstruction group. RESULTS: The test-retest result showed high correlation in co-contraction test (r=0.511), shuttle run test (r=0.746), carioca test (r=0.742). In the ACL reconstruction group, the IKDC score, Tegner activity score, extensor power at 60degrees/s, and one leg hop test also showed high correlation between each test. CONCLUSIONS: The three FPTs showed correlations with the established methods for determining return to sports activities after ACL reconstruction and had high test-retest reliability. Therefore we believe the three FPTs can be useful methods to assess knee function in athletes after ACL reconstruction.

The Evaluation of Proprioceptive Function and Effectiveness of Joint Position Sense Test after Meniscal Allograft Transplantation / 대한스포츠의학회지

To evaluate the effects on the restoration of proprioception, we compared joint position sense (JPS) after meniscal allograft transplantation. Nine patients who underwent meniscal allograft transplantation between March 2008 and January 2010 were evaluated at preoperation and 6 months post-operation. International Knee Documentation Committee (IKDC) subjective score and Lysholm score were evaluated. The peak torque of the isokinetic flexor and extensor strength test was performed using Biodex system III. Passive JPS was assessed to evaluate proprioceptive function. In the results, IKDC subjective score and Lysholm score were improved (p=0.05). The flexor and extensor power decreased, however there was no statistically significant difference. In the assessment of JPS, there was improvement from 6.56degrees and 4.11degrees to 4.89degrees and 1.89degrees, however, this was not statistically significant. Although, proprioception was improved in JPS at 6 months after meniscus transplantation, it did not show statistic significance. Therefore, future studies using combined methods will be needed to evaluate proprioceptive function after meniscal allograft transplantation.

The Effectiveness of Joint Position Sense Test in Evaluating the Proprioceptive Function after Anterior Cruciate Ligament Reconstruction / 대한스포츠의학회지

We designed a study to evaluate the change of the proprioceptive function with joint position sense (JPS) during 1 year follow-up period after anterior cruciate ligament (ACL) reconstruction using hamstring autograft. Thirty-eight men who underwent ACL reconstruction were tested for International Knee Documentation Committee subjective knee score, Tegner activity score, Lysholm score, KT-2000 arthrometer, isokinetic strength test, functional performance test (carioca, co-contraction, shuttle run test, one-hop test) and JPS at preoperation, 6 months, and 12 months postoperation. The contralateral healthy knee was used as control. There were no significant differences of JPS between the involved knee and healthy knee at any time period. Repeated measures analysis of variance of the active JPS revealed that there was no significant difference during the follow up periods. The change patterns of passive JPS of extension and flexion were out of accordance with the improving clinical status following ACL reconstruction. Most of the clinical parameters did not show the significant correlation with active and passive JPS at any time period. In conclusion, JPS does not reflect the change of proprioceptive function following ACL reconstruction.