What Are Our Patients Really Telling Us? Psychological Constructs Associated With Patient-Reported Outcomes After Anterior Cruciate Ligament Reconstruction.

CONTEXT: Depressed patient-reported outcomes (PROs) are directly related to suboptimal recovery after anterior cruciate ligament reconstruction (ACLR). Various PROs commonly used after ACLR can provide a gross estimation of function but do not fully elucidate the causes of self-perceived disability. OBJECTIVE: To more fully characterize the factors driving responses on PROs. DESIGN: Cross-sectional study. A mixed-methods approach was used, in which qualitative interviews were conducted alongside administration of PROs to uncover the themes behind a participant's PRO responses. SETTING: Laboratory. PATIENTS OR OTHER PARTICIPANTS: Twenty-one individuals with unilateral ACLR (age = 20.90 ± 2.86 years, height = 172.0 ± 11.03 cm; mass = 71.52 ± 13.59 kg, postsurgery = 3.66 ± 3.03 years). MAIN OUTCOME MEASURE(S): Patient-reported outcome measures were administered and qualitative interviews were conducted. The PROs consisted of the International Knee Documentation Committee form, Knee Injury and Osteoarthritis Outcomes Score (KOOS), ACL-Return to Sport after Injury (ACL-RSI) scale, and Tampa Scale of Kinesiophobia (TSK). A hierarchical cluster analysis was used to identify subgroups based on PRO responses. Qualitative interviews provided supplemental insight into perceived disability. Independent t tests examined cluster differences for themes. Spearman ρ correlations indicated associations between PRO responses and themes. RESULTS: Two clusters (perceived high or low disability) emerged. Individuals with low perceived disability scored better on all PROs (P < .05) except for the KOOS-Activities of Daily Living. Internal and external facilitators or barrier subthemes emerged from the interviews. A significant difference was present between clusters and themes. Lower TSK andgreater ACL-RSI and KOOS-Quality of Life scores were associated with more perceived facilitators. CONCLUSIONS: Participants with greater internal motivation and confidence and a support network had improved PROs. Those with avoidance tendencies, fear, lack of clear expectations, and less social support scored worse on PROs. The TSK, ACL-RSI, and KOOS-Quality of Life scales were best able to capture the constructs associated with perceived wellness, which reinforces their utility in recovery.

Protracted alterations in muscle activation strategies and knee mechanics in patients after Anterior Cruciate Ligament Reconstruction.

PURPOSE: Altered quadriceps muscle activity can contribute to reduced ability of the muscle to quickly generate force and appropriately attenuate landing forces, exacerbating poor landing and movement strategies commonly seen after anterior cruciate ligament reconstruction (ACLR). The purpose was to evaluate if electromyographic (EMG) activity and knee biomechanics during a single-limb forward hop task are influenced by a history of ACLR. METHODS: Twenty-six individuals with a history of unilateral ACLR (age 20.2 ± 2.7 years, height 1.7 ± 0.1 m; weight 69.6 ± 12.4 kg; time from surgery, 2.9 ± 2.7 years; graft type, 21 bone-patellar-tendon bone, 5 hamstring) and 8 healthy controls (age 23.3 ± 1.8 years, height 1.7 ± 0.1 m; mass 66.3 ± 13.9 kg) volunteered. Sagittal plane knee kinetics and EMG of the vastus lateralis were synchronized and measured using a three-dimensional motion analysis system during a single-limb forward hop task. Mixed-effect models were used to assess the effect of group on kinetic and EMG variables. RESULTS: Kinetic outcomes (peak and rate of knee extension moment) and temporal muscle activity and activation patterns differed between the ACLR limb and healthy-control limb. Inter-limb asymmetries in the ACLR group were observed for all variables except EMG onset time; no limb differences were observed in the healthy cohort. CONCLUSION: Years after ACLR, persistent quadriceps functional deficits are present, contributing to altered neuromuscular control strategies during functional tasks that may increase the risk of reinjury. To counteract these effects, emerging evidence indicates that clinicians could consider the use of motor learning strategies to improve neuromuscular control after ACLR. LEVEL OF EVIDENCE: III.