Functional outcome of primary hamstring anterior cruciate ligament reconstruction in patients with different body mass index classes.

PURPOSE: We compared functional outcomes after primary hamstring-graft anterior cruciate ligament (ACL) reconstruction in patients with different body mass index (BMI) classes. METHODS: Functional outcomes after ACL reconstruction were measured using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Lysholm score. The procedures were carried out by a single surgeon between 2001 and 2009 in 2 groups of patients with different BMI classes: a normal-BMI group (BMI 18.5 to 24.9) and a high-BMI group (BMI ≥ 25), with a minimum of 2 years' follow-up. Rolimeter readings for ligament laxity as well as complications between the 2 groups were also analyzed. RESULTS: A total of 92 patients were reviewed, with the normal-BMI group consisting of 49 patients, whereas there were 43 patients in the high-BMI group. There were no significant differences between the groups in any of the preoperative and postoperative scores or ligament laxity. Both groups showed comparable clinically significant improvement in their postoperative scores compared with their preoperative scores. Patients in the high-BMI group had a slightly increased postoperative complication rate when compared with the normal-BMI group. CONCLUSIONS: Primary hamstring ACL reconstruction is an effective treatment option in patients irrespective of preoperative BMI. High BMI does not adversely affect functional outcomes as measured by the KOOS and Lysholm scores up to and at 2 years postoperatively, and these patients benefit in a manner comparable to that of patients with normal BMI. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

A comparison of Star Excursion Balance Test reach distances between ACL deficient patients and asymptomatic controls.

ACL injury has been associated with a decrease in proprioceptive performance and specifically postural control. Tests of postural control have been criticised for not being sufficiently challenging. The Star Excursion Balance Test (SEBT) has been proposed to offer sufficient challenge to be a sensitive test for detecting performance deficits related to pathology. The purpose of this study was to determine if decrements SEBT reach distance is associated with ACL deficiency (ACLD). Twenty five ACLD patients ACLD (17 male and 8 female, mean age 30 (SD 4.5) years) and twenty five matched controls were examined carrying out the SEBT. Factorial ANOVA showed the main effects of limb (p=0.006) and direction (p<0.001) and interaction of limb and direction (p=0.015) all had significant differences between the groups. Further analysis revealed significant differences between the control group and the ACLD limb for the limb movement directions of anterior (p=0.0032), lateral (p=0.005), posterior-medial (p=0.0024) and medial (p=0.001). There were also significant differences between the control limbs and uninjured limb of the patients for the directions of medial (p=0.001) and lateral (p=0.001). ACLD patients appear to have deficiencies in their dynamic postural control when compared to normal asymptomatic subjects. Interestingly, in the ACLD patients, their uninjured leg show deficits compared to the control in two of the four directions the ACLD leg was deficient, this may be indicative of a postural control deficit in these patients, which may have predisposed to the ACL injury and would warrant further study.

An investigation to examine the inter-tester and intra-tester reliability of the Rolimeter knee tester, and its sensitivity in identifying knee joint laxity.

PURPOSE: The purpose of this study is to evaluate the Rolimeter knee tester (Aircast, Europe) as reliable and clinically sensitive tool for identifying and quantifying knee joint laxity utilising a sample of both known ACLD and normal knees. METHODS: Thirty matched subjects (15 known ACLD and 15 normal subjects) were tested for knee joint laxity using the Rolimeter. Each subject was measured at both 90 degrees and 30 degrees of knee flexion, by each of the six investigators. This was then repeated again by all six investigators so that inter-tester and intra-tester reliability could be examined. RESULTS: Results showed that there was good reliability between testers, and intra-tester reliability was good for both left and right knees in both 90 degrees and 30 degrees of flexion. Results also demonstrated a high level of sensitivity for determining knee joint laxity in ACLD compared to normal knees. CONCLUSION: The Rolimeter knee tester is a reliable device for quantifying knee joint laxity, and is sensitive enough to identify anterior cruciate ligament deficiency.