Summary
The ACL-RSI score at 6 months predicts the medium-term outcome and apprehension as it is significantly correlated with functional scores and ACL-RSI at a 4-year follow-up but the lack of correlation between the components of the 6-month composite assessment and reruptures should encourage the search for other prognostic evaluation factors.
Abstract
Introduction
The comprehensive assessment at 6 months after Anterior Cruciate Ligament (ACL) reconstruction allows for functional evaluation and strength assessment with the aim of correcting deficits and reducing the risks of rerupture or contralateral injury. The hypothesis of this study was that there is a correlation between the 6-month postoperative assessment with the return-to-sport test and the medium-term clinical and functional outcomes.
Materials And Methods
This was a prospective, single-center study that consecutively included all patients who underwent primary ACL reconstruction with a minimum follow-up of 3 years and had a 6-month test including isokinetic analysis of flexor/extensor strength, jump tests, and ACL-RSI (Anterior Cruciate Ligament-Return to Sport Index). The evaluation at the final follow-up included IKDC (International Knee Documentation Committee), Tegner, SKV, and ACL RSI scores. Analysis of reruptures, reoperation rates, and return to sports rates was recorded.
Results
A total of 498 patients were included in the study with an average follow-up of 4.9 years. The demographic data of the series showed 64% males, a mean BMI of 24.1±3.7, and a preoperative Tegner score of 7.1±0.9. At 6 months, the average ACL-RSI score was 65±19%. At the final follow-up, there was a significant improvement in ACL RSI to 69±25%. The mean SKV was 86.8±14.3, mean Tegner score was 6±2.1 and mean IKDC score was 76.95%, with a statistical correlation between the three tests. The rerupture rate was 5.6% with a reoperation rate of 12%. There was a significant correlation between the 6-month ACL-RSI score and the Tegner, SKV, and IKDC scores at the longest follow-up (p<0.001 for all three tests). No correlation was found between the 6-month ACL-RSI score, isokinetic analysis at 6 months, and reruptures.
Conclusion
Patient satisfaction at the 4-year follow-up is important, with an SKV score above 85, but there was only a 4-point increase in ACL-RSI and a one-point decrease in the Tegner score. The ACL-RSI score at 6 months predicts the medium-term outcome and apprehension as it is significantly correlated with functional scores and ACL-RSI. Rehabilitation in the first 6 months should, therefore, aim to restore a maximum of confidence. The lack of correlation between the components of the 6-month composite assessment and reruptures should encourage the search for other prognostic evaluation factors.