Purpose To analyze the prognostic factors influencing subjective and objective outcomes and return to play (RTP) after anterior cruciate ligament reconstruction (ACL-R). Methods Primary ACL-Rs using a transtibial technique performed between 2008 and 2012 were included. Data regarding patients, surgery, sports, and rehabilitation, including an on-field rehabilitation (OFR) and duration of the rehabilitation program, were collected. The International Knee Documentation Committee (IKDC) subjective andobjectiveevaluationforms,andtheKneeInjuryandOsteoarthritisOutcomeScore and Lysholm questionnaires were used for the assessment of subjective and objective outcomes. The Subjective Patient Outcome for Return to Sports and ACL–return to sportafterinjury(RSI)scoreswereusedforRTPevaluation.Severalpotentialpredictors of outcome were tested with a univariate analysis. All the variables with p < 0.1 were retestedinalogisticregressionmodeltoevaluatetheirassociationwiththeoutcomes. Results In total, 176 cases were included with an average follow-up of 44.1 months. Ofthepatients,92.2%wereratedasnormalornearlynormalattheIKDCevaluation.In addition, 90.1% of the patients returned to sport, with 57.6% returning to the same preinjury level. Objective outcomes were negatively influenced by late rehabilitation (odds ratio [OR] ¼ 2.75). Performing an OFR phase during the rehabilitation was associated with better subjective outcomes (OR ¼ 2.71). Length of rehabilitation strongly influenced the RTP rate (OR ¼ 13.16). Conversely, higher ACL-RSI score was inversely related to RTP. Objective IKDC score was inversely related to the ACL-RSI (OR ¼ 0.31),whereassubjectivescorewascorrelatedwithboththetotalACL-RSIscore (OR ¼ 0.15) and the level of activity (OR ¼ 0.20). Conclusion Thisstudyconfirmedtheroleofrehabilitationonsubjectiveandobjective outcomes and on RTP. Particularly, the complete adherence to a rehabilitation program, including an OFR phase, resulted in better subjective outcomes and higher RTP rate. The relationship between psychological factors, measured through the ACLRSI score, and RTP was confirmed.

Factors Affecting Subjective and Objective Outcomes and Return to Play in Anterior Cruciate Ligament Reconstruction: A Retrospective Cohort Study

Rossi, Roberto
First
;
Dettoni, Federico;Cambursano, Simone;Cottino, Umberto;Bonasia, Davide;Rosso, Federica
2018

Abstract

Purpose To analyze the prognostic factors influencing subjective and objective outcomes and return to play (RTP) after anterior cruciate ligament reconstruction (ACL-R). Methods Primary ACL-Rs using a transtibial technique performed between 2008 and 2012 were included. Data regarding patients, surgery, sports, and rehabilitation, including an on-field rehabilitation (OFR) and duration of the rehabilitation program, were collected. The International Knee Documentation Committee (IKDC) subjective andobjectiveevaluationforms,andtheKneeInjuryandOsteoarthritisOutcomeScore and Lysholm questionnaires were used for the assessment of subjective and objective outcomes. The Subjective Patient Outcome for Return to Sports and ACL–return to sportafterinjury(RSI)scoreswereusedforRTPevaluation.Severalpotentialpredictors of outcome were tested with a univariate analysis. All the variables with p < 0.1 were retestedinalogisticregressionmodeltoevaluatetheirassociationwiththeoutcomes. Results In total, 176 cases were included with an average follow-up of 44.1 months. Ofthepatients,92.2%wereratedasnormalornearlynormalattheIKDCevaluation.In addition, 90.1% of the patients returned to sport, with 57.6% returning to the same preinjury level. Objective outcomes were negatively influenced by late rehabilitation (odds ratio [OR] ¼ 2.75). Performing an OFR phase during the rehabilitation was associated with better subjective outcomes (OR ¼ 2.71). Length of rehabilitation strongly influenced the RTP rate (OR ¼ 13.16). Conversely, higher ACL-RSI score was inversely related to RTP. Objective IKDC score was inversely related to the ACL-RSI (OR ¼ 0.31),whereassubjectivescorewascorrelatedwithboththetotalACL-RSIscore (OR ¼ 0.15) and the level of activity (OR ¼ 0.20). Conclusion Thisstudyconfirmedtheroleofrehabilitationonsubjectiveandobjective outcomes and on RTP. Particularly, the complete adherence to a rehabilitation program, including an OFR phase, resulted in better subjective outcomes and higher RTP rate. The relationship between psychological factors, measured through the ACLRSI score, and RTP was confirmed.
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knee anterior cruciate ligament reconstruction instability athlete
Rossi, Roberto; Dettoni, Federico; Cambursano, Simone; Cottino, Umberto; Bonasia, Davide; Rosso, Federica
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/2318/1662267
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