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      Limb Symmetry Indexes Can Overestimate Knee Function After ACL Injury

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          Abstract

          Study Design

          Prospective Cohort

          Background

          The high risk of second ACL injuries after return-to-sport highlights the importance of return-to-sport decision-making. Objective return-to-sport criteria frequently use LSI’s to quantify quadriceps strength and hop scores. Whether using the uninvolved limb in LSI’s is optimal is unknown.

          Objectives

          To evaluate the uninvolved limb as a reference standard for limb symmetry indexes (LSI’s) utilized in return-to-sport testing and its relationship with second ACL injury rates.

          Methods

          Seventy athletes completed quadriceps strength and 4 single-legged hop tests before ACL reconstruction (ACLR) and 6 months after ACLR. LSI’s for each test compared involved limb measures at 6 months to uninvolved measures at 6 months. Estimated pre-injury capacity (EPIC) levels for each test compared involved measures at 6 months to uninvolved measures before ACLR. Second ACL injuries were tracked for a minimum 2-year follow-up after ACLR.

          Results

          Forty (57.1%) patients achieved 90% LSI’s for quadriceps strength and all hop tests. Only 20 (28.6%) patients met 90% EPIC levels (comparing involved limb at 6 months after ACLR to uninvolved limb before ACLR) for quadriceps strength and all hop tests. Twenty-four (34.4%) patients who achieved 90% LSI’s for all measures 6 months after ACLR did not achieve 90% EPIC levels for all measures. EPIC levels were more sensitive to LSI’s in predicting second ACL injuries (LSI’s: 0.273 (95% CI: 0.010–0.566); EPIC: 0.818 (95% CI: 0.523–0.949)).

          Conclusion

          LSI’s frequently overestimate knee function after ACLR and may be related to second ACL injury risk. These findings raise concern whether the variable ACL return-to-sport criteria utilized in current clinical practice are stringent enough to achieve safe and successful return-to-sport.

          Level of Evidence

          Therapy, level 2b.

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          Author and article information

          Journal
          7908150
          2417
          J Orthop Sports Phys Ther
          J Orthop Sports Phys Ther
          The Journal of orthopaedic and sports physical therapy
          0190-6011
          1938-1344
          21 April 2017
          29 March 2017
          May 2017
          01 May 2018
          : 47
          : 5
          : 334-338
          Affiliations
          [1 ]University of Nebraska Medical Center, Omaha, NE, USA
          [2 ]University of Delaware, Newark, DE, USA
          [3 ]University of Vermont, Burlington, VT, USA
          Author notes
          Corresponding author’s name, address, and e-mail address: Elizabeth Wellsandt, Physical Therapy Education, 984420 Nebraska Medical Center, Omaha, NE, 68198-4420, elizabeth.wellsandt@ 123456unmc.edu
          Article
          PMC5483854 PMC5483854 5483854 nihpa868526
          10.2519/jospt.2017.7285
          5483854
          28355978
          7831dcd4-d62e-494e-a3c8-41e8f18ddb7b
          History
          Categories
          Article

          symmetry,ACL,anterior cruciate ligament,rehabilitation,return-to-sport

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