Is 12 months enough to reach function after athletes’ ACL reconstruction: a prospective longitudinal study

Felix, Ellen Cristina Rodrigues; Alonso, Angelica Castilho; Brech, Guilherme Carlos; Fernandes, Tiago Lazzaretti; Almeida, Adriano Marques de; Luna, Natalia Mariana Silva; Soares-Junior, Jose Maria; Baracat, Edmund Chada; Hernandez, Arnaldo José; Greve, Julia Maria D’Andrea

doi:10.1016/j.clinsp.2022.100092

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Sumário

Original articles • Clinics 77 • 2022 • https://doi.org/10.1016/j.clinsp.2022.100092 copy

Is 12 months enough to reach function after athletes’ ACL reconstruction: a prospective longitudinal study

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Context:

Anterior Cruciate Ligament (ACL) injury is disabling in several sports because it causes knee instability and functional deficit. Usually, surgical treatments produce the best functional outcomes, however, sometimes they are not always able to fully restore stability and function.

Objective:

The objective of this study was to evaluate postural balance, muscle strength, and functional performance of young athletes with an ACL injury before and after ACL reconstruction.

Design:

This was a longitudinal observational prospective study.

Method:

74 athletes, 60 men, and 14 women, aged between 16 and 45, divided into two groups: the Group-Lesion of ACL with 34 athletes (24.1 years) and the Group-Control with 40 athletes without ACL lesion (27.7 years old). All volunteers performed posturography, isokinetic dynamometry, and the Hop-Test. The ACL-Group was evaluated before and 12 months after the reconstruction and the control group was evaluated once.

Results:

The Postoperative ACL Group presented greater limb symmetry, 0.96 (± 0.12), than the preoperative ACL Group, 0.87 (± 0.17), p < 0.01 in the Hop-Test. In the posturography, the displacement area was smaller in the postoperative ACL Group, 19.85 (± 5.74), compared to the preoperative ACL Group, 24.20 (± 8.97), p < 0.01. In isokinetic dynamometry the torque peak was greater in the postoperative ACL Group, 0.91 (± 0.14), than in the preoperative ACL Group, 0.74 (± 0.15), p < 0.01.

Conclusion:

The functional outcomes increased in ACL reconstruction athletes after 12 months, but not at the same level as in the Control Group. The result indicates an incomplete functional recovery, adaptive changes in postural control after injury, reconstruction, and return to sport.

Keywords:
Postural balance; Isokinetic evaluation; Return to sport; Anterior cruciate ligament injuries

Highlights

Anterior cruciate ligament injury is disabling in several sports.
Interior cruciate ligament injury causes knee instability and functional deficit.
Usually, surgical treatments produce best functional outcomes.

	ACLG (n = 34)		CG (n = 40)
	Mean	SD	Mean	SD	p
Age (years)	25.05	6.82	27.7	8.16	>0.05
Body mass (kg)	72.11	10.19	70.50	15.21	>0.05
Height (m)	1.74	0.69	1.72	0.88	>0.05
BMI (kg/m²)	23.62	2.72	23.68	0.29	>0.05
Tegner activity scale	7.6	1.2	8.0	1.3	>0.05

	F(%)	F(%)
Gender
Male	79.4%	82.5%	>0.05
Female	20.6%	17.5%	>0.05
Category
Professional	35.3%	27.5%	>0.05
Amateur	64.7%	72.5%	>0.05

	ACLG (n = 34)				CG (n = 40)
	Preoperative Operated	Non operated	Postoperative Operated	Non operated		p	Effect size (d)
	Mean (SD)	Mean (SD)	Mean (SD)	Mean (SD)	Mean (SD)
Kick Test	26.29 (10.92)	31.77 (11.88)^c c Significant between postoperative ACL Group and Control Group. p ≤ 0.05, Mann Whitnney test. ,^d d Significant between preoperative ACL Group non operated limb and postoperative ACL Group non operated limb. p ≤ 0.05, Mann Whitnney test.	24.38 (8.09)	24.91 (6.39)^d d Significant between preoperative ACL Group non operated limb and postoperative ACL Group non operated limb. p ≤ 0.05, Mann Whitnney test.	23.36 (7.22)^c c Significant between postoperative ACL Group and Control Group. p ≤ 0.05, Mann Whitnney test.	<0.01	0.03‒0.22
Squat Test	24.20 (8.97)^a a Significant between preoperative ACL Group and postoperative ACL Group. p ≤ 0.05, Wilcoxon test.bSignificant between preoperative ACL Group and Control Group. p ≤ 0.05, Mann Whitney test.	24.05 (10.42)	19.85 (5.74)^a a Significant between preoperative ACL Group and postoperative ACL Group. p ≤ 0.05, Wilcoxon test.bSignificant between preoperative ACL Group and Control Group. p ≤ 0.05, Mann Whitney test.	20.62 (7.51)	20.08 (6.51)	<0.01	0.57

	ACLG (n = 34)		CG (n = 40)
	Preoperative	Postoperative		p	Effect size (d)
	Mean (SD)	Mean (SD)	Mean (SD)
Single-Leg Hop Test PT/W	0.87 (0.17)^a a Significant between preoperative ACL Group and postoperative ACL Group. p ≤ 0.05, Wilcoxon test. ,^b b Significant between preoperative ACL Group and Control Group. p ≤ 0.05, Mann Whitney test.	0.96 (0.12)^a a Significant between preoperative ACL Group and postoperative ACL Group. p ≤ 0.05, Wilcoxon test.	1.02 (0.95)^b b Significant between preoperative ACL Group and Control Group. p ≤ 0.05, Mann Whitney test.	<0.01	0.08–0.61
Quadriceps	0.74 (0.15)^a a Significant between preoperative ACL Group and postoperative ACL Group. p ≤ 0.05, Wilcoxon test. ,^b b Significant between preoperative ACL Group and Control Group. p ≤ 0.05, Mann Whitney test.	0.91 (0.14)^a a Significant between preoperative ACL Group and postoperative ACL Group. p ≤ 0.05, Wilcoxon test. ,^c c Significant between postoperative ACL Group and Control Group. p ≤ 0.05, Mann Whitnney test.	0.98 (0.11)^b b Significant between preoperative ACL Group and Control Group. p ≤ 0.05, Mann Whitney test. ,^c c Significant between postoperative ACL Group and Control Group. p ≤ 0.05, Mann Whitnney test.	<0.01	0.57–1.87
Hamstring	0.88 (0.18)	0.91 (0.15)	0.94 (0.12)	>0.05	0.05–0.23

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[1] *Corresponding author. E-mail address:ellenfelix@hotmail.com (E.C.R. Felix).