Mallory A Law1, Yi-An Ko2, Ashley L Miller1, Kristin N Lauterbach1, Christopher L Hendley3, Julie E Johnson4, Liang-Ching Tsai5. 1. Department of Physical Therapy, Georgia State University, Atlanta, GA, USA. 2. Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA. 3. Sovereign Rehabilitation, Atlanta, GA, USA. 4. Children's Healthcare of Atlanta, Atlanta, GA, USA. 5. Department of Physical Therapy, Georgia State University, Atlanta, GA, USA. Electronic address: ltsai@gsu.edu.
Abstract
OBJECTIVES: To examine the effect of age on post-ACLR rehabilitative outcomes and identify surgical/rehabilitative characteristics as ACL re-injury risk factors in adolescents. DESIGN: Cohort study. SETTING: Children's hospital. PARTICIPANTS: 273 adolescents with first-time ACLR. MAIN OUTCOME MEASURES: Demographics, injury history, surgery, and outcomes documented during post-ACLR physical therapy (PT) sessions were extracted from medical records. Effects of age on outcomes were examined using multivariate regression. ACL re-injury risk factors were identified using survival analysis with Cox regression. RESULTS: Re-injury was recorded in 47 patients (17.2%) with a median follow-up time of 3.1 years and median re-injury time of 13.4 months post-surgery. Younger age (Hazard-Ratio, HR = 1.264 per year decrease; P = 0.005), receiving surgery within 1 month post-injury (HR = 3.378 vs. >3 months; P = 0.012), starting PT within 3 days post-surgery (HR = 3.068; P = 0.022), and decreased number of PT sessions (HR = 1.118 per 3-session decrease; P = 0.010) increased re-injury risk. Although age was associated with re-injury risk, age was not associated with any outcome (P > 0.059). CONCLUSION: Adolescents who are younger, receive surgery and post-surgery PT sooner, or attend fewer PT sessions may be at an increased re-injury risk. Younger patients achieved similar outcomes despite elevated re-injury risk. Current discharge criteria are inadequate in identifying high re-injury risk patients.
OBJECTIVES: To examine the effect of age on post-ACLR rehabilitative outcomes and identify surgical/rehabilitative characteristics as ACL re-injury risk factors in adolescents. DESIGN: Cohort study. SETTING:Children's hospital. PARTICIPANTS: 273 adolescents with first-time ACLR. MAIN OUTCOME MEASURES: Demographics, injury history, surgery, and outcomes documented during post-ACLR physical therapy (PT) sessions were extracted from medical records. Effects of age on outcomes were examined using multivariate regression. ACL re-injury risk factors were identified using survival analysis with Cox regression. RESULTS: Re-injury was recorded in 47 patients (17.2%) with a median follow-up time of 3.1 years and median re-injury time of 13.4 months post-surgery. Younger age (Hazard-Ratio, HR = 1.264 per year decrease; P = 0.005), receiving surgery within 1 month post-injury (HR = 3.378 vs. >3 months; P = 0.012), starting PT within 3 days post-surgery (HR = 3.068; P = 0.022), and decreased number of PT sessions (HR = 1.118 per 3-session decrease; P = 0.010) increased re-injury risk. Although age was associated with re-injury risk, age was not associated with any outcome (P > 0.059). CONCLUSION: Adolescents who are younger, receive surgery and post-surgery PT sooner, or attend fewer PT sessions may be at an increased re-injury risk. Younger patients achieved similar outcomes despite elevated re-injury risk. Current discharge criteria are inadequate in identifying high re-injury risk patients.
Authors: Bianca Marois; Xue Wei Tan; Thierry Pauyo; Philippe Dodin; Laurent Ballaz; Marie-Lyne Nault Journal: Int J Environ Res Public Health Date: 2021-07-17 Impact factor: 3.390