Marc Dauty1, Pascal Edouard2, Pierre Menu1, Olivier Mesland3, Alban Fouasson-Chailloux4. 1. Physical medicine and rehabilitation center, university hospital of Nantes, CHU Nantes, Nantes, France; Service de médecine du sport, university hospital of Nantes, CHU Nantes, Nantes, France; Inserm UMR U1229/RMeS, regenerative medicine and skeleton - Nantes university, Nantes, France. 2. Inter-university laboratory of human movement science (LIBM EA 7424), university of Lyon, university Jean-Monnet, 42023 Saint-Étienne, France; Department of clinical and exercise physiology, sports medicine unit, faculty of medicine, university hospital of Saint-Etienne, Saint-Étienne, France. 3. Physical medicine and rehabilitation center, university hospital of Nantes, CHU Nantes, Nantes, France; Inserm UMR U1229/RMeS, regenerative medicine and skeleton - Nantes university, Nantes, France. 4. Physical medicine and rehabilitation center, university hospital of Nantes, CHU Nantes, Nantes, France; Service de médecine du sport, university hospital of Nantes, CHU Nantes, Nantes, France; Inserm UMR U1229/RMeS, regenerative medicine and skeleton - Nantes university, Nantes, France. Electronic address: alban.fouassonchailloux@chu-nantes.fr.
Abstract
BACKGROUND: After anterior cruciate ligament reconstruction (ACLR), the decision to allow a return to running is empirical, and the post-operative delay is the most-used criterion. The Quadriceps isokinetic-strength Limb Symmetry Index (Quadriceps LSI), with a cutoff of 60%, could be a useful criterion. OBJECTIVE: To determine the association between a Quadriceps LSI≥60% and return to running after ACLR. METHODS: Over a 10-year period, we retrospectively included 470 patients who underwent ACLR. Four months after ACLR, participants performed an isokinetic test; quadriceps concentric peak torque was used to calculate the Quadriceps LSI at 60̊/s. With a Quadriceps LSI≥60%, a return to running was suggested. At 6 months after ACLR, participants were clinically evaluated for a return to sport and post-operative middle-term complications. A multivariable predictive model was built to assess the efficiency diagnosis of this cutoff in order to consider cofounding factors. Quadriceps LSI cutoff≥60% was assessed with sensitivity, specificity and the area under the receiver operating characteristic curve (AUC). RESULTS: According to our decision-making process with the 60% Quadriceps LSI cutoff at 60̊/s, 285 patients were authorized to return to running at 4 months after ACLR and 185 were not, but 21% (n=59) and 24% (n=45), respectively, were not compliant with the recommendation. No iterative autograft rupture or meniscus pathology occurred at 6 months of follow-up. On multivariable logistic regression analysis, a return to running by using the 60% Quadriceps LSI cutoff was associated with undergoing the hamstring strand procedure (odds ratio 2.60, 95% confidence interval [CI] 1.75-3.84; P<0.0001) and the absence of knee complications (1.18, 1.07-1.29; P=0.001) at 4 months. The sensitivity and specificity of the 60% Quadriceps LSI cutoff were 83% and 70%, respectively. The AUC was 0.840 (95% CI 0.803-0.877). CONCLUSIONS: Using the 60% cutoff of the isokinetic Quadriceps LSI at 4 months after ACLR could help in the decision to allow a return to running.
BACKGROUND: After anterior cruciate ligament reconstruction (ACLR), the decision to allow a return to running is empirical, and the post-operative delay is the most-used criterion. The Quadriceps isokinetic-strength Limb Symmetry Index (Quadriceps LSI), with a cutoff of 60%, could be a useful criterion. OBJECTIVE: To determine the association between a Quadriceps LSI≥60% and return to running after ACLR. METHODS: Over a 10-year period, we retrospectively included 470 patients who underwent ACLR. Four months after ACLR, participants performed an isokinetic test; quadriceps concentric peak torque was used to calculate the Quadriceps LSI at 60̊/s. With a Quadriceps LSI≥60%, a return to running was suggested. At 6 months after ACLR, participants were clinically evaluated for a return to sport and post-operative middle-term complications. A multivariable predictive model was built to assess the efficiency diagnosis of this cutoff in order to consider cofounding factors. Quadriceps LSI cutoff≥60% was assessed with sensitivity, specificity and the area under the receiver operating characteristic curve (AUC). RESULTS: According to our decision-making process with the 60% Quadriceps LSI cutoff at 60̊/s, 285 patients were authorized to return to running at 4 months after ACLR and 185 were not, but 21% (n=59) and 24% (n=45), respectively, were not compliant with the recommendation. No iterative autograft rupture or meniscus pathology occurred at 6 months of follow-up. On multivariable logistic regression analysis, a return to running by using the 60% Quadriceps LSI cutoff was associated with undergoing the hamstring strand procedure (odds ratio 2.60, 95% confidence interval [CI] 1.75-3.84; P<0.0001) and the absence of knee complications (1.18, 1.07-1.29; P=0.001) at 4 months. The sensitivity and specificity of the 60% Quadriceps LSI cutoff were 83% and 70%, respectively. The AUC was 0.840 (95% CI 0.803-0.877). CONCLUSIONS: Using the 60% cutoff of the isokinetic Quadriceps LSI at 4 months after ACLR could help in the decision to allow a return to running.
Authors: Jérôme Grondin; Vincent Crenn; Marie Gernigon; Yonis Quinette; Bastien Louguet; Pierre Menu; Alban Fouasson-Chailloux; Marc Dauty Journal: Int J Environ Res Public Health Date: 2022-07-06 Impact factor: 4.614