Influence of residual anterior laxity on functional outcomes after anterior cruciate ligament reconstruction - 15/05/22
, Florent Gaillard a
Bienvenue sur EM-consulte, la référence des professionnels de santé.
Article gratuit.
Connectez-vous pour en bénéficier!
Abstract |
Introduction |
Residual laxity can persist after anterior cruciate ligament (ACL) reconstruction. This increased anterior translation can be measured with a knee arthrometer. Nevertheless, the measurement parameters and functional impact of this residual laxity are not well understood. The aims of this study were to (1) evaluate the effect of applying loads of 134N, 200N and 250N on the measured residual laxity after ACL reconstruction and (2) evaluate the prognostic ability of the various measurement parameters on the functional outcomes.
Hypothesis |
After ACL reconstruction, the functional outcomes will be correlated to the postoperative residual laxity.
Methods |
We did a prospective study of 61 recreational athletes who underwent surgical reconstruction of their ACL with the Kenneth-Jones technique between 2016 and 2019. The mean age of these patients was 27±7 years, and most were men (75%). The side-to-side difference in laxity was measured pre- and postoperatively using the GNRB® arthrometer at three load levels: 134N, 200N and 250N. The functional outcomes were determined based on the return to sports and the KOOS, IKDC and ARPEGE scores. The mean follow-up was 30±10 months.
Results |
Half the patients had returned to sport at their pre-injury levels, while 25% had returned to a lower level and 25% had stopped doing any physical activity. At 134N, a 1-mm increase in side-to-side difference was associated with a 2-fold higher risk of not returning to sports (OR 2; 95% CI 1.22–3.23; p<0.01). At 200N, a 1-mm increase in side-to-side difference was associated with a 50% higher probability of having a poor/fair ARPEGE score (OR 1.5; 95% CI 1.05–2.02; p=0.02). At 200N, a 4-mm side-to-side difference was the prognostic threshold for failure to return to sports with a positive predictive value of 86% and specificity of 98%.
Conclusions |
This case series found a strong correlation between residual laxity and the functional outcomes after ACL reconstruction. A threshold of 4mm residual laxity evaluated on the GNRB® at 200N was predictive of adverse outcomes and failure to return to sports in our population of recreational athletes.
Level of evidence |
IV, retrospective study.
Le texte complet de cet article est disponible en PDF.Keywords : Anterior cruciate ligament reconstruction, GNRB®, Knee arthrometer, Laxity, Knee instability
Abbreviations : ACL, N, BMI, PPV
Plan
Vol 108 - N° 3
Article 103264- mai 2022 Retour au numéro
Article précédent
- Surgical technique of anterior cruciate ligament ligamentoplasty with pedicular hamstrings via an inside-out approach: BIOFAST hamstring tendons graft
- Elena Lang, Alexandre Hardy, Olimpia Tufis, Olivier Grimaud, Antoine Gerometta, Yoann Bohu, Nicolas Lefevre, Alain Meyer
- Significant risk of arthrolysis after simultaneous anterior cruciate ligament reconstruction and treatment of dislocated bucket-handle meniscal tear
- Etienne Deroche, Cécile Batailler, John Swan, Sébastien Lustig, Elvire Servien
Bienvenue sur EM-consulte, la référence des professionnels de santé.