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Adhitya IPGS, Wibawa A, Aryana IGNW, Suprawesta L, Kurniawati I, Kamayoga IDGA, Kinandana GP. Predictors of lower knee function improvement two years after anterior cruciate ligament reconstruction. PHYSICIAN SPORTSMED 2024; 52:239-245. [PMID: 37218654 DOI: 10.1080/00913847.2023.2217877] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 05/22/2023] [Indexed: 05/24/2023]
Abstract
OBJECTIVES The extent to which knee functions improve after anterior cruciate ligament reconstruction (ACLR) varies. This study aimed to determine the factors that affect lower knee function improvement after two years of ACLR. METHODS The study included 159 patients who underwent ACLR in the Indonesian ACL community between August 2018 and April 2020. The concomitant injury and graft types of ACLR were determined using patients' pre-surgical MRI and medical records. The five subscales of the knee injury and osteoarthritis outcome score (KOOS) were used to evaluate the patient at baseline, first year, and second year following ACLR. A linear mixed-effect model (LMEM) was used to predict the longitudinal improvement models for the five-subscales KOOS score after ACLR. RESULTS The LMEM predicted lower KOOS subscales scores improvements by 0.5 for QOL, 0.1 for symptom, ADL, and QOL, and 0.2 for sports/recreation, respectively, for a one score increase of age and time from injury to surgery. Male patients had higher KOOS subscale scores with the improvement of pain, symptom, and ADL by 5.7, 5.9, and 6.3 compared to female patients, respectively, while patients with patellar tendon grafts had lower improvement of KOOS score pain by 6.5 compared to hamstring tendon grafts. CONCLUSION As the age and time from injury to surgery increased, the KOOS subscales scores of QOL and symptoms, ADL, sports/recreation, and QOL decreased. Male patients reported higher KOOS subscales scores for pain, symptoms, and ADL, while patients with patella tendon grafts had a lower improvement in pain score.
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Affiliation(s)
| | - Ari Wibawa
- Department of Physical Therapy, College of Medicine, Universitas Udayana, Denpasar, Indonesia
| | - I Gusti Ngurah Wien Aryana
- Department of Orthopaedic and Traumatology, College of Medicine and Sanglah General Hospital, Universitas Udayana, Denpasar, Indonesia
| | - Lalu Suprawesta
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan
- Department of Sport and Health Education, Faculty of Sport Science and Public Health, Universitas Pendidikan Mandalika, Mataram, Indonesia
| | - Ida Kurniawati
- Department of Histology, Faculty of Medicine and Health Sciences, Universitas Warmadewa, Bali, Indonesia
| | | | - Gede Parta Kinandana
- Department of Physical Therapy, College of Medicine, Universitas Udayana, Denpasar, Indonesia
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Adhitya IPGS, Yu WY, Kurniawati I, Lin MR. Risk factors of knee reinjury after anterior cruciate ligament reconstruction. INTERNATIONAL ORTHOPAEDICS 2024; 48:983-990. [PMID: 38195945 DOI: 10.1007/s00264-023-06084-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 12/27/2023] [Indexed: 01/11/2024]
Abstract
PURPOSE This study aimed to investigate whether the return to level I sports, concomitant injuries, foot-related problems, and other factors would increase the risk of knee reinjury after anterior cruciate ligament reconstruction (ACLR). METHODS This study used a prospective cohort study design. Online enrolment from August 2018 to January 2019 in ACL Community Indonesia recruited 148 patients who had undergone ACLR less than one month prior to injury. Knee injury occurrence after ACLR was diagnosed through a physical examination and positive MRI or arthroscopic findings. RESULTS During the study, 55 knee reinjuries occurred. The proportional hazards model analysis revealed that the risk of knee reinjury at 12 and 24 months for patients who returned to level I sports (hazards ratio (HR)=3.17 and HR=3.90, respectively) was significantly higher than that of the patients who did not return to sports and that the risk for those who returned to level II/III sports did not significantly increase at 12 or 24 months. Patients with concomitant meniscus injury had a significantly higher risk of knee reinjury at 12 and 24 months (HR=3.33 and HR=2.25, respectively) than those without, and the risk of knee reinjury for patients with concomitant posterior cruciate ligament injury was significantly higher at 12 months (HR=3.05) but not at 24 months. Fewer knee symptoms after ACLR were significantly associated with a lower risk of knee reinjury (HR=0.98) at 12 and 24 months. CONCLUSIONS The return to level I sports, concomitant meniscus and posterior cruciate ligament injury, and knee symptoms after ACLR may increase the risk of knee reinjury for post-ACLR patients.
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Affiliation(s)
- I Putu Gde Surya Adhitya
- Department of Physical Therapy, College of Medicine, Universitas Udayana, P.B Sudirman Street, Denpasar, Bali, 80232, Indonesia
| | - Wen-Yu Yu
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, 250 Wu-Hsing Street, Taipei, 11031, Taiwan, Republic of China
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan, Republic of China
| | - Ida Kurniawati
- Department of Histology, Faculty of Medicine and Health Sciences, Universitas Warmadewa, Denpasar, Bali, Indonesia
| | - Mau-Roung Lin
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, 250 Wu-Hsing Street, Taipei, 11031, Taiwan, Republic of China.
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Adhitya IPGS, Wibawa A, Aryana IGNW, Tegner Y. Reliability, validity, and responsiveness of the Indonesian version of the Lysholm knee score and Tegner activity scale in patients with anterior cruciate ligament reconstruction. J Bodyw Mov Ther 2023; 34:53-59. [PMID: 37301557 DOI: 10.1016/j.jbmt.2023.04.062] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 02/08/2023] [Accepted: 04/12/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVES This study aims to examine the reliability, validity, and responsiveness of the Lysholm knee score (LKS) and Tegner activity scale (TAS) in Indonesian patients with anterior cruciate ligament reconstruction (ACLR). DESIGN Cross-sectional study. SETTING The LKS and TAS were translated into Indonesian through standardized procedures with the owners' permission, and the test-retest reliabilities, validities, and responsiveness were performed. PARTICIPANTS Data of LS, TAS, Short Form (SF)-36, as well as MRI results were collected from 206 patients with unilateral ACLR. MAIN OUTCOME MEASURES LKS and TAS. RESULTS The questionnaires showed an adequate interclass correlation coefficient of 0.81-0.84 for the test-retest reliabilities, while an appropriate Cronbach's alpha value of 0.83 was obtained for internal consistency using LKS. They also had moderate-high correlations with the selected measures, which have similar constructs (r values, 0.44-0.68) except for the TAS with SF-36 physical function (PF; r value, 0.32). Meanwhile, low associations were observed with other measures with different constructs (r, 0.21-0.31). The results showed that Guyatt's responsiveness index for LKS and TAS changed in the SF-36's PF from 0.50 to 1.60 after one year. CONCLUSIONS The Indonesian version of LKS and TAS have acceptable reliabilities, validities, and responsiveness in ACLR patients.
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Affiliation(s)
- I Putu Gde Surya Adhitya
- Department of Physical Therapy, College of Medicine, Universitas Udayana, P.B Sudirman Street, Denpasar, 80232, Bali, Indonesia.
| | - Ari Wibawa
- Department of Physical Therapy, College of Medicine, Universitas Udayana, P.B Sudirman Street, Denpasar, 80232, Bali, Indonesia
| | - I Gusti Ngurah Wien Aryana
- Department of Orthopaedic and Traumatology, College of Medicine and Sanglah General Hospital, Universitas Udayana, Pulau Nias Street, Denpasar, 80113, Bali, Indonesia
| | - Yelverton Tegner
- Department of Health, Education and Technology, Luleå University of Technology, Luleå, Sweden
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Tan L, Liang J, Feng J, Cao Y, Luo J, Liao Y, Cao X, Wang Z, He J, Wu S. Medial meniscus tears are most prevalent in type I ACL tears, while type I ACL tears only account for 8% of all ACL tears. Knee Surg Sports Traumatol Arthrosc 2022; 31:2349-2357. [PMID: 35842857 DOI: 10.1007/s00167-022-07068-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 07/01/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE This study aimed to assess the distribution of different anterior cruciate ligament (ACL) tear locations in different magnetic resonance imaging (MRI) planes, and to explore the relationships of ACL tear types with both meniscus injuries and bone bruising. METHODS A retrospective study was performed in patients under 60 years old who underwent MRI scans in the sagittal and coronal oblique planes of the knee for ACL tears between 2014 and 2020. Patients with reports of chronic tears, partial tears, or prior surgeries were excluded. Tear locations were classified into five types, and the meniscus tear measurement variables included the presence of ramp, root, bucket-handle, and other types of tears. All injuries were confirmed by arthroscopy. Meanwhile, the presence and location of bone bruising were analysed and scored with the Whole-Organ Magnetic Resonance Imaging Score (WORMS) bone bruising subscale. RESULTS A total of 291 patients were included. The prevalence rates of type I and type III injuries were 23/291 (7.9%) and 145/291 (49.8%) in the sagittal plane and 22/291 (7.6%) and 179/291 (61.5%) in the oblique coronal plane, respectively. The prevalence of medial meniscus tears with ACL tears was 126/291 (43.3%), while that of lateral meniscus tears with ACL tears was 77/291 (26.5%). The highest prevalence of medial meniscus injury with ACL tears was 15/22 (68.2%) for type I injuries. Bone bruises were located on the lateral femoral center in 125 patients (46%) and on the lateral tibia posterior in 132 patients (48%); the common areas of bone bruising were slightly correlated with type III ACL tears but not correlated with type I ACL tears. CONCLUSION The plane in which an MRI scan is performed affects the classification of ACL tears. The tear type is associated with the prevalence of medial meniscus injuries, and medial meniscus tears are most prevalent in type I ACL tears. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Lingjie Tan
- Department of Orthopaedic Surgery, Third Xiangya Hospital of Central South University, Changsha, 410013, Hunan, China
| | - Jiehui Liang
- Department of Orthopaedic Surgery, Third Xiangya Hospital of Central South University, Changsha, 410013, Hunan, China
| | - Jing Feng
- Department of Orthopaedic Surgery, Third Xiangya Hospital of Central South University, Changsha, 410013, Hunan, China
| | - Yangbo Cao
- Department of Orthopaedic Surgery, Third Xiangya Hospital of Central South University, Changsha, 410013, Hunan, China
| | - Jiewen Luo
- Department of Orthopaedic Surgery, Third Xiangya Hospital of Central South University, Changsha, 410013, Hunan, China
| | - Yunjie Liao
- Department of Radiology, Third Xiangya Hospital of Central South University, Changsha, China
| | - Xu Cao
- Department of Orthopaedic Surgery, Third Xiangya Hospital of Central South University, Changsha, 410013, Hunan, China
| | - Zili Wang
- Department of Orthopaedic Surgery, Third Xiangya Hospital of Central South University, Changsha, 410013, Hunan, China
| | - Jinshen He
- Department of Orthopaedic Surgery, Third Xiangya Hospital of Central South University, Changsha, 410013, Hunan, China.
| | - Song Wu
- Department of Orthopaedic Surgery, Third Xiangya Hospital of Central South University, Changsha, 410013, Hunan, China
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