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1ComparisonofKneeStability,StrengthDeficits,andFunctionalScoreinPrimaryandRevisionAnteriorCruciateLigamentReconstructedKneesDoKyungKim1,GeonPark1,KamarulzamanBinHajiM.
S.
Kadir2,Liang-TsengKuo3&WonHahPark1Comparingtoprimarysurgery,revisionACLreconstructionismoretechnicallydemandingandhasahigherfailurerate.
Theoretically,rehabilitationcanimprovekneefunctionafterACLreconstructionsurgery.
Thisstudyaimedtocomparekneestability,strength,andfunctionbetweenprimaryandrevisionACLreconstructedknees.
40primaryand40revisionACLreconstructionsurgerieswereincludedbetweenApril2013andMay2016.
Patientswithrevisionsurgeryhadahigheranteroposteriortranslationcomparingthosewithprimaryreconstruction(medianlaxity,2.
0mmvs.
3.
0mm,p=0.
0022).
Nodifferenceswerenotedinkneeextensorat60°/secor180°/sec(p=0.
308,p=0.
931,respectively)orinflexormusclestrengthat60°/secor180°/secbetweenprimaryandrevisionACLreconstructionknees(p=0.
091,p=0.
343,respectively).
TherewerealsonosignificantdifferencesbetweenfunctionalscoresincludingIKDCscoreandLysholmscoreinprimaryversusrevisionsurgeriesat12thmonthsafterindexoperation(p=0.
154,p=0.
324,respectively).
Inconclusion,despitehavinghigheranteroposteriorinstability,patientswithrevisionACLreconstructioncanhavenon-inferioroutcomesinisokinetickneestrengthandfunctioncomparedtothosewithprimaryACLreconstructionafterproperrehabilitation.
Anteriorcruciateligamentreconstruction(ACLR)surgeryisacommonproceduretoimprovefunctionalstabilityafterananteriorcruciateligament(ACL)injury.
ThesuccessfulrateofprimaryACLRisapproximatedtobe75%to97%amongpatients1,2.
Thismeansthatalmostone-fourthofprimaryACLRsurgeriesboundtofaildespiteimprovedsurgicalmethods3.
ThecausesassociatedwithfailedACLRsurgeryaresurgicalfactorsandrepetitiveinjurytotheknee4,5.
Amongthesepatients,approximately2.
9to8.
9%underwentthefollowingrevisionACLRsurgery6,7.
ComparedtoprimaryACLRsurgery,revisionsurgeryismoretechnicallydemanding.
Inrevisionsurgery,accessibilitytooriginaltunnelsisakeyfactorofsuccesssincetheremovalofhardwareisoftenrequiredandbonegraftingislikelytobenecessary8.
Thiscontributestoanestimated35%failurerateofrevisionACLRsurgery,whichtranslatedtoapproximately54%ofpatientsreturningtopre-injurylevels9.
Therefore,withthesetechnicaldifficulties,thesuccessrateofrevisionACLRsurgeryiscommonlylesscomparedtoprimaryACLRsurgery10.
Inadditiontoregainthejointstability,thegoalofACLRsurgeryisalsotorecoverthefunctionofthekneejointandmusclestrength10.
Tomaximizetheoutcomesofsurgeryandenhancethefunctionalrecovery,anappro-priaterehabilitationprogramisincorporatedintotheroutinepostoperativecare.
TheimpairedkneefunctionsassociatedwithACLinjuryincludeinstabilityindynamicmovementandquadricepsweakness.
Asbeingcriticaltodynamicjointstability,thequadricepsmuscleweaknesseventuallyleadstodecreasedkneefunction,andpoor1DepartmentofSportsMedicine,SamsungMedicalCenter,SungkyunkwanUniversitySchoolofMedicine,Seoul,Korea.
2DepartmentofOrthopaedicSurgery,HospitalTengkuAmpuanRahimahKlang,MinistryofHealth,Selangor,Malaysia.
3DepartmentofOrthopaedicSurgeryandSportsMedicineCenter,ChangGungMemorialHospital,Chiayi,Taiwan.
Liang-TsengKuoandWonHahParkcontributedequallytothiswork.
CorrespondenceandrequestsformaterialsshouldbeaddressedtoL.
-T.
K.
(email:light71829@gmail.
com)orW.
H.
P.
(email:pk90007@naver.
com)Received:11January2018Accepted:1June2018Published:xxxxxxxxOPEN2exerciseperformance,andmaycontributeearlyonsetofosteoarthritis11–13.
Thus,thestrengthofmusclearoundthekneejoint,especiallythequadricepsmuscle,wasthemaintargetoftrainingandkeepindicatorformonitor-ingthefunctionalrecoveryafterACLRsurgery13.
Thus,toevaluatethesuccessofprimaryACLRsurgery,jointstability,musclestrengthandkneefunctionwerecommonoutcomesreportedinpreviousstudies1,10,11.
However,therewerelimitedstudieswhichhaveassessedmusclestrengthrecoveryfollowingrevisionACLRsurgery.
Thus,weperformedthisstudytoassessthestabilityandfunctionalrecoveryafterprimaryandrevisionACLRsurgeryunderthescheduledrehabilitationprogram.
Thisstudyaimedto(1)comparerecoveryofkneeextensormuscle(quadriceps)andflexormuscle(hamstring)strengthinprimaryversusrevisionACLRsurgery,and(2)compareclinicalfunctionalandstabilityoutcomesinprimaryversusrevisionACLRsurgery.
ResultsDemographics.
Therewere80maleparticipantsincludedinthisstudy.
Therewerenostatisticallysignificantdifferencesinage,heightandbodyweightbetweenprimaryandrevisiongroups(p=0.
538,p=0.
105,p=0.
969respectively)(Table1).
Ligamentstability.
TheAPlaxitybetweengroupswasstatisticallydifferent(p=0.
0022)(Fig.
1).
Themedianlaxitywas2.
0mm(IQR,1.
0mm–2.
5mm)inprimarygroupand3.
0mm(IQR,2.
0mm–3.
25mm)inrevi-siongroup.
APlaxitybetweeninvolvedandhealthylimbwasalsorecorded.
Fortheprimarygroup,thedifferencewas5mminnoneofthecases.
Fortherevisiongroup.
Thediffer-encewas5mmin5cases.
Thedegreeofside-to-sidelaxitydifferencewassignificantlydifferentbetweentwogroups(X2test,p5mm0(0%)5(12.
5%)Table2.
Anteroposteriorligamentlaxity.
Resultsareshownasnumberwithpercentage.
Chi-Squaredtest:p0.
80atanalphalevelequalto0.
05wasusedtodeterminethatasamplesizeof35foreachgroupwasnecessarytodetermineinKT-2000arthrometryvalue32.
AlldatastatisticalanalysiswasperformedusingSPSSversion13.
0(SPSSInc.
,Chicago,IL,USA).
Chi-SquaredtestandMann-WhitneyUtestwereusedthroughouttocomparevariablesbetweentwogroups,withpPaessler,H.
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AuthorContributionsD.
K.
K.
andW.
H.
P.
designedthestudyanddirectedtheproject.
D.
K.
K.
andG.
P.
performedthetestandrecordedthedata.
D.
K.
K.
andL.
T.
K.
analyzedthedataandpreparedthetablesandfigures.
D.
K.
K.
,G.
P.
andK.
B.
H.
M.
K.
wrotethepaper.
D.
K.
K.
,G.
P.
andL.
T.
K.
contributedtointerpretationoftheresults.
Allauthorsprovidedcriticalfeedbackandhelpedshapetheresearch,analysisandmanuscript.
AdditionalInformationCompetingInterests:Theauthorsdeclarenocompetinginterests.
Publisher'snote:SpringerNatureremainsneutralwithregardtojurisdictionalclaimsinpublishedmapsandinstitutionalaffiliations.
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