Optimizing Healthcare Decision Making Following ACL-Reconstruction

Reinjury rates are high among individuals following anterior cruciate ligament reconstruction (ACLR). To improve outcomes following ACLR, functional assessments are administered to identify deficits prior to the patient’s return to activity (RTA). Through the Lower Extremity Assessment Protocol (LEAP) program, these assessments are administered at 4- and 6-months following surgery. This battery of assessments consists of patient reported outcomes, quadriceps and hamstring strength and symmetry, and single leg hopping performance and symmetry. Manuscript I used data from the 6-month assessment, manuscript II assessed the progression from the 4- and 6-month assessments, and manuscript III utilized 4- and 6-month measures to determine the effectiveness of a rehabilitation intervention. The focus of manuscript I was to assess the utility of commonly administered functional assessments to predict the ability to RTA and subsequent ACL injury. We found that greater measures of quadriceps symmetry and subjective knee function increased the odds of RTA and also increased the odds of subsequent ACL injury. In individuals that returned to activity after 8-month, the odds of subsequent ACL injury decreased with every month RTA was delayed. Current practice of accelerating patients back to high levels of activity may increase their probability for subsequent reinjury. The focus of manuscript II was to identify components of a 4-month functional assessments that can predict patients that demonstrate persistent muscle weakness. We found that higher age, lower levels of activity, and higher measures of quadriceps symmetry at the 4-month assessment were indicative of patients with persistent muscle weakness. Serial assessments administered throughout the post-ACLR progression could inform clinicians on the patient’s progression and their response to current treatments. The focus of manuscript III was to assess the ability of visuomotor therapy to modulate corticospinal excitability inpatients following ACLR. We found that a single session of visuomotor therapy increased quadriceps corticospinal excitability compared to a sham intervention of passive motion. Submaximal, force matching tasks may address underlying neuromuscular impairments developed following ACLR. Objective measures of patient function can be used to guide clinicians in their decisions of post-operative treatments, progressions, or that of returning to high levels of activity.