LASTA - Changes in laxity of the reconstructed ACL in professional and recreational athletes
ESSKA Academy. Siupsinskas L. May 9, 2018; 209958; P23-575 Topic: Sports Related Injuries
Assoc. Prof. Laimonas Siupsinskas
Assoc. Prof. Laimonas Siupsinskas
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Objectives: The aim of the study was to follow up changes of the reconstructed ACL with hamstring graft in male athletes at a time of 3, 6 and 12 months after the surgery.

Methods: 218 men at the age of 31.43 ± 8.57 years were tested. All the patients were professional or recreational athletes and suffered the ACL injury during the sport activities. 81 athletes were tested 3 months, 78 - 6 months and 59 - 12 months after the ACL reconstruction with hamstring graft. The knee laxity was measured with motorized and computerized arthrometer during the anteroposterior tibial translation at 20° of knee flexion thus reproducing the Lachman test at forces 134 N, 150 N, 200 N and 250 N. The healthy knees should have not more than 1 mm anteroposterior tibial translation, the partial tear of ACL can be suspected when the side-to-side difference of anteroposterior tibial translation is 1-3 mm. More than 3 mm difference is indicating total ACL tear. Slope of curves of displacement was measured as a unique indicator of the functional instability of the knee. Difference of slopes of curves delta P2 (µm/N) was analysed: delta P2 > 10 - high of risk of functional instability; 5 < delta P2 < 10 - medium and delta P2 < 5 - low risk of functional instability. Data presented in mean ± standard deviation and degree of statistical significance was set at P<0.05.

Results: 3 months after the surgery the average of side-to-side difference at 134 N force during the anteroposterior tibial translation was 0.95 ± 1.45 mm. 6 months after the surgery we had similar side-to-side difference - 0.70 ± 1.22 mm. The average of side-to-side difference after the 12 months was 0.43 ± 1.40 mm. Despite the fact that results in the follow-up can be named as "acceptable" - we can conclude that the stability of the knee and the tightness of the ACL graft statistically significant increased. Side-to-side difference of anteroposterior tibial translation at 134 N during the robotic ACL laxity measurement decreased from 0.95 ± 1.45 to 0.43 ± 1.40 mm (p=0.034). The risk of functional instability of the operated knee - slopes of curves - delta P2 (µm/N) remained in the same medium risk of instability level - 6.28 ± 5.07 - 3 months and 5.79 ± 4.83 - 12 months after the surgery (p=0.565). These findings confirm the importance of the physiotherapy to regain knee stability, muscle strength, range of motion, proprioception, confidence and psychological readiness to return to play.

Conclusions: The reconstructed ACL needs time to "adapt" in the operated knee. The ACL hamstring graft becomes about twice tighter in about 12 months after the surgery, although the risk of functional instability of the knee remains in the medium level. This fact leads to the conclusion that knee laxity measurements should be included into the return to play decision algorithm for professional and recreation athletes in order to avoid re-injury of the ACL and emphasizes the role of criterion-based rehabilitation for full recovery.

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