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Lower extremity performance following ACL rehabilitation in the KANON-trial: impact of reconstruction and predictive value at 2 and 5 years [with consumer summary]
Ericsson YB, Roos EM, Frobell RB
British Journal of Sports Medicine 2013 Oct;47(15):980-985
clinical trial
5/10 [Eligibility criteria: No; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: The additional effect of anterior cruciate ligament (ACL) reconstruction on muscle strength and physical performance after a structured exercise programme is not well understood. OBJECTIVES: To investigate and compare muscle strength and physical performance test results after a structured exercise programme, in young active adults with acute ACL injury, between those treated with and without ACL reconstruction (ACLR) and to evaluate these test results as predictors of clinical outcomes 2 and 5 years after injury. STUDY DESIGN: Prospective cohort study. METHODS: In a treatment randomised controlled trial of acute ACL injury (the KANON-study), 87/121 young active adults underwent two muscle strength tests and five physical performance tests after a structured exercise programme (median 37 (IQR 24) weeks after injury). Results were presented and compared as limb symmetry indices (LSI); endpoints in predictive analyses were having a delayed ACLR over the first 5 years and self-reported knee function (Knee injury and Osteoarthritis Outcome Score; KOOS4) at 2 and 5 years. RESULTS: Overall, 74 to 95% of patients had LSI >= 90% in the individual tests, with no difference between treatment groups (p = 0.08 to 0.92). Results of the one-leg rise tests predicted KOOS4 at 2 and 5 years (R2 = 0.25 and 0.24, p = 0.001 and 0.002) and vertical hop results predicted having a delayed ACLR over a 5-year course after injury (p = 0.048) in those starting with exercise alone (n = 21). CONCLUSIONS: After an acute ACL tear, the majority of young active adults regain physical performance and muscle strength after a structured exercise programme, with or without surgical reconstruction. Poor physical performance at the end of rehabilitation predicted worse patient-reported outcomes at 2 and 5 years regardless of treatment. REGISTRATION NUMBER: ISRCTN84752559.
Reproduced with permission from the BMJ Publishing Group.

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