Functional and Patient-Reported Outcomes Improve Over the Course of Rehabilitation: A Secondary Analysis of the ACL-SPORTS Trial

Amelia J H Arundale, Jacob J Capin, Ryan Zarzycki, Angela Smith, Lynn Snyder-Mackler, Amelia J H Arundale, Jacob J Capin, Ryan Zarzycki, Angela Smith, Lynn Snyder-Mackler

Abstract

Background: The Anterior Cruciate Ligament-Specialized Post-Operative Return to Sports (ACL-SPORTS) randomized controlled trial was designed to address deficits in functional and patient-reported outcomes. The trial examined the effects of a secondary ACL prevention program that included progressive strengthening, agility training, plyometrics (SAP), and other components of current primary prevention protocols, with perturbation training (SAP + PERT group) and without PERT (SAP group). A secondary purpose of this study was to examine whether study outcomes differed between men and women.

Hypotheses: (1) Athletes in both the SAP and SAP + PERT groups will have improved knee function and patient-reported outcome measures from pre- to posttraining, (2) the SAP + PERT group would have higher outcome scores than the SAP group, and (3) outcomes will differ by sex.

Study design: Randomized controlled trial (NCT01773317).

Level of evidence: Level 2.

Methods: A total of 79 athletes (39 women) were randomized into the SAP and SAP + PERT groups. All athletes had undergone primary ACL reconstruction and achieved 80% quadriceps strength limb symmetry (QI), full range of motion, had minimal effusion, and had no pain. Additionally, all had begun running again. Prior to and after the training program, athletes' QI, hopping, and patient-reported outcomes were assessed. Repeated-measures analyses of variance were used to determine whether there were differences between groups. Subsequently, the SAP and SAP + PERT groups were collapsed to analyze differences between sexes.

Results: There were significant increases for all variables, with the exception of QI. There were no differences between the SAP and SAP + PERT groups. Both men and women made significant improvements in all knee function and patient-reported outcome measures except QI. Men made significant improvements in QI, whereas women did not.

Conclusion: The common elements of the training program that all athletes received (10 sessions of progressive strengthening, agility training, plyometrics, and secondary prevention) may be a beneficial addition to the return-to-sport phase of ACL reconstruction rehabilitation. The results suggest that women may require further quadriceps strengthening to maintain and improve QI, an important focus given the relationship between QI and risk for reinjury.

Clinical relevance: During the return-to-sport phase of ACL reconstruction rehabilitation, clinicians tend to shift their focus away from strengthening toward more advanced sports-related tasks. These results indicate that women in particular need continued focus on quadriceps strengthening.

Keywords: anterior cruciate ligament; rehabilitation; return to sport; secondary prevention.

Conflict of interest statement

<?release-delay 12|0>The following authors declared potential conflicts of interest: Amelia J.H. Arundale and Jacob J. Capin are supported by a grant from the Foundation for Physical Therapy.

Figures

Figure 1.
Figure 1.
CONSORT (Consolidated Standards of Reporting Trials) flow diagram of athletes included in the study. SAP, secondary prevention, agilities, and plyometrics; SAP + PERT = secondary prevention, agilities, and plyometrics with the addition of perturbation training.
Figure 2.
Figure 2.
Change in single-leg hop limb symmetry from pre- to posttraining.
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/6116107/bin/10.1177_1941738118779023-img1.jpg

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