Limb Preference Impacts Single‐Leg Forward Hop Limb Symmetry Index (LSI) Values Following ACL Reconstruction

2021 ◽  
Author(s):  
Brooke Farmer ◽  
Dillon Anderson ◽  
Dimitrios Katsavelis ◽  
Jennifer J. Bagwell ◽  
Kimberly A. Turman ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Symmetry Index ◽  
Limb Symmetry Index

scholarly journals Hop Testing Provides a Reliable and Valid Outcome Measure During Rehabilitation After Anterior Cruciate Ligament Reconstruction

2007 ◽  
Vol 87 (3) ◽  
pp. 337-349 ◽  
Author(s):  
Andrea Reid ◽  
Trevor B Birmingham ◽  
Paul W Stratford ◽  
Greg K Alcock ◽  
J Robert Giffin
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Outcome Measure ◽  
Cruciate Ligament ◽  
Measurement Properties ◽  
Global Rating ◽  
Symmetry Index ◽  
Limb Symmetry Index ◽  
Hop Tests ◽  
Anterior Cruciate

Background and Purpose Although various hop tests have been proposed as performance-based outcome measures following anterior cruciate ligament (ACL) reconstruction, limited reports of their measurement properties exist. The purpose of this study was to investigate the reliability and longitudinal validity of data obtained from hop tests during rehabilitation after ACL reconstruction. Subjects Forty-two patients, 15 to 45 years of age, who had undergone ACL reconstruction participated in the study. Methods and Measures The study design was prospective and observational with repeated measures. The subjects performed a series of 4 hop tests on 3 separate occasions within the 16th week following surgery and on a fourth occasion 6 weeks later. The tests were a single hop for distance, a 6-m timed hop, a triple hop for distance, and crossover hops for distance. Performance on the ACL-reconstructed limb was expressed as a percentage of the performance on the nonoperative limb, termed the “limb symmetry index.” Subjects also completed the Lower Extremity Functional Scale and a global rating of change questionnaire. Results Intraclass correlation coefficients for limb symmetry index values ranged from .82 to .93. Standard errors of measurement were 3.04% to 5.59%. Minimal detectable changes, at the 90% confidence level, were 7.05% to 12.96%. Changes in hop test scores on the operative limb were statistically greater than changes on the nonoperative limb. Pearson correlations (r) between change in hop performances and self-reported measures ranged from .26 to .58. Discussion and Conclusion The results show that the described series of hop tests provide a reliable and valid performance-based outcome measure for patients undergoing rehabilitation following ACL reconstruction. These findings support the use and facilitate the interpretation of hop tests for research and clinical practice.

scholarly journals Return to Level I Sports After Anterior Cruciate Ligament Reconstruction: Evaluation of Age, Sex, and Readiness to Return Criteria

2018 ◽  
Vol 6 (8) ◽  
pp. 232596711878804 ◽  
Author(s):  
Kate E. Webster ◽  
Julian A. Feller
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Return Rate ◽  
Return Rates ◽  
Symmetry Index ◽  
Limb Symmetry Index ◽  
Level I ◽  
Anterior Cruciate ◽  
Satisfactory Recovery

Background: Return to sport (RTS) after anterior cruciate ligament (ACL) reconstruction is a topic of current interest. The high reinjury rates reported in younger athletes may be due in part to an early RTS. Purpose: To determine the proportion of athletes who return to level I (jumping, hard pivoting, and cutting) sport at less than 1 year after ACL reconstruction and compare return rates by age and sex. A secondary purpose was to examine whether RTS is associated with some commonly used outcome criteria. Methods: A cohort of 1440 athletes (992 males, 448 females) satisfied criteria for inclusion in this study (primary ACL reconstruction, normal contralateral knee, no additional surgery within the first year after the reconstruction, and participation in level I sport on a weekly basis prior to injury). The proportion of athletes in this sample who had resumed level I sport by 12 months after surgery was recorded, along with measurements of knee function (single-legged hop symmetry), laxity (KT-1000 arthrometer), and self-reported outcomes (International Knee Documentation Committee [IKDC] subjective score). Limb symmetry index scores of 90 or higher, side-to-side difference in anterior knee laxity of 2 mm or less, and IKDC scores of 95 or higher were considered indicators of satisfactory recovery from surgery. Results: Rates of return to level I sport were significantly higher for athletes aged 25 years and younger (48% return rate) compared with older athletes (26-35 years, 32% return rate [ P < .0001]; ≥36 years, 19% return rate [ P < .001]). Male athletes who were in the ≤25-year and 26- to 35-year age brackets had significantly higher return rates than female athletes (52% vs 39% and 37% vs 18%, respectively), whereas no sex-based differences in RTS were seen after 36 years of age. A significantly higher proportion of younger patients met the selected indicators of a satisfactory recovery. Regardless of age, athletes had twice the odds of RTS if they had limb symmetry index scores of 90 or higher ( P ≤ .0001) and 3 times the odds of RTS if they had IKDC scores of 95 or higher ( P < .0001). Conclusion: Almost half of younger athletes (aged ≤25 years) in the current cohort returned to level I sports within 12 months after ACL reconstruction. Younger athletes were also more likely to meet criteria that indicate a satisfactory functional recovery and that have been used to indicate readiness to RTS. There may be a role for adjusting thresholds for these criteria based on age.

scholarly journals Return to Sport After ACL Reconstruction: Strength and Functionality Testing

2021 ◽  
Vol 1 (5) ◽  
pp. 263502542110405
Author(s):  
Simon J. Padanilam ◽  
Steven R. Dayton ◽  
Ryan Jarema ◽  
Michael J. Boctor ◽  
Vehniah K. Tjong
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Rehabilitation Program ◽  
Isokinetic Testing ◽  
Symmetry Index ◽  
Limb Symmetry Index ◽  
Rehabilitation Programs ◽  
Increased Risk ◽  
Hop Test

Background: Functionality testing following anterior cruciate ligament (ACL) reconstruction can benefit clinicians and patients in determining readiness for return to sport. While a component of a multifactorial decision, inability to perform well on these tests predicts increased risk of reinjury. As of 2013, only 41% of orthopaedic surgeons report using strength or functionality testing in evaluating patients for return to sport (RTS). Indications: In the intermediate to late stages of their rehabilitation program, patients may undergo these tests to determine readiness and safety to return to sport. Technique Description: The tests described in this video include the single and triple hop for distance, triple crossover hop, single and double vertical leg jump tasks, drop jump landing task, and isokinetic and isometric strength testing. Results: Clinicians who incorporate these tests into patient rehabilitation programs may reduce patient risk of ACL reinjury by 75% to 84%. The limb symmetry index (LSI) is a reliable calculated measure for these tests, with a strong reliability for the hop tests. The limb symmetry index can be calculated for each test and represents the ratio of measured performance of the involved, or post-ACL reconstruction, leg when compared against the uninvolved leg. The commonly used limb symmetry index threshold for passing each hop test is 90%. Patients who score 90% or greater on each of these tests are less likely to experience knee reinjury. Discussion/Conclusion: The ability of knee strength and functionality tests in determining RTS following ACL reconstruction has been highlighted as a tool in potentially reducing risk of knee reinjury. Other isometric and isokinetic testing can be used in addition to the described functionality tests but may not be possible in certain practices due to equipment and funding limitations. Usage of these strength and functionality tests, in conjunction with clinician evaluation, may lead to more optimal outcomes for patients and lower rates of reinjury. Psychological assessment may aid in evaluating patient readiness for return to sport. Importantly, further sport-specific testing is still recommended and will optimize patient outcomes.

scholarly journals Blood Flow Restriction Training Does Not Improve Quadriceps Strength After Anterior Cruciate Ligament Reconstruction

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0029
Author(s):  
Michael Curran ◽  
Asheesh Bedi ◽  
Christopher Mendias ◽  
Edward M. Wojtys ◽  
Megan Kujawa ◽  
...  
Keyword(s):  
Blood Flow ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Quadriceps Strength ◽  
Blood Flow Restriction ◽  
Effect Sizes ◽  
Leg Press ◽  
Symmetry Index ◽  
Flow Restriction ◽  
Anterior Cruciate

Objectives: Blood flow restriction training (BFRT) involves obstruction of venous outflow of working muscles during exercise and may lead to more substantial recovery of quadriceps strength after anterior cruciate ligament (ACL) reconstruction. The purpose of this study is to examine the effects of BFRT in ACL reconstruction patients before and after exposure to BFRT. Methods: This study was a randomized controlled trial in which 36 patients who had torn their ACL and were scheduled to undergo ACL reconstructive surgery (ACLR) with an autograft were randomized to receive exercise with BFRT (N=18) or exercise without BFRT (N=18). Participants in both groups performed the same exercise, but either did or did not have blood flow restricted. The exercise component of the intervention consisted of all subjects performing a single-leg isokinetic leg press, at an intensity of 70% of the subjects’ one-repetition maximum, for four sets of ten repetitions two times per week for 8 weeks beginning at 8 weeks post-operatively. Patients randomized to the BFRT group performed the leg-press exercise with a blood flow restriction cuff applied to the thigh and set to a limb occlusion pressure of 80 percent. All participants were concurrently undergoing standard ACL rehabilitation at the same physical therapy clinic. Bilateral isometric (recorded at a knee angle of 90°) and isokinetic (60°/second) quadriceps strength were recorded using a Biodex dynamometer (System 4, Shirley, NY) prior to ACLR and after the conclusion of the 8-week intervention. Peak isometric and isokinetic quadriceps strength were utilized to generate isometric and isokinetic quadriceps symmetry indices ((ACLR limb strength/Healthy limb strength) x100). Change from baseline symmetry scores were then generated using the following equation: (post-intervention symmetry - pre-intervention symmetry)/pre-intervention symmetry in order to account for possible differences in strength between groups prior to intervention delivery. Change from baseline isometric and isokinetic quadriceps symmetry scores were then compared between groups (exercise with BFRT, exercise without BFRT) using one-way analysis of variance tests with an a priori α set to P≤ 0.05. Effect sizes (Cohen’s d) and 95% confidence intervals were also computed. Results: No significant differences were found for change from baseline isokinetic quadriceps symmetry index (P=0.39, BFRT mean=-0.05, Control mean=-0.19) or change from baseline isometric quadriceps symmetry index (P=0.62, BFRT mean=-0.04, control mean=-0.10). The effect sizes for isokinetic quadriceps symmetry index (d=0.28, 95% CI= -0.37, 0.93) and isometric quadriceps symmetry (d=0.16, 95% CI= -0.49, 0.80) were small with confidence intervals that crossed zero. Conclusion: An 8-week blood flow resistance training + exercise intervention did not increase quadriceps muscle strength in patients who had undergone ACL reconstruction. Based on our findings, application of blood flow restriction training in ACL reconstruction patients to improve quadriceps strength may not be warranted. Future studies may benefit from a longer follow-up and larger sample size.

scholarly journals Reference values for fatigued versus non-fatigued limb symmetry index measured by a newly designed single-leg hop test battery in healthy subjects: a pilot study

2017 ◽  
Vol 14 (1) ◽  
pp. 105-113 ◽  
Author(s):  
Iris Leister ◽  
Georg Mattiassich ◽  
Harald Kindermann ◽  
Reinhold Ortmaier ◽  
Jürgen Barthofer ◽  
...  
Keyword(s):  
Pilot Study ◽  
Reference Values ◽  
Healthy Subjects ◽  
Test Battery ◽  
Symmetry Index ◽  
Limb Symmetry Index ◽  
Hop Test ◽  
Single Leg Hop Test

Evolution of Functional Recovery using Hop Test Assessment after ACL Reconstruction

2020 ◽  
Vol 41 (10) ◽  
pp. 696-704
Author(s):  
Alexandre J.M. Rambaud ◽  
Jérémy Rossi ◽  
Thomas Neri ◽  
Pierre Samozino ◽  
Pascal Edouard
Keyword(s):  
Functional Recovery ◽  
Functional Performance ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Interquartile Range ◽  
Return To Play ◽  
Symmetry Index ◽  
Limb Symmetry Index ◽  
Hop Tests ◽  
Hop Test

AbstractThe purpose of this study was to evaluate improvements in functional performance through the use of the Limb Symmetry Index of Single and Triple Hop tests between 12 and 52 weeks after anterior cruciate ligament reconstruction, and to compare these values with usual time-based and performance-based criteria used during the return to sport continuum. Repeated functional assessments using Single and Triple Hop Tests at 12, 16, 22, 26, 39 and 52 postoperative weeks were evaluated. At each session, the median and interquartile range of Limb Symmetry Index of tests were calculated and compared with the usual criteria: return to participation:≥85%, between 12–16 w; return to play:≥90%, between 26–39 w. The results indicate that the median increased over time to 39 postoperative weeks and then stabilized. For Single Hop Test, wide variability was seen at 12 and 16 weeks (interquartile range=20%); this was lower from 22 to 52 weeks (interquartile range=8–6%). At 12 weeks for Single Hop Test, the median was 83.6% and did not meet>85% criteria for return to participation. Hop tests could be interesting functional tests to follow the functional recovery and help decision-making regarding return to participation and return to play.

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