Subsequent Surgery for Loss of Motion After Anterior Cruciate Ligament Reconstruction Does Not Influence Function at 2 Years: A Matched Case-Control Analysis

2019 ◽  
Vol 47 (11) ◽  
pp. 2550-2556 ◽  
Author(s):  
Jacob Worsham ◽  
Walter R. Lowe ◽  
Dorcas Copa ◽  
Shelby Williams ◽  
Jacquelyn Kleihege ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Surgical Treatment ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Knee Function ◽  
Quality Data ◽  
Control Group ◽  
Manipulation Under Anesthesia ◽  
Anterior Cruciate ◽  
Loss Of Motion

Background: Loss of motion (LOM) remains a common complication after anterior cruciate ligament (ACL) reconstruction and can be detrimental to patient outcomes after surgery. LOM is multifactorial, but nonsurgical and surgical solutions to this complex problem are available. A paucity of quality data exists evaluating clinical outcomes after the surgical treatment of patients with LOM after ACL reconstruction. Hypothesis: Patients undergoing surgical lysis of adhesions and manipulation under anesthesia for LOM after ACL reconstruction will exhibit decreased function, lower outcome scores, and delayed time of release to play when compared with matched controls without LOM. Study Design: Cohort study; Level of evidence, 3 Methods: A database of 1572 patients undergoing ACL reconstruction was sampled from 2013 to 2017 to identify a total of 58 patients (LOM group [n = 29] vs matched control group [n = 29]). Group comparisons were examined for patients requiring a second surgical procedure for LOM versus matched controls after ACL reconstruction for differences in surgical timing, self-reported International Knee Disability Committee scores, objective function at release to play, and subjective knee function at 2 years with the Single Assessment Numeric Evaluation. The risk of a type I error was set at α = .05 for all statistical analyses. Results: Patients who underwent lysis of adhesions and manipulation under anesthesia for LOM after ACL reconstruction exhibited no differences in Single Assessment Numeric Evaluation knee function at 2 years when compared with matched controls (85.8 ± 14.9 vs 88.0 ± 10.8, P = .606). All patients met release-to-play criteria. Only International Knee Disability Committee scores ( P = .046) and single-legged hop testing ( P = .050) reached statistically significant differences, with higher scores in the control group. There was no difference in the time to release to play ( P = .034) or level of participation ( P = .180) between the control and surgical groups. Subjective function scores at 2 years were not significantly different between groups. Tourniquet time during the index ACL reconstruction was shorter in the control group ( P = .034). Conclusion: The findings of this study suggest that patients who undergo surgical treatment for LOM after ACL reconstruction can release to play at similar times but display relative deficits in single-legged-hop symmetry and lower self-reported function when compared with matched controls. Longer surgical times may increase the risk for LOM after ACL reconstruction. Registration: NCT03704376 (ClinicalTrials.gov identifier)

scholarly journals Effects of autologous adipose-derived regenerative stem cells administered at the time of anterior cruciate ligament reconstruction on knee function and graft healing

2019 ◽  
Vol 27 (3) ◽  
pp. 230949901986758 ◽  
Author(s):  
Eduard Alentorn-Geli ◽  
Roberto Seijas ◽  
Adrián Martínez-De la Torre ◽  
Xavier Cuscó ◽  
Gilbert Steinbacher ◽  
...  
Keyword(s):  
Stem Cells ◽  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
International Knee Documentation Committee ◽  
Knee Function ◽  
Soccer Players ◽  
Control Group ◽  
Anterior Cruciate ◽  
Bone Autograft

Purpose: To compare the healing and clinical outcomes of anterior cruciate ligament (ACL) reconstruction between patients with or without intraoperative administration of adipose-derived regenerative stem cells (ADRC). Methods: Between 2013 and 2014, the outcomes of 20 soccer players undergoing ACL reconstruction using bone–patellar tendon–bone autograft infiltrated with ADRC at the end of the procedure were compared to a historical, matched cohort of 19 soccer players undergoing the same procedure without ADRC. Outcomes were obtained at baseline, and 6 and 12 months postop for IKDC (International Knee Documentation Committee), Lysholm, and Lequesne, and at 2, 4, 6, and 12 months postop for VAS (visual analogue scale) for pain and graft maturation to evaluate the ligamentization process (magnetic resonance imaging (MRI)-based). Results: Both groups significantly improved the IKDC ( p < 0.001 in both groups), Lysholm ( p < 0.001 in both groups), Lequesne index ( p < 0.001 in both groups), VAS for pain ( p = 0.002 for the ADRC and p < 0.001 for the control group), and MRI scores ( p < 0.001 in both groups) in the 12 months postop compared to baseline scores. However, there were no significant differences in the improvement of the outcomes between groups across time ( p > 0.05). All patients returned to sports after surgery, but 8 (40%) patients in the ADRC and 13 (68.4%) patients in the control group had lower Tegner activity score at 12 months postop. Conclusions: Patients receiving ADRC at the time of ACL reconstruction significantly improved knee function and healing/maturation of the graft at 12 months. However, this improvement was not statistically significant compared to a control group undergoing ACL reconstruction alone.

Twenty-Year Outcomes After Anterior Cruciate Ligament Reconstruction: A Systematic Review of Prospectively Collected Data

2021 ◽  
pp. 036354652110273
Author(s):  
Joshua S. Everhart ◽  
Sercan Yalcin ◽  
Kurt P. Spindler
Keyword(s):  
Systematic Review ◽  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Knee Function ◽  
Increased Risk ◽  
Patient Reported ◽  
The Mean ◽  
Anterior Cruciate

Background: Several long-term (≥20 years) follow-up studies after anterior cruciate ligament (ACL) reconstruction have been published in recent years, allowing for a systematic evaluation of outcomes. Purpose: To summarize outcomes at ≥20 years after ACL reconstruction and identify patient and surgical factors that affect these results. Study Design: Systematic review; Level of evidence, 4. Methods: Prospective studies of primary ACL reconstructions with hamstring or bone–patellar tendon—bone (BTB) autograft via an arthroscopic or a mini-open technique and with a mean follow-up of ≥20 years were identified. When possible, the mean scores for each outcome measure were calculated. Factors identified in individual studies as predictive of outcomes were described. Results: Five studies met the inclusion and exclusion criteria with a total of 2012 patients. The pooled mean follow-up for patient-reported outcome measures was 44.2% (range, 29.6%-92.7%) and in-person evaluation was 33.2% (range, 29.6%-48.9%). Four studies (n = 584) reported graft tears at a mean rate of 11.8% (range, 2%-18.5%) and 4 studies (n = 773) reported a contralateral ACL injury rate of 12.2% (range, 5.8%-30%). Repeat non-ACL arthroscopic surgery (4 studies; n = 177) to the ipsilateral knee occurred in 10.4% (range, 9.5%-18.3%) and knee arthroplasty (1 study; n = 217) in 5%. The pooled mean of the International Knee Documentation Committee subjective knee function (IKDC) score was 79.1 (SD, 21.8 [3 studies; n = 644]). In 2 studies (n?= 221), 57.5% of patients continued to participate in strenuous activities. The IKDC-objective score was normal or nearly normal in 82.3% (n = 496; 3 studies), with low rates of clinically significant residual laxity. Moderate-severe radiographic osteoarthritis (OA) (IKDC grade C or D) was present in 25.9% of patients (n = 605; 3 studies). Medial meniscectomy is associated with increased risk of radiographic OA. Radiographic OA severity is associated with worse patient-reported knee function, but the association with knee pain is unclear. Conclusion: Currently available prospective evidence for ACL reconstruction with hamstring or BTB autograft provides several insights into outcomes at 20 years. The rates of follow-up at 20 years range from 30% to 93%. IKDC-objective scores were normal or nearly normal in 82% and the mean IKDC-subjective score was 79 points.

Comparison of the Position-Matching and Position-Reproducing Tasks to Detect Deficits in Knee Position Sense After Reconstruction of the Anterior Cruciate Ligament

2020 ◽  
Vol 29 (1) ◽  
pp. 87-92
Author(s):  
Takuma Hoshiba ◽  
Hiroki Nakata ◽  
Yasuaki Saho ◽  
Kazuyuki Kanosue ◽  
Toru Fukubayashi
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Sport Participation ◽  
Cruciate Ligament ◽  
Knee Extension ◽  
Position Sense ◽  
Matching Task ◽  
Control Group ◽  
Knee Position ◽  
Anterior Cruciate

Context: Deficits in knee position sense following reconstruction of the anterior cruciate ligament (ACL) can delay an athlete’s return to sport participation and increase the risk of reinjury. Deficits in position sense postreconstruction have been evaluated using either a position-reproducing or position-matching task. Objective: The aim of our study was to combine both to determine which assessment would be more effective to identify deficits in knee position sense. Design: Longitudinal laboratory-based study. Participants: Eleven athletes (6 men and 5 women; mean age, 20.5 [1.2] y), who had undergone ACL reconstruction with an ipsilateral hamstring autograft, and 12 age-matched controls. Interventions: Position sense was evaluated at 6 and 12 months postreconstruction and once for the control group. In addition, peak isokinetic knee extension and flexion strength, at 60°/s and 180°/s, was assessed for the ACL reconstruction group to evaluate possible influences of muscle strength on knee joint position sense. Main Outcome Measures: The variables include the angular differences between the reference limb and indicator limb, and peak torque values of isokinetic knee extension and flexion. Results: Significant matching differences were identified at 6 months postsurgery on the position-matching task, but not at 12 months postsurgery. No significant between-group and within-subject differences were identified on the position-reproducing task. No significant matching errors were identified for the control group. There was no correlation between errors in position sense and maximum isokinetic strength. Conclusion: The position-matching task is more sensitive than the position-reproducing task to identify deficits in knee position sense over the first year following ACL reconstruction surgery.

scholarly journals Gait Analysis and Knee Kinematics in Patients with Anterior Cruciate Ligament Rupture: Before and After Reconstruction

2020 ◽  
Vol 10 (10) ◽  
pp. 3378
Author(s):  
Dmitry Skvortsov ◽  
Sergey Kaurkin ◽  
Alexander Akhpashev ◽  
Aljona Altukhova ◽  
Alexander Troitskiy ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Gait Analysis ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Surgical Reconstruction ◽  
Control Group ◽  
Cycle Duration ◽  
Post Surgery ◽  
Before And After ◽  
Anterior Cruciate

The objective of the study was to evaluate the clinical, functional, and biomechanical symptoms in patients with anterior cruciate ligament (ACL) rupture before and after ACL reconstruction. The study enrolled 20 patients and 20 healthy subjects as controls. Walking biomechanics was assessed at three time points: before surgery and three months and a year or more after surgical reconstruction. Impact loads on both sides differed significantly from the respective values before surgery (p<0.05). Walking cycle duration decreased with time after surgery. On both sides (affected and unaffected), hip movement amplitudes were significantly smaller than in control (p<0.05). They remained so in the follow-up periods after the reconstruction. Before ACL reconstruction, the amplitude of the main flexion of the knee was significantly reduced both on the affected and unaffected sides. The amplitude gradually increased after the reconstruction, and a year post-surgery, it reached, on the operated side, the same values as in the control group. Complete functional recovery of the knee joint was not achieved within a year after the ACL surgical reconstruction. The remaining changes, however, were not clinically pronounced and could only be detected by instrumental gait analysis. The compensatory processes developed bilaterally, in both the hip and knee joints.

scholarly journals Mesenchymal stromal cells and platelet-rich plasma promote tendon allograft healing in ovine anterior cruciate ligament reconstruction

2020 ◽  
Author(s):  
Adam T. Hexter ◽  
Anita Sanghani-Kerai ◽  
Nima Heidari ◽  
Deepak M. Kalaskar ◽  
Ashleigh Boyd ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Stromal Cells ◽  
Femoral Tunnel ◽  
Platelet Rich Plasma ◽  
Cruciate Ligament ◽  
Control Group ◽  
Tendon Allograft ◽  
Tunnel Diameter ◽  
Anterior Cruciate

Abstract Purpose The effect of bone marrow mesenchymal stromal cells (BMSCs) and platelet-rich plasma (PRP) on tendon allograft maturation in a large animal anterior cruciate ligament (ACL) reconstruction model was reported for the first time. It was hypothesised that compared with non-augmented ACL reconstruction, BMSCs and PRP would enhance graft maturation after 12 weeks and this would be detected using magnetic resonance imaging (MRI). Methods Fifteen sheep underwent unilateral tendon allograft ACL reconstruction using aperture fixation and were randomised into three groups (n = 5). Group 1 received 10 million allogeneic BMSCs in 2 ml fibrin sealant; Group 2 received 12 ml PRP in a plasma clot injected into the graft and bone tunnels; and Group 3 (control) received no adjunctive treatment. At autopsy at 12 weeks, a graft maturation score was determined by the sum for graft integrity, synovial coverage and vascularisation, graft thickness and apparent tension, and synovial sealing at tunnel apertures. MRI analysis (n = 2 animals per group) of the signal–noise quotient (SNQ) and fibrous interzone (FIZ) was used to evaluate intra-articular graft maturation and tendon–bone healing, respectively. Spearman’s rank correlation coefficient (r) of SNQ, autopsy graft maturation score and bone tunnel diameter were analysed. Results The BMSC group (p = 0.01) and PRP group (p = 0.03) had a significantly higher graft maturation score compared with the control group. The BMSC group scored significantly higher for synovial sealing at tunnel apertures (p = 0.03) compared with the control group. The graft maturation score at autopsy significantly correlated with the SNQ (r = − 0.83, p < 0.01). The tunnel diameter of the femoral tunnel at the aperture (r = 0.883, p = 0.03) and mid-portion (r = 0.941, p = 0.02) positively correlated with the SNQ. Conclusions BMSCs and PRP significantly enhanced graft maturation, which indicates that orthobiologics can accelerate the biologic events in tendon allograft incorporation. Femoral tunnel expansion significantly correlated with inferior maturation of the intra-articular graft. The clinical relevance of this study is that BMSCs and PRP enhance allograft healing in a translational model, and biological modulation of graft healing can be evaluated non-invasively using MRI.

scholarly journals The Influence of Anterior Cruciate Ligament Remnant on Postoperative Clinical Results in Patients with Remnant Preserving Anterior Cruciate Ligament Reconstruction

2017 ◽  
Vol 5 (5) ◽  
pp. 624-629 ◽  
Author(s):  
Alan Goce Andonovski ◽  
Sonja Topuzovska ◽  
Milan Samardziski ◽  
Zoran Bozinovski ◽  
Biljana Andonovska ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Clinical Results ◽  
Control Group ◽  
Single Bundle ◽  
Knee Stability ◽  
The Mean ◽  
Anterior Cruciate ◽  
Proprioceptive Function

BACKGROUND: Anterior Cruciate Ligament (ACL) remnants have important biomechanical, vascular and proprioceptive function.AIM: To determine the influence of the ACL residual remnants after partial and complete ACL ruptures on postoperative clinical results in patients with remnant preserving ACL reconstruction.PATIENTS AND METHODS: The study included 66 patients divided into two groups. In patients from the investigation group remnant preserving ACL reconstruction was performed, in patients from the control group single bundle ACL reconstruction was performed. The results were assessed by Rolimeter measurements, Lysholm and Tegner scores and proprioception evaluation.RESULTS: The mean side-to-side difference of anterior tibia displacement (mm) was improved from 4.4 ± 1.06 to 0.4 ± 0.7 in the investigation group, and from 4.6 ± 0.68 to 1.9 ± 0.64 in the control group (p < 0.001). Difference in the angles in which the knee was placed by the device and the patient has improved from 1.5 ± 0.96° to 0.5 ± 0.53° in the investigation group and from 1.8 ± 0.78° to 1.3 ± 0.97° in the control group (p < 0.05).  Tegner and Lysholm scores showed no difference between the groups.CONCLUSION: Preservation of the ACL residual bundle provides a better knee stability and proprioceptive function.

Vancomycin Presoaking of the Graft Appears to Prevent Infection After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis

2021 ◽  
pp. 155633162110116
Author(s):  
Francisco Figueroa ◽  
David Figueroa ◽  
Rafael Calvo ◽  
Alex Vaisman ◽  
Marilaura Nuñez ◽  
...  
Keyword(s):  
Systematic Review ◽  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Meta Analysis ◽  
Case Series ◽  
Control Group ◽  
Infection Rates ◽  
Reconstruction Methods ◽  
Anterior Cruciate

Background: Vancomycin presoaking of the graft has been shown to decrease infection rates in some case series of anterior cruciate ligament (ACL) reconstruction. Purpose: We sought to substantiate the efficacy of vancomycin presoaked grafts for the prevention of infection after ACL reconstruction. Methods: We performed a systematic review of Medline and OVID to assess the incidence of postoperative infection in studies comparing patients undergoing ACL reconstruction with the use of vancomycin presoaked ACL grafts and a control group of patients undergoing ACL reconstruction without the use of presoaked grafts. The efficacy of vancomycin presoaking was calculated using the Agresti-Coull confidence interval. Relative risk (RR) was calculated for every study and the total sample. Results: The 11 studies that met inclusion criteria comprised 24,298 patients. In patients with vancomycin presoaking of the graft, 1 infection was reported in 8764 cases (0.01% rate). In the studies with control groups that did not have vancomycin presoaked grafts, there were 125 infections in 15,534 ACL reconstructions (0.8% rate). The efficacy of vancomycin presoaking in preventing infection after ACL reconstruction was 99.9% (0.999%–1.000% CI). The overall RR obtained was 0.07 (0.03–0.16 CI). All included studies were retrospective cohort studies (level III). Conclusions: Vancomycin presoaking of the graft has been shown to decrease infection rates after ACL reconstruction in studies of low evidence level. This suggests the need for prospective randomized controlled trials addressing this issue so that recommendations on the routine use of vancomycin presoaking of ACL grafts can be made with confidence.

scholarly journals Career Length and Injury Incidence After Anterior Cruciate Ligament Reconstruction in Major League Soccer Players

2018 ◽  
Vol 6 (1) ◽  
pp. 232596711775082 ◽  
Author(s):  
Amelia Joanna Hanford Arundale ◽  
Holly Jacinda Silvers-Granelli ◽  
Lynn Snyder-Mackler
Keyword(s):  
Anterior Cruciate Ligament ◽  
Lower Extremity ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Control Group ◽  
Lower Extremity Injuries ◽  
Career Length ◽  
Major League Soccer ◽  
Anterior Cruciate ◽  
Extremity Injuries

Background: Little is known about career length after anterior cruciate ligament (ACL) reconstruction in Major League Soccer (MLS), the top men’s professional soccer league in the United States. Further, it is unspecified whether athletes returning to soccer after ACL reconstruction are at a higher risk for injuries, beyond new knee injuries. Purpose: To examine career length and the incidence of lower extremity injuries in MLS athletes after ACL reconstruction in comparison with age-matched controls. Study Design: Cohort study; Level of evidence, 3. Methods: Injuries and athletic exposures (AEs; games and training sessions) were recorded in the HealtheAthlete database, the injury surveillance system of MLS. All athletes who had undergone ACL reconstruction and returned to MLS were identified and age-matched with controls. Multivariate analyses of variance were used to compare career length and percentage of regular/postseason games that athletes started, substituted, or did not play. Generalized linear model regressions were used to examine the injury risk. Results: Athletes in the ACL group had shorter careers (1.3 ± 1.3 years) than those in the control group (2.5 ± 1.3 years) ( P < .01), but while they were playing, athletes in the ACL group participated in a similar number of AEs as those in the control group (169.9 ± 129.0 vs 171.6 ± 124.9 AEs, respectively; P = .95). Athletes in the ACL group started fewer regular/postseason games (36.7% ± 34.3% vs 60.1% ± 33.8%, respectively; P < .01) and did not play in more regular/postseason games (47.4% ± 35.5% vs 31.0% ± 34.4%, respectively; P = .03) compared with those in the control group. The ACL group was not at a significantly greater risk for lower extremity injuries compared with the control group (relative risk, 0.87; 95% CI, 0.55-1.37). Conclusion: Although MLS athletes after ACL reconstruction are not at a greater risk for lower extremity injuries, this study suggests that they are not utilized in regular/postseason games as frequently and that their careers in MLS are shorter than age-matched controls. Further research is necessary to elucidate reasons for these athletes’ shortened MLS careers. This study supports the view of return to sport not as a single time point but as a continuum from return to participation to return to play and return to performance.

scholarly journals Reducing Intra-Articular Haemarthrosis After Arthroscopic Anterior Cruciate Ligament Reconstruction

2014 ◽  
Vol 2 (11_suppl3) ◽  
pp. 2325967114S0013
Author(s):  
Fatih Karaaslan ◽  
Sinan Karaoğlu ◽  
Musa Uğur Mermerkaya
Keyword(s):  
Anterior Cruciate Ligament ◽  
Blood Loss ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Acl Reconstruction ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Control Group ◽  
Double Blind Study ◽  
Cruciate Ligament Reconstruction ◽  
Anterior Cruciate

Objectives: A significant proportion of surgeons use intra-articular drains after arthroscopic anterior cruciate ligament (ACL) reconstruction. Haemarthrosis and pain adversely affects the functional outcome of ACL reconstruction. The purpose of the study was to evaluate the effect of tranexamic acid (TXA) administration to minimize pain and stiffness of knee joint by reducing haemarthrosis. Methods: The study enrolled 123 patients who underwent arthroscopic anterior cruciate ligament reconstruction in a prospective, randomized, double-blind study. The patients who were randomized into the TXA group (71 patients) received both intravenous and intra-articular TXA. The control group (52 patients) did not receive TXA. The anesthetist, surgeon, and observer were blinded to the study group (double-blinded). TXA was administered as a bolus dose of 15 mg/kg 10 minutes before the inflation of the tourniquet on the first side. This was followed by continued intra-articular administration of 3 g at 10 minutes before the deflation of the tourniquet. Intravenous infusion of 10 mg/kg/h was continued for the next 3 hours. Equal volumes of placebo were administered at the same rate and by the same route. We measured volume of drained blood 48 hours postoperatively. Results: The mean (± SD) postoperative volume of blood loss from the drain in the TXA and control groups was 100.6 ± 72mL and 164.3 ± 75mL ml, respectively. The difference between the two groups was significant (p < 0.005). Conclusion: This prospective randomized study showed that during arthroscopic anterior cruciate ligament reconstruction, TXA reduced blood loss and helped to reduce haemarthrosis amount and frequency with negligible side effects. With regard to the administration route, combined intravenous–intra-articular administration of TXA significantly reduces blood loss and the need for puncturing associated with arthroscopic anterior cruciate ligament reconstruction without enhancing the risk of deepssssssahrombosis.

scholarly journals Validation of a Composite Test for Assessment of Readiness for Return to Sports After Anterior Cruciate Ligament Reconstruction: The K-STARTS Test

2018 ◽  
Vol 10 (6) ◽  
pp. 515-522 ◽  
Author(s):  
William G. Blakeney ◽  
Hervé Ouanezar ◽  
Isabelle Rogowski ◽  
Gregory Vigne ◽  
Meven Le Guen ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Intraclass Correlation ◽  
Control Group ◽  
Diagnostic Study ◽  
Return To Sports ◽  
Sensitivity To Change ◽  
Significant Difference ◽  
Anterior Cruciate

Background: There is limited information on the appropriate timing of return to sports after anterior cruciate ligament (ACL) reconstruction. A composite test was developed to assess the athlete’s ability to return to sports after ACL reconstruction: the Knee Santy Athletic Return To Sport (K-STARTS) test. Hypothesis: The K-STARTS test meets validation criteria for an outcome score assessing readiness for return to sports after ACL reconstruction. Study Design: Diagnostic study. Level of Evidence: Level 3. Methods: A prospective comparative study identified 410 participants: 371 participants who had undergone ACL reconstruction and a control group of 39 healthy participants. The K-STARTS score is calculated as the sum of 7 tests (8 components), for a maximal value of 21 points. Construct validity, internal consistency, discriminant validity, and sensitivity to change were used to validate this new test. Results: The K-STARTS assessment showed a high completion rate (100%), high reproducibility (intraclass correlation coefficient, 0.87; coefficient of variation, 7.8%), and high sensitivity to change. There was moderate correlation with the ACL Return to Sports after Injury scale (ACL-RSI) and hop tests. There were no ceiling or floor effects. There was a significant difference between K-STARTS scores assessed at 6 and 8 months postoperatively (11.2 ± 2.7 vs 17.1 ± 3.2; P < 0.001). The K-STARTS score in the control group was significantly higher than that in the ACL reconstruction group (17.3 ± 2.1 and 13.7 ± 3.8, respectively; P < 0.001). Conclusion: The K-STARTS test is an objective outcome measure for functional improvement after ACL reconstruction. Clinical Relevance: It is important for the clinician to determine when return to sports is optimal after ACL reconstruction to reduce the current high risk of reinjury.

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