NORMATIVE DATA AND THE EFFECT OF GRAFT CHOICE ON ISOKINETIC KNEE MUSCLE STRENGTH IN PAEDIATRIC PATIENTS FOLLOWING ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION: A RETROSPECTIVE STUDY
Notice bibliographique
Résumé
Return to sport (RTS) criteria after an anterior cruciate ligament reconstruction (ACLR) is typically based on functional tests results and knee strength recovery. Patients aim to reach a limb symmetry index (LSI) of 90% and hamstrings-to-quadriceps (H/Q) ratios of 0.5–0.8. While attaining these postoperative objectives, the risk of re-injury has risen to 30%. Therefore, comparing peak isokinetic torque data to normative data in addition to the aforementioned metrics may add to the current assessment of postoperative strength deficits and readiness to RTS. Strength deficits are typically directly related to the location of the graft harvested. Due to the paucity of studies that compare postoperative outcomes in pediatric patients who either received a hamstring tendon autograft (HTA), quadriceps tendon autograft (QTA), or a patellar tendon autograft (PTA), graft choice remains dependent on the operating surgeon's preference and patients individual needs. The primary objective of this study was to generate normative data from the non-injured knee flexors and extensors isokinetic strength parameters of 13- to 18-year-old patients. The secondary objective was to determine the effects of graft choice on postoperative knee strength and patient-reported outcomes. A retrospective chart review was conducted including patients aged 13–18 years that underwent primary ACLR and performed a standardized bilateral isokinetic knee strength assessment between June 1st 2017 and March 1st 2022 at our institution. Anthropometric data, ACL-RSI and Pedi-IKDC scores, and isokinetic knee strength testing results at 6 to 7 months postoperatively were collected. Normative data calculated using patient's non-operated knee average peak torque relative to body mass at 60 deg/sec, 180 deg/sec, and 300 deg/sec in flexion and extension. Using the norms measured, Z-scores were calculated and compared between grafts. ANOVAs were performed to compare postoperative strength results and patient-reported outcomes between grafts. A total of 286 patients were included in this study. The mean age of patients in the cohort was 15.78& 1.26 years and 63% of the cohort was female. Males and patients with higher BMI had greater average relative peak torque at all three speeds in flexion and extension (p<0.05). HTAs were associated to significantly greater knee extension strength at 60 deg/sec on the operated side (p=0.0001 vs QTA, p=0.007 vs PTA). Patients having received a HTA normalized their average relative peak torque to a greater extent than patients having received a QTA (–0.51 vs −0.78, p=0.0002) or PTA (–0.51 vs −0.97, p=0.008) in flexion at 60 deg/sec. The HTA (n=167) were associated to significantly higher LSI in extension at all three speeds (p<0.05) than QTA (n=45) and PTA (n=55). QTA were associated to a significantly higher LSI in flexion at 60 deg/sec than HTA (p=0.01). ACL-RSI and Pedi-IKDC scores were not significantly different between the three autograft groups (p≥0.05). The postoperative pediatric ACLR knee strength norms calculated can be used as clinical reference values for patients awaiting RTS clearance. Additionally, our findings suggest that HTAs lead to greater and more normal postoperative knee average peak torque relative to body mass and LSI compared to QTAs and PTAs.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,007 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,002 | 0,002 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».