Uvod: V raziskavi smo: 1) primerjali subjektivni in objektivni izid rekonstrukcije sprednje križne vezi (SKV) s podatki iz literature, 2) preverili povezave med objektivnimi parametri in subjektivnim izidom zdravljenja po rekonstrukciji SKV, 3) ocenili razlike v mišičnem statusu med normalnimi (? 15 percentile normirane vrednosti IKDC) in subnormalnimi (< 15 percentila normirane vrednosti IKDC) preiskovanci in 4) ocenili parametre mišičnega statusa kot možne napovedne dejavnike za dober subjektivni izid zdravljenja. V dosedanji literaturi ni objavljenih raziskav, ki bi primerjale značilnosti mišičnega statusa (TMG, izokinetična dinamometrija) pri normalnih oziroma subnormalnih preiskovancih v zgodnjem pooperativnem obdobju.
Metode: V preučevano skupino je bilo vključenih 60 preiskovancev po primarni anatomski rekonstrukciji SKV. 1) Pri vseh preiskovancih smo opravili pregled kolena po protokolu IKDC Examination Form z instrumentalno meritvijo stabilnosti vezi in funkcionalni test dolžinskega poskoka. Preiskovanci so izpolnili vprašalnike o subjektivni oceni kolena (IKDC in Lysholm) ter lestvico aktivnosti po Tegnerju. Pregled smo ponovili šest in nato 12 mesecev po operaciji. Dobljene podatke smo primerjali s tistimi, zbranimi v objavljeni literaturi. 2) Zbrane podatke v omenjenih časovnih obdobjih smo analizirali in preverili korelacije med subjektivno oceno kolenskega sklepa in objektivnim kliničnim statusom kolena. 3) Šest mesecev po posegu smo preiskovance razdelili glede na subjektivni izid po IKDC v normalno in subnormalno skupino ter opravili TMG in izokinetične meritve ekstenzorjev in fleksorjev obeh kolenskih sklepov za ovrednotenje mišičnega statusa. 4) S pomočjo regresijskih modelov smo določili parametre za dober subjektivni izid po IKDC in Lysholmu, višji nivo aktivnosti po Tegnerju 12 mesecev po operaciji.
Rezultati: 1) Naša preučevana populacija je imela povprečno starost 31,8 let, vrednost IKDC pred operacijo je znašala 55,4 in nestabilnost, merjena s KT-1000, ki je bila 3,3 mm. Podatki so bili primerljivi s podatki iz literature. 2) Opazili smo blage korelacije med testom poskoka in subjektivnim izidom po IKDC in Lysholmu. Večje povezave med objektivnim kliničnim statusom kolena in subjektivnim izidom nismo zaznali. 3) Šest mesecev po posegu je 21 preiskovancev (35 %) ocenilo stanje svojega kolena kot normalno, ostale preiskovance (39 oziroma 65 %) smo uvrstili v subnormalno skupino. Med obema skupinama ni bilo razlike v kliničnem statusu, vendar je normalna skupina dosegla višje vrednosti po IKDC, Lysholmu in Tegnerjevi lestvici ter višji indeks funkcionalnega testa dolžinskega poskoka. V normalni skupini je TMG pokazal večji radialni odmik zadnjih stegenskih mišic operirane okončine (BF = 7,0 mm in ST + SM = 9,9 mm), medtem ko so pri izokinetičnemu testiranju dosegli višji navor (2,44 Nm/kg) in povprečno moč (133,0 W) ekstenzorjev kolena. 4) Radialni odmik biceps femorisa in mišična moč ekstenzorjev kolena sta pozitivna napovedna dejavnika za boljši subjektivni izid po IKDC in višji nivo aktivnosti po Tegnerjevi lestvici 12 mesecev po operaciji.
Zaključki: Z analizo subjektivnega izida in objektivnega kliničnega statusa kolena smo dokazali statistično značilen napredek skozi opazovano obdobje. Naši rezultati so primerljivi z objavljenimi podatki v literaturi. Pomembnih korelacij med subjektivnim izidom in objektivnimi kliničnim statusom kolena nismo zaznali. Preiskovanci, ki funkcijo svojega kolena šest mesecev po rekonstrukciji SKV ocenijo kot normalno, imajo boljše nevromuskularne lastnosti stegenskih mišic. Slabša mišična moč ekstenzorjev kolena in povečana togost zadnjih stegenskih mišic sta negativna napovedna dejavnika za subjektivni izid po IKDC in Lysholmu, nivo aktivnosti po Tegnerju 12 mesecev po posegu in zgoden povratek k polni aktivnosti. Z raziskavo smo pokazali, da je mišični status stegenskih mišic šest mesecev po operaciji v pomembni soodvisnosti s subjektivnim izidom rekonstrukcije SKV in napovedni dejavnik za subjektivni izid po enem letu.Introduction: The aim of our study was to: 1) compared the objective and subjective outcome of anterior cruciate ligament (ACL) reconstruction to data in the literature, 2) assess the correlation between objective parameters and subjective outcomes (ACL) reconstruction, 3) asses the differences in muscular status between normal (⡥15 percentile IKDC normative value) and subnormal (<15 percentile IKDC normative value) patients and 4) test different neuro-muscular parameters as possible predictors for good subjective outcome. In the literature there are no published studies to compare neuro-muscular characteristics (Tensiomyography (TMG), isokinetic testing) between patients with normal and subnormal short-term subjective outcome.
Methods: Sixty patients after primary anatomical single-bundle hamstring ACL reconstruction were prospectively enrolled. 1) Demographics, subjective, clinical, and functional status of the injured knee were recorded at baseline, 6, and 12 months post-operatively. We compared the acquired parameters with results from the literature. 2) We analyzed the parameters in tried to find correlations between subjective outcome and objective clinical knee joint status. 3) The patients were assigned into normal or sub-normal outcome group based on their IKDC scores at 6 months. TMG and isokinetic dynamometry of thigh muscles were performed and compared between the groups. 4) We determined muscular predictive factors for higher IKDC and Lysholm score as well as higher Tegner level of activity at 12 months after surgery
Results. 1) Our patients had an average age of 31,8 years, preoperative IKDC of 55,4 and instrumental instability (KT-1000) of 3,3 mm. Our results were similar to published data. 2) We noticed only minor correlations between the single-leg hop test and IKDC score and Lysholm score. There were no important correlations between the objective clinical knee status and subjective outcome. 3) At 6 months’ timeline, 21 patients (35%) perceived their knee function as normal, while 39 (65%) were sub-normal. There were no differences in clinical status of the knee between both groups but patients in normal group achieved higher IKDC, Lysholm, Tegner scores as well as longer single-leg hop test. TMG revealed higher biceps femoris as well as semitendinosus and semimembranosus radial displacement values on the operated leg in normal group (BF=7,0 mm in ST+SM=9,9 mm). Isokinetic dynamometry showed significantly higher normalized peak torque (2,44 Nm/kg) and average power (133,0 W) of knee extensor muscles. 4) Biceps femoris displacement and extensor peak torque are positive predictive factors for higher IKDC score and higher Tegner activity level at 12 months
Conclusions: Our study confirmed a significant progress of patients’ subjective and objective parameters during the follow-up period. Our results are similar to those published in recent literature. There were no significant correlations between objective clinical knee joint status and subjective outcome after ACL reconstruction. Patients who perceive their knee function as normal at six-months following ACL reconstruction presented with better neuromuscular properties of the thigh muscles. Decreased hamstring stiffness and higher peak torque of extensor muscles seem to have a profound impact on better subjective outcome and higher activity 1 year after surgery as well as shorter time of returning to preinjury activity. Our research showed that thigh muscle status 6 months after surgery is in significant co-dependence with subjective outcome following ACL reconstruction and a predictive factor for subjective outcome after 1 year
