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A 10-Year Prospective Trial of a Patient Management Algorithm and Screening Examination for Highly Active Individuals With Anterior Cruciate Ligament Injury

Part 2, Determinants of Dynamic Knee Stability

Wendy J. Hurd, PT, PhD^*,, Michael J. Axe, MD and Lynn Snyder-Mackler, PT, ScD, FAPTA^*,,

From the ^* Department of Physical Therapy, University of Delaware, Newark, Delaware, Graduate Program in Biomechanics and Movement Science, University of Delaware, Newark, Delaware, and First State Orthopaedics, Newark, Delaware

Address correspondence to Lynn Snyder-Mackler, PT, ScD, FAPTA, Department of Physical Therapy, University of Delaware, 301 McKinly Laboratory, Newark, DE 19716 (e-mail: smack{at}udel.edu).

Objective: To clarify the determinants of dynamic knee stability early after anterior cruciate ligament injury.

Study Design: Cohort study (diagnosis); Level of evidence, 1.

Methods: Three hundred forty-five consecutive patients who were regular participants in International Knee Documentation Committee level I/II sports before injury and had an acute isolated anterior cruciate ligament injury from the practice of a single orthopaedic surgeon underwent a screening examination including clinical measures, knee laxity, quadriceps strength, hop testing, and patient self-reported knee function a mean of 6 weeks after injury when impairments were resolved. Independent t tests were performed to evaluate differences in quadriceps strength and anterior knee laxity between potential copers and noncopers. Hierarchical regression was performed to determine the influence of quadriceps strength, preinjury activity level, and anterior knee laxity on hop test performance, as well as the influence of timed hop, crossover hop, quadriceps strength, preinjury activity level, and anterior knee laxity on self-assessed global function.

Results: Neither anterior knee laxity nor quadriceps strength differed between potential copers and noncopers. Quadriceps strength influenced hop test performance more significantly than did preinjury activity level or anterior knee laxity, but the variance accounted for by quadriceps strength was low (range, 4%–8%). Timed hop performance was the only variable that affected self-assessed global function.

Conclusion: Traditional surgical decision making based on passive anterior knee laxity and preinjury activity level is not supported by the results, as neither is a good predictor of dynamic knee stability. A battery of clinical tests that capture neuromuscular adaptations, including the timed hop test, may be useful in predicting function and guiding individualized patient management after anterior cruciate ligament injury.

Key Words: knee • quadriceps strength • neuromuscular control