Physical prognostic factors predicting outcome following anterior cruciate ligament reconstruction: A systematic review and narrative synthesis

Andrew Middlebrook, Nicola Middlebrook, Sheree Bekker, Alison Rushton

Research output: Contribution to journalReview articlepeer-review

Abstract

Background: Anterior cruciate ligament (ACL) injuries are common. Many patients undergo ACL reconstruction (ACLR), with rehabilitation key to successful outcome. Understanding physical prognostic factors is integral to clinical decision-making, but factors predicting outcome are inadequately defined. The objective was to establish physical prognostic factors predicting outcome following ACLR. Methods: A systematic review following a published protocol (CRD42019127732) searched MEDLINE, CINAHL, EMBASE, key journals and grey literature to November 28, 2020. Prospective cohort studies, participants ≥16 years of age who had undergone ACLR were included, with multi-ligament and/or ACL repair surgery, and studies not published in English excluded. Two independent reviewers conducted searches, extracted data, assessed risk of bias (QUIPS) and overall quality of evidence (GRADE). Meta-analysis was not possible, therefore narrative synthesis was performed. Results: 13 studies (16 articles) were included (1 low, 12 high risk of bias). Low-level evidence supports postoperative degenerative changes and poor lower-limb strength predicting poorer outcome long term (KOOS). Very low-level evidence supports greater postoperative quadriceps strength predicting improved functional performance medium term; with lower body mass index predicting improvement of multiple outcome measures. Conclusion: Limited evidence of low or very low-level indicates multiple prognostic factors predicting outcome following ACLR. A high-quality prognostic study is required.

Original languageEnglish
Pages (from-to)115-142
Number of pages28
JournalPhysical Therapy in Sport
Volume53
Early online date4 Dec 2021
DOIs
Publication statusPublished - 31 Jan 2022

Keywords

  • ACL
  • Injury
  • Knee joint
  • Rehabilitation
  • Surgery

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Physical Therapy, Sports Therapy and Rehabilitation

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