ISAKOS: 2019 Congress in Cancun, Mexico

2019 ISAKOS Biennial Congress ePoster #828


A Qualitative Investigation for Symptomatic Patients After Anterior Cruciate Ligament Reconstruction

Shozaburo Terai, MD, PhD, Straubing, Bavaria GERMANY
Thore Zantop, MD, Straubing, Bayem GERMANY
Christian Zantop, DipSpSc, Straubing, Bayern GERMANY
Anja Höninger, MSc, Straubing, Bayern GERMANY
Hiroaki Nakamura, Prof., Osaka JAPAN

Sporthopaedicum Straubing, Straubing, Bavaria, GERMANY

FDA Status Not Applicable


Task battery and patient-reported outcome were measured after RTS in ACLR patients. Out of 40, 15 patients were symptomatic on the operated leg. The ACL-RSI score and Lysholm score were significantly higher in asymptomatic group than symptomatic group. No significant differences were measured in task battery.



Primary anterior cruciate ligament reconstruction (ACLR) is known to have excellent outcomes, but many patients still have symptoms on the operated knee even after return to sport (RTS). The purpose of this study is to investigate the properties of the patient who are symptomatic after return to sport. We hypothesize that symptomatic patients show poor result in physical and psychological tests.

Material And Method

Recreational and competitive level athletes seen at a private orthopaedic clinic with an ACL injury were consecutively recruited. Of the patients who had undergone ACLR from February 2015 to October 2016, 40 cases (40 knees) and could RTS were selected to be in the study. All patients were tested task battery (postural stability, jump test (hop for distance), agility test (multiple speed chase), and isokinetic test (extension and flexion)) and clinical outcomes (Lysholm score, Beighton score, Tegner activity scale, and The Anterior Cruciate Ligament – Return to Sport After Injury (ACL-RSI) score questionnaires) after RTS. Those tests were measured between 6 to 12 months post-operatively. The result of task battery was expressed as an LSI (involved limb/uninvolved limb × 100 %). Agility test and jump test were also measured in fatigue condition. At the same time point, patients visited outpatient clinic and their knee condition were assessed.


15 out of 40 patients had symptoms on the operated leg after ACLR. 12 patients had knee pain. 5 patients had knee swelling. 2 patients had thigh atrophy. 1 patient had a crepitus on the knee. In statistics, the ACL-RSI and Lysholm score were significantly lower in symptomatic patients than in asymptomatic patients (respectively p = 0.0002, p = 0.02). The result of task battery (normal condition and fatigue condition) and the clinical score were not significantly different between 2 groups. There were also no significant difference in age, sex, graft type, body mass index and dominant side between who had and didn’t have symptoms on the operated knee.


The most important findings in this study was that patients with symptoms on the operated leg scored significantly lower result in the ACL-RSI than patients without symptoms, even though both groups could RTS. The ACL-RSI was used to measure psychological readiness to return to sports and Ardern et al reported a cut-off score of 56 points in ACL-RSI at 4 months post-ACLR predicted RTS at 12 months with a sensitivity of 58 % and specificity of 83 %. On the other hand, contrary to our expectations, there were no significant differences in the result of task battery in normal and fatigue condition between 2 groups. Therefore, it is assumed to say that symptomatic knee decreases the confidence to play sport, even though patients physically recovered and could return to sport. We have several limitations in current study. The task battery and clinical score were not measured preoperatively. The number of patients is not large and follow up period is short.