Determining The Association of Patient Reported Outcomes with Lower Extremity Biomechanical Function and Quadriceps Strength
Anterior cruciate ligament (ACL) injury in the knee is a common, debilitating injury in athletes and the general population. Most individuals undergo ACL reconstruction (ACLR) to repair the ligament and restore functional capabilities and then return-to-play criteria are applied to determine readiness to return to play. One tool to determine readiness to return to play is the Knee injury and Osteoarthritis Outcome (KOOS) score which is a patient oriented outcomes tool that assesses patient symptoms, pain, activities of daily living, sports and recreation, and quality of life sub-scores. There are also functional tests that may be used, however the relationship between these patient oriented outcomes and functional criteria is not clear. The purpose of this project was to determine if strength (quadriceps strength symmetry) or functional hop test measurements correlated with KOOS sport/recreation activities and quality of life sub-scores. 10 ACLR subjects and 10 healthy control subjects participated in this University IRB approved study. The subjects completed the KOOS, had quadriceps strength tested by a dynamometer along with other biomechanical variables, and completed functional tests. Independent samples t-tests revealed that the ACLR group had significantly poorer KOOS sub-scores in 4 categories than the healthy group. The sub-scores for the ACLR vs Healthy groups respectively were as follows: Symptoms 79.29%±16.04 vs 98.21%±2.52 (p=.002), Pain 85.56%±14.80 vs 98.89%±1.94 (p=.011), Activities of daily living 94.85%±7.91 vs 99.85%±0.47 (p=.061), Sport 77.50%±20.85 vs 100%±0.00 (p=.003), Quality of life 71.25%±21.08 vs 98.13%±3.02 (p=.001). Quadriceps strength was not correlated with either the sport/rec sub-score (ACLR: r=-.524, p=.120; Healthy could not be computed because these sub-scores were all 100%) or quality of life sub-score (ACLR r=-.236, p=.512; Healthy r=-.519, p=.124) for either group. In addition, none of the hop test measurements were significantly correlated with the KOOS sub-scores (p>0.05). A limitation of the current study was that a small sample size was used and potentially statistically underpowered. Alternatively, if these results are true, the KOOS sub-scores may be telling us something that the functional hop tests and quadriceps strength cannot. Further research on the subject would require a larger sample size as well as further investigation to determine the utility of the KOOS as a part of return to play criteria.
Booysen, Grethe. (May 2021). Determining The Association of Patient Reported Outcomes with Lower Extremity Biomechanical Function and Quadriceps Strength (Honors Thesis, East Carolina University). Retrieved from the Scholarship. (http://hdl.handle.net/10342/9219.)
Booysen, Grethe. Determining The Association of Patient Reported Outcomes with Lower Extremity Biomechanical Function and Quadriceps Strength. Honors Thesis. East Carolina University, May 2021. The Scholarship. http://hdl.handle.net/10342/9219. December 10, 2023.
Booysen, Grethe, “Determining The Association of Patient Reported Outcomes with Lower Extremity Biomechanical Function and Quadriceps Strength” (Honors Thesis., East Carolina University, May 2021).
Booysen, Grethe. Determining The Association of Patient Reported Outcomes with Lower Extremity Biomechanical Function and Quadriceps Strength [Honors Thesis]. Greenville, NC: East Carolina University; May 2021.
East Carolina University