Abstract
PurposeClinical test batteries for evaluation of knee function after injury to the Anterior Cruciate Ligament (ACL) should be valid and feasible, while reliably capturing the outcome of rehabilitation. There is currently a lack of consensus as to which of the many available assessment tools for knee function that should be included. The present aim was to use a statistical approach to investigate the contribution of frequently used tests to avoid redundancy, and filter them down to a proposed comprehensive and yet feasible test battery for long-term evaluation after ACL injury.MethodsIn total 48 outcome variables related to knee function, all potentially relevant for a long-term follow-up, were included from a cross-sectional study where 70 ACL-injured (17–28 years post injury) individuals were compared to 33 controls. Cluster analysis and logistic regression were used to group variables and identify an optimal test battery, from which a summarized estimator of knee function representing various functional aspects was derived.ResultsAs expected, several variables were strongly correlated, and the variables also fell into logical clusters with higher within-correlation (max ρ = 0.61) than between clusters (max ρ = 0.19). An extracted test battery with just four variables assessing one-leg balance, isokinetic knee extension strength and hop performance (one-leg hop, side hop) were mathematically combined to an estimator of knee function, which acceptably classified ACL-injured individuals and controls. This estimator, derived from objective measures, correlated significantly with self-reported function, e.g. Lysholm score (ρ = 0.66; p<0.001).ConclusionsThe proposed test battery, based on a solid statistical approach, includes assessments which are all clinically feasible, while also covering complementary aspects of knee function. Similar test batteries could be determined for earlier phases of ACL rehabilitation or to enable longitudinal monitoring. Such developments, established on a well-grounded consensus of measurements, would facilitate comparisons of studies and enable evidence-based rehabilitation.
Highlights
Rupture of the anterior cruciate ligament (ACL) is a common injury especially in individuals who participate in sports [1, 2]
Similar test batteries could be determined for earlier phases of ACL rehabilitation or to enable longitudinal monitoring
The aim of this paper was to investigate the possibility of applying such a statistical approach to a large set of knee assessments, thereby detecting highly correlated variables and filter them down to a suggestion of a comprehensive and yet feasible clinical test battery consisting of only a few tests to be used in long-term evaluation after ACL injury
Summary
Rupture of the anterior cruciate ligament (ACL) is a common injury especially in individuals who participate in sports [1, 2]. Attempts to determine knee function often combine several assessment tools covering different aspects of knee function based mainly on clinical examination, knee-specific scores and functional tests. The latter are aimed at capturing indicators of physical capacity, e.g. muscular strength, balance, motor coordination etc. A test battery consisting of three commonly used hop tests (vertical hop, one-leg hop for distance, and side hop), has shown a high ability to discriminate between the injured and non-injured leg of individuals with ACL injury [12] Another test battery consisting of four hop tests (one-leg hop for distance, 6-m timed hop, triple hop for distance and crossover hop for distance) has been demonstrated to be reliable and valid [14, 15]. It would be desirable to analyze several variables simultaneously
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