Validity and reproducibility of the PPLP score in the follow-up of anterior cruciate ligament reconstruction in athletes

Abstract

Objectives:In a context where psychological scores appear to have an increasing influence on the resumption of sports, it would also appear to be essential to evaluate the relevance of global scores with multiple criteria. The PPLP score (Psychological Physical Ligament Predictive score) enables an analysis of subjective, clinical and isokinetic muscle assessment items.Methods:We prospectively followed anterior cruciate ligament (ACL) reconstructions in several series for which we analyzed the validity of the score (763 patients), the reproducibility, the sensitivity to change, the relevance in the follow-up of ligamentoplasty (3,296 ligamentoplasties followed postoperatively) as well as the predictive nature in the resumption of sports (258 patients). The PPLP score has two parts: one (PPLP1) based on 100 points for postoperative follow-up and the other also based on 100 points (PPLP2) which is added to the first score for follow-up at a certain period of time after surgery to determine a new score of 200 points. We also tried to identify correlations with other scores in the literature (OAK, Lysholm, Tegner, KOOS, Arpeggio, IKDC Subjective and the Psychovitality Test).Results:We demonstrated the distinction of the items (r coefficient of 0.20) for construct validity. Intra-examiner and extra-examiner reproducibility was excellent, ranging from 0.92 to 1. The PPLP score changed in a statistically significant way during hospitalization and according to the operating lead time with phases of higher variation. Complicated clinical changes manifested in a low score, in particular neuro-algodystrophies (1.9%) with a mean PPLP1 of 80.33 while changes without complications (80.8%) had a mean score of 94.28 with a significant difference (p < 0.0001). The PPLP2 score correlated significantly with the resumption of competition (p = 0.012). A high score was associated with faster recovery. The optimal cut-off score was 176 (sensitivity 79.7% and specificity 49.3%). The results of the PPLP score were correlated with the other scores.Conclusion:The PPLP score was validated in terms of construction, reproducibility, and sensitivity in the follow-up of ACL ligamentoplasties. It provides indications on the quality of change and the possibilities of resuming sports. It is the only score that incorporates isokinetic assessments.