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Sara Cordell Ithaca College. Protocol timeline Concomitant injuries or complications Knee stability and strength Objective vs. subjective data Reliability,

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Presentation on theme: "Sara Cordell Ithaca College. Protocol timeline Concomitant injuries or complications Knee stability and strength Objective vs. subjective data Reliability,"— Presentation transcript:

1 Sara Cordell Ithaca College

2 Protocol timeline Concomitant injuries or complications Knee stability and strength Objective vs. subjective data Reliability, validity, accuracy, functional relevance of tests Individual circumstances, fears, values, motivation, etc Demands of particular sport(s) Clinical experience/judgment

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4 90% symmetry between involved and uninvolved sides for objective testing (isokinetic testing, hop testing, etc) Full, nonpainful ROM No joint effusion Joint stability- KT test 3mm side-to-side difference MD and PT opinions

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6 Biodex Isokinetic Testing KT Testing Agility testing- Modified T-test Balance testing- Stabilometer Goniometry to measure symmetry of movement Compare symmetry of GRFs Deceleration testing Hop testing

7 Common tests- single leg hop for distance, 6m timed hop, triple hop for distance, crossover hops for distance Limb symmetry index (LSI=involved/uninvolved x100% for distance measures, opposite for time) Begun ~12-16weeks post-op Pros- test many aspects of LE movement at once, time efficient, minimal equipment Cons- learning curve, functional relevance, dont address quality of movement, measurement error

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9 TestReliability (ICC)MDC (%) Single hop m timed hop Triple hop Crossover hop Overall combination Four tests together- sensitivity= 82% Single hop test alone- sensitivity= 38-52%

10 Vertical jump Single hop for distance Drop jump followed by double hop Square hop Side hop

11 StatisticVertical jump Hop for distance Drop jump w/ double hop Square hopSide hop Sensitivity Specificity Accuracy

12 Vertical jump, single hop for distance, side hop Sensitivity: 91% for identifying patient as abnormal when at least 1 of the 3 tests was abnormal Accuracy: 84% for truly normal subjects and 88% for truly abnormal subjects

13 54% had abnormal LSI in ALL 3 tests 91% had an abnormal value in at least one of the 3 tests Only 9% had all normal LSI values

14 Test*LeftRightLSI Single Hop1.48m1.62m91.3% Vertical Jump10.43in13.03in80.0% Side Hop34in49in69.3% Test*LeftRightLSI Single Hop1.48m1.62m91.3% 6m Hop2.5s2.63s105.2% Triple Hop4.72m4.82m97.9% Crossover Hop4.1m4.8m85.4% Reid Test Battery Gustavsson Test Battery

15 Augustsson et al. evaluated effect of fatigue on single hop testing results Fatigue- repeat as many reps as possible at 50% 1RM All patients included in study had 90% symmetry in non-fatigued conditions After pre-exhaustion exercise, 68% demonstrated abnormal hop symmetry

16 Do not use only one or two testing methods Consider whole athlete and demands of sport Reference protocol timeline but also use functional goals as criteria for progression No objective tests are perfect, supplement with clinical judgment and experience Consider testing athlete in non-fatigued and fatigued conditions

17 Criteria based algorithm as proposed by Myer? Can you identify the most important factors when deciding return to sport? Most clinically useful objective measures? Most reliable/valid hop tests? Testing in fatigued vs. non-fatigued state? Commonly overlooked factors?

18 Augustsson J, Thomeé R, Karlsson J. Ability of a new hop test to determine functional deficits after anterior cruciate ligament reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal Of The ESSKA. Sept 2004;12(5): Gustavsson A, Neeter C, Karlsson J, et al. A test battery for evaluating hop performance in patients with an ACL injury and patients who have undergone ACL reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal Of The ESSKA. August 2006;14(8): Hartigan EH, Axe MJ, Snyder-Mackler L. Time line for noncopers to pass return-to-sports criteria after anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther. 2010; 40: Kvist J. Rehabilitation following anterior cruciate ligament injury: current recommendations for sports participation. Sports Medicine. 2004;34(4): Myer G, Paterno M, Ford K, Quatman C, Hewett T. Rehabilitation after anterior cruciate ligament reconstruction: criteria-based progression through the return-to-sport phase. The Journal Of Orthopaedic And Sports Physical Therapy. June 2006;36(6): Reid A, Birmingham T, Stratford P, Alcock G, Giffin J. Hop testing provides a reliable and valid outcome measure during rehabilitation after anterior cruciate ligament reconstruction. Physical Therapy. March 2007;87(3):


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