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Kneeling difficulty is common following anterior cruciate ligament reconstruction with hamstring autograft and correlates with outcome measures

  • Arthroscopy and Sports Medicine
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Patients frequently have discomfort or difficulty with kneeling following anterior cruciate ligament reconstruction (ACLR). This study aimed to report the prevalence of, and reasons for, kneeling difficulty after ACLR with a hamstring autograft; and to investigate the association between the degree of kneeling difficulty, presence of concurrent meniscal surgery, and clinical outcomes, including patient-reported outcome measures (PROMs) and functional tests.

Materials and methods

A total of 104 patients undergoing ACLR with ipsilateral hamstring autograft were enrolled. Participants completed a kneeling difficulty questionnaire and other PROMs including the International Knee Documentation Committee (IKDC) questionnaire, the Knee Injury and Osteoarthritis Outcome Score (KOOS), the Cincinnati Knee Rating System (CKRS), the Lysholm Knee Scoring Scale (LKS), the Tegner Activity Scale (TAS), the 36-Item Short Form Health Survey (SF-36), and the Knee Outcome Survey (KOS). Patients were also assessed objectively via peak isokinetic knee extensor and flexor strength, range of movement (ROM), and functional hop tests.

Results

The prevalence of kneeling difficulty on the operated knee was 77% and 54% at 1 and 2 years after ACLR, respectively. Strong associations were observed between kneeling difficulty and PROMs, ranging from CKRS at 1 year of r = 0.403 (95% CI 0.228–0.553, p < 0.001) to KOS at 2 years of r = 0.724 (95% CI 0.618, 0.804, p < 0.001). No associations were observed with age, body mass index, or knee ROM measures. Weak-to-moderate associations were demonstrated with functional hop tests. The degree of kneeling difficulty did not differ with concurrent meniscal surgery.

Conclusions

Kneeling difficulty occurs in as much as 77% of patients following ACLR with hamstring grafts at 1 year, and 54% at 2 years. This has a moderate-to-very strong association with patient-reported assessment of knee pain, symptoms, sport and recreation, and knee-related quality of life. There appears to be no association with patient age, BMI, time from injury to surgery, knee ROM, or concurrent meniscal surgery.

Level of evidence

IV

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Author information

Authors and Affiliations

  1. Department of Orthopaedics, Royal Perth Hospital, Perth, 6000, Australia

    Nicholas D. Calvert

  2. School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia

    Anne Smith

  3. School of Human Sciences (Exercise and Sport Science), University of Western Australia, Perth, Australia

    Tim Ackland & Jay Ebert

  4. Perth Orthopaedic and Sports Medicine Centre, West Perth, Australia

    Markus S. Kuster

  5. HFRC Rehabilitation Clinic, Perth, Australia

    Jay Ebert

Authors
  1. Nicholas D. Calvert
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  2. Anne Smith
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  4. Markus S. Kuster
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Correspondence to Nicholas D. Calvert.

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Conflict of interest

Markus S. Kuster has received royalties from Zimmer and Springer publishing. Nicholas D. Calvert, Anne Smith, Tim Ackland, Markus S Kuster, and Jay Ebert declare that they have no conflict of interest.

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Calvert, N.D., Smith, A., Ackland, T. et al. Kneeling difficulty is common following anterior cruciate ligament reconstruction with hamstring autograft and correlates with outcome measures. Arch Orthop Trauma Surg 140, 913–921 (2020). https://doi.org/10.1007/s00402-020-03401-x

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  • DOI: https://doi.org/10.1007/s00402-020-03401-x

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