Fatores preditores de segunda lesão após reconstrução do ligamento cruzado anterior

Abstract

Background: Several factors can predict an anterior cruciate ligament (ACL) reinjury, including factors commonly addressed in rehabilitation. Objective: To identify whether the interaction between anthropometric data, knee function, psychological readiness, postural stability, and muscle strength can predict the risk of ACL reinjury in individuals who underwent primary ACL reconstruction (ACLR). Methods: Participants who were between the sixth and twenty-fourth month after the primary ACL injury surgery were included. At baseline, all participants completed an assessment form, two questionnaires (self-reported function and psychological readiness) and performed an assessment of single-legged postural stability and muscle strength. Participants were contacted and questioned about the occurrence of reinjury and return to sport from two to four years after the return to sport criteria were evaluated. The classification and regression tree (CART) was used to determine

the predictors of reinjury. Results: Eighty-eight participants responded to the follow- up. Fourteen participants (15.9%) had reinjury, of which 11 had graft injury and

three had contralateral injury. Two reinjury profiles were identified: (1) return to sports, Anterior Cruciate Ligament - Return to Sport After Injury (ACL-RSI) ≤ 87.9%, hamstring strength deficit at 300o/s ≤ 3.3%, ACL-RSI ≤ 47.05% and body mass index (BMI) > 25.42 and (2) return to sport and ACL-RSI > 87.9%; and two profiles without reinjury: (1) do not return to sport and hamstrings/quadriceps ratio of injured limb at 60o/s > 46.15%; and (2) return to sport, ACL-RSI ≤ 87.9% and hamstring strength deficit at 300o/s > 3.3%. The CART’s model classified 90.9% of the participants, with a sensitivity of 75% (95%CI 42.8-94.5%) and specificity of 93.4% (95%CI 85.3-97.8%). Conclusions: Return to sport, poor or excessive psychological readiness, hamstring strength symmetry, and overweight may predict the risk of reinjury. Due to better specificity, to identify absence of reinjury because of the interaction between not returning to sport and strength balance between hamstrings and quadriceps or returning to sport, adequate psychological readiness, and greater deficit of hamstring strength.