| Objectives: Anterior cruciate ligament reconstruction(ACLR)is the most common surgery for anterior cruciate ligament(ACL)injuries.Although one of the primary purposes of ACLR is return to sport(RTS),the actual RTS rate is not high.Muscle strength,proprioception and tactile sensation are potential factors influencing RTS.However,to our knowledge,no one has yet to correlate strength,proprioception and tactile sensation with RTS in ACLR patients in a single study,their relationship and the priority of different rehabilitation approaches is difficult to be determined.This study aimed to investigate the correlations of strength,proprioception,and tactile sensation to the RTS [Knee Santy Athletic Return to Sport(K-STARTS),Anterior Cruciate Ligament Return to Sports after Injury scale(ACL-RSI)and functional test] among patients with ACLR.It is expected to clarify the necessity and priority of rehabilitation programs based on strength recovery and sensory enhancement,so as to provide scientific and effective rehabilitation programs for return to sport in patients with ACLR.Methods: Forty-two participants who received ACLR for at least 6 months were enrolled in this study(female = 12,male = 30,age: 27.6 ± 6.8 years,height: 181.8 ± 9.0cm,weight: 80.4 ± 8.9 kg,BMI: 24.4 ± 2.7,postoperative duration: 10.3 ± 3.8 months).Their RTS readiness,muscle strength,proprioception,and tactile sensation were tested.RTS readiness was measured with the K-STARTS test,which consists of a psychological scale(ACL-RSI)and a seven-item functional test.The Peak knee flexion/extension moments on the affected leg were measured using the Iso Med 2000 strength testing system(D.& R.Ferstl Gmb H,Hemau,Germany).The proprioception thresholds of knee flexion/extension threshold were assessed using a proprioception test device(Sunny,APII,China).The tactile sensation thresholds at the great toe,first metatarsals,fifth metatarsals,arch,and heel were assessed using Semmes–Weinstein monofilaments(North Coast Medical,Inc.,Morgan Hill,CA,USA).Partial correlations were used to determine their correlations while controlling for covariates(age,height,weight,and postoperative duration),and factor analysis and multivariable linear regressions were used to determine the degrees of correlation.Results: Partial correlation analysis showed that knee flexion strength was moderately correlated with K-STARTS total(r=0.340,p=0.032)and functional score(r=0.374,p=0.017),and knee extension strength was moderately correlated with KSTARTS total(r=0.415,p=0.008),ACL-RSI(r=0.358,p=0.023),and functional score(r=0.327,p=0.040).Knee flexion proprioception was moderately correlated with KSTARTS total(r=-0.316,p=0.047)and functional score(r=-0.355,p=0.025),and knee extension proprioception was moderately correlated with K-STARTS total(r=-0.321,p=0.044)and functional score(r=-0.340,p=0.032).Tactile sensation at the fifth metatarsal was moderately correlated with K-STARTS total(r=-0.395,p=0.012)and functional score(r=-0.426,p=0.006).Factor analysis showed that compared with proprioception,strength has more contribution to K-STARTS total and functional score.In the K-STARTS total score,the β value of muscle strength(β=0.483)is higher than that of proprioception(β=0.268).In the functional scores,the β value of muscle strength(β=0.439)is higher than that of proprioception(β=0.332).Conclusion: Knee extension strength was positively correlated with K-STARTS total,ACL-RSI,and functional scores.Knee flexion strength,knee flexion and extension proprioception,and tactile sensation at the fifth metatarsal were correlated with KSTARTS total and functional scores.Strength has higher levels of correlation with functional scores than proprioception.It is recommended that rehabilitation to promote muscle strength,proprioception and tactile sensation should be performed among patients with ACLR,muscle strength has the highest priority,followed by proprioception,with tactile sensation making the least contribution. |
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