"For athletes with these types of injuries, the question is always, 'Can we play them now and fix them later?'" explains Lynn Snyder-Mackler, an associate professor in UD's Department of Physical Therapy, a top 10 graduate program according to U.S. News & World Report's recent rankings. "And, weekend athletes looking forward to a long-awaited skiing vacation or workers who can't take time off to recover from surgery also should benefit from this screening method."
Approximately 100,000 Americans rupture their anterior cruciate ligament each year, with a growing number of injuries attributed to female athletes over the past 10 years, Snyder-Mackler says. The UD screening examination, developed in cooperation with Michael Axe, M.D., of First State Orthopaedics of Newark, Del., and a clinical associate professor in the physical therapy department, identifies patients who can delay reconstructive knee surgery by undertaking an extensive rehabilitation program. These possible "copers"--individuals with outstanding rehabilitation potential--can be identified without the use of expensive equipment, using only a stopwatch, a tape measure and questionnaires, says Snyder-Mackler.
In UD tests, candidates were screened using one-legged hop tests; a validated rating of knee function; a strength test for the involved and uninvolved quadriceps femoris muscles; and self-reported incidences of knee instability [giving way] and knee function during daily activities, according to Snyder-Mackler's graduate student, G. Kelley Fitzgerald, who presented the team's findings. Failure of any one measure excluded subjects from the non-surgical rehabilitation category, Fitzgerald says, and certain score levels were set as criteria to identify rehabilitation candidates. Individuals with multiple ligament damage and those who decided to modify future physical activity to avoid surgery were not tested, he adds.
The validity of the patient questionnaire [The Knee Outcome Survey Activities of Daily Living Scale] was established in conjunction with the questionnaire's developers at the University of Pittsburgh. The article describing this testing, "Development of a Patient Reported Measure of Function for the Knee," has been accepted for publication in the Journal of Bone and Joint Surgery.
According to the UD report, 48 athletes participated in the original screening. Following analysis, 17 subjects were classified as rehabilitation candidates, and 12 decided to attempt rehabilitation without surgery. Nine of the 12, or 75 percent, were able to return successfully to full athletic activity after an intensive, but brief, rehabilitation program. A followup study showed that none of these individuals further injured their knees as a result of the rehabilitation regimen or a return to athletic competition.
Snyder-Mackler cautions that all patients participating in her research were carefully screened and continuously monitored. Those who decided against reconstructive surgery, instead, underwent an extensive regimen of physical therapy. "Patients with knee injuries obviously should follow the advice of their doctors and physical therapists," she emphasizes. "But we believe that this new screening method could help many more people pursue a broader range of activities, whether they play sports professionally or just for fun and exercise."
The UD physical therapy team included Snyder-Macker, Fitzgerald, Axe and Leslie Lear. The research received support from the Foundation for Physical Therapy Doctoral Dissertation and the National Athletic Trainers Association Research Fund.
PRESENTATION INFORMATION:
This session of the American Academy of Orthopaedic
Surgeons meeting will take place at 10:30 a.m. Central Time (11:30 a.m. ET)
Thursday, March 19 in Room 90/92 of the New Orleans Convention Center.
For information on UD's Department of Physical Therapy, go to http://www.udel.edu/staciec/uodpt.html
Journal
Journal of Bone and Joint Surgery