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. 2024 Oct 23;12(10):23259671241280982.
doi: 10.1177/23259671241280982. eCollection 2024 Oct.

Association of the COVID-19 Pandemic With Outcomes After Anterior Cruciate Ligament Reconstruction: A Retrospective Comparative Study Examining Changes in Health Care Access, Delivery, and Functional Outcomes

Quinn Steiner  1 , Anthony Zacharias  2 , Elizabeth Chumanov  3 , Geoffrey S Baer  1 , Brian E Walczak  4   5
Affiliations

Association of the COVID-19 Pandemic With Outcomes After Anterior Cruciate Ligament Reconstruction: A Retrospective Comparative Study Examining Changes in Health Care Access, Delivery, and Functional Outcomes

Quinn Steiner et al. Orthop J Sports Med. .

Abstract

Background: Structured rehabilitation optimizes outcomes and reduces reinjury risk after anterior cruciate ligament reconstruction (ACLR). The coronavirus 2019 (COVID-19) pandemic interrupted standard rehabilitation, possibly affecting ACLR outcomes.

Purpose: To characterize changes to ACLR functional outcomes related to the COVID-19 pandemic.

Study design: Cohort study; Level of evidence, 3.

Methods: Patients who underwent ACLR between June 11, 2019, and March 11, 2020, (postpandemic group) were compared retrospectively with those who underwent ACLR the year before (June 11, 2018, to March 11, 2019). A mixed-effects linear regression model was used to estimate group differences in isokinetic quadriceps testing. A Kaplan-Meier analysis assessed the probability of achieving >90% limb symmetry index (LSI) for isokinetic quadriceps strength at 60 deg/s and passing all return-to-sport functional outcomes at 1 year postoperatively.

Results: A total of 176 patients (80 in the control group and 96 in the postpandemic group) were included. The rate of achieving >90% LSI in isokinetic strength at 60 deg/s at 1 year postoperatively was 39% (95% CI, 27%-49%) for the control group versus 22% (95% CI, 13%-30%) for the postpandemic group (P = .01). Similarly, the rate of achieving >90% LSI in all functional tests at 1 year postoperatively was 15% (95% CI, 7%-22%) for the control group versus 7% (95% CI, 2%-12%) for the postpandemic group (P = .04). The number of in-person physical therapy visits per patient was 25.8 ± 6.8 in the control group versus 24.4 ± 7.5 in the postpandemic group (P = .23). Only the postpandemic group accessed physical therapy using remote telemedicine. Each additional telehealth rehabilitation visit was associated with a 1-week delay in achieving >90% LSI in isokinetic quadriceps strength for the postpandemic group.

Conclusion: The COVID-19 pandemic was associated with a decrease in lower extremity strength and a lower probability of achieving limb symmetry and passing the criteria for return to sport at 1 year postoperatively. These results were not due to lack of access to physical therapy.

Keywords: ACL reconstruction; COVID-19; functional outcomes.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: G.S.B. has received consulting fees from Linvatec and Medical Device Business Services and nonconsulting fees from Linvatec. B.E.W. has received hospitality payments from Smith & Nephew and Stryker. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

Figure 1.
Figure 1.
Kaplan-Meier analysis of achieving (A) >90% LSI for isokinetic quadriceps testing and (B) the threshold for RTS. The solid line represents the mean value, and shaded areas represent 95% CIs. CI, confidence interval; LSI, limb symmetry index; RTS, return to sport.
Figure 2.
Figure 2.
(A) Histogram representation of the relative frequency of the total (in-person and RRVs) physical therapy visits between the control and postpandemic groups. (B) Histogram representation of the frequency of RRVs for the postpandemic group. RRV, remote rehabilitation visit.
See this image and copyright information in PMC

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