Summary

COVID-19 related policy measures were associated with lower quadriceps strength and a lower probability of achieving the threshold for returning to sport-related functional activities after ACLR.

Abstract

Introduction

The coronavirus 2019 (COVID-19) pandemic resulted in policies that limited access to health care resources, including rehabilitation services following elective surgery. This study aimed to assess the impact of these COVID-19 measures on functional outcomes after anterior cruciate ligament reconstruction (ACLR).

Methods

Our institution shut down all in-person services in March 2020. Patients who underwent ACLR within the previous nine months (6/11/2019–3/11/2020) were defined as having their rehabilitation interrupted due to COVID-19 (COVID-I). Patients with ACLR done the year prior (6/11/2018-3/11/2019) were the comparative cohort. Multi-ligament reconstruction, physeal sparing ACLR, and lack of 1-year follow-up excluded patients. Dependent functional outcomes included: isokinetic quadriceps testing at 60 deg/sec and 240 deg/sec, vertical 4-hop, horizontal hop, and 4-cross-over hop distances. A linear mixed-effects regression model was used to estimate group differences for isokinetic quadriceps testing. A reverse Kaplan-Meier analysis assessed the probability of achieving >90% limb symmetry index (LSI) for all functional outcomes and isokinetic quadriceps strength at 60 deg/ at 1-year postoperative.

Results

A total of 176 patients, 80 Non-COVID patients and 96 COVID-I patients, were included. Twenty-nine patients (16.4%) were excluded. Baseline characteristics were similar between groups. The rate of achieving >90% LSI for all functional tests at 1-year postoperative was significantly less for COVID-I patients. Similarly, the rate of achieving an isokinetic strength at 60 deg/sec of >90% LSI at 1-year postoperative was significantly less for COVID-I patients. Controlling for postoperative time, sex, BMI, and age, patients in the Non-COVID group had a 2.96% (95% CI: -1.66 to 7.60) greater isokinetic quadriceps strength LSI at 60 deg/sec compared to the COVID-I group (p-value = 0.215). Similarly, patients in the Non-COVID group had a 4.69% (95%CI: 1.08 to 8.31) greater isokinetic quadriceps strength LSI at 240 deg/sec compared to the COVID-I group (p-value = 0.013).

Conclusion

COVID-19 related policy measures were associated with lower quadriceps strength and a lower probability of achieving the threshold for returning to sport-related functional activities after ACLR.