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; Anthony Zacharias; Elizabeth Chumanov; Geoffrey S Baer; Brian E Walczak

doi:10.1177/23259671241280982

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

Orthop J Sports Med. 2024 Oct 23;12(10):23259671241280982. doi: 10.1177/23259671241280982. eCollection 2024 Oct.

Authors

Quinn Steiner¹, Anthony Zacharias², Elizabeth Chumanov³, Geoffrey S Baer¹, Brian E Walczak^{4

5}

Affiliations

¹ Departments of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin, USA.
² Froedtert South, Pleasant Prairie, Wisconsin, USA.
³ University of Wisconsin Health Sciences, University of Wisconsin-Madison, Madison, Wisconsin, USA.
⁴ Castle Orthopedics and Sports Medicine, Rush Copley Medical Center, Rush University, Aurora, Illinois, USA.
⁵ Advancing Translational Orthopedics and Medical Sciences (ATOMS) Laboratory, Department of Orthopedics, University of Wisconsin-Madison, Madison, Wisconsin, USA.

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.