Reliability of the Subjective Evaluation of Patient Biomechanics and Motor Control During an Anterior Cruciate Ligament Return-to-Sport Assessment.

Abstract

Objective: To determine the inter- and intrarater reliability of physical therapists and athletic trainers to rate the subjective biomechanical and motor control risk factors exhibited by patients undergoing a structured postoperative anterior cruciate ligament (ACL) return-to-sport (RTS) assessment.

Design: Interrater and intrarater reliability.

Setting: University sports medicine clinic.

Patients: Thirty adult patients with ACL reconstruction who underwent a standardized ACL RTS assessment.

Intervention: Video data demonstrating the performance of the ACL RTS assessments were distributed to 4 skilled raters. The limb performance of each test was evaluated for hip/pelvic stability, knee flexion, varus/valgus, shock absorption, trunk stability, power, and body control on a 3-point scale. For each patient, the scores (1-3) for each subjective component were added to attain a total subjective score for each of the 17 tests.

Main outcome measures: Total scores for each of the tests were used to calculate interrater and intrarater reliability for all 4 raters.

Results: Most of the tests demonstrated substantial agreement across the 4 raters with interclass coefficients ranging from 0.61 to 0.77. The posteromedial and posterolateral components of the Y Balance test had lower coefficients (0.57-0.61). Although the leg press had near perfect agreement (0.81-0.86), hamstrings and hip abduction strength had moderate agreement (0.33-0.68).

Conclusions: This study has demonstrated the substantial agreement of a subjective rating system to evaluate the biomechanical and motor control risk patterns of patients after ACL reconstruction undergoing a standardized return-to-sport assessment. Multiple raters were able to substantially agree on the patients' risk profile across 14 of the 17 different tests of physical function. Further work is required to improve the interrater reliability of the Y balance test and hamstrings/hip strength evaluations.