Laxity, instability, and functional outcome after ACL injury: copers versus noncopers

The purpose of this study was to determine the relationship among laxity, quadriceps strength, instability, and function in subjects with complete rupture of the anterior cruciate ligament (ACL) who compensate well for the injury (copers) and those who require surgical stabilization (noncopers).

Forty-five patients with unilateral ACL rupture (confirmed via arthroscopy or magnetic resonance imaging (MRI) and arthrometer measurements) participated in this study. Subjects were divided into two groups: copers (N = 12), and subacute noncopers (N = 18) and chronic noncopers (N = 15). All copers had returned to all preinjury activity (including index sport) without limitation. Maximum manual anterior tibiofemoral laxity measurements, quadriceps femoris muscle strength measurements, and a series of hop tests were performed. Lysholm Scale, Knee Outcome Survey (KOS), global rating of knee function, and the International Knee Documentation Committee (IKDC) form were completed.

There was no significant difference in laxity between copers (X = 5.5+/-2.7 mm) and noncopers (chronic, X = 5.1+/-2.8 mm and subacute, X = 4.2+/-2.2 mm) or in IKDC scores among the groups. The copers, however, scored significantly better than the chronic and subacute ACL-deficient subsets on all other measures. Measurements of laxity were not correlated to any functional outcome measure or to episodes of instability.

Copers were not different in any meaningful way from the noncopers before injury, had equal or greater side-to-side laxity differences, and functioned normally. A battery of tests was identified that accurately discriminated noncopers from copers even early after injury. Thus, measurements of laxity alone are insufficient for determining functional status after ACL injury.