Article

Validate the use of the PPLP scoring scale in the follow-up of
athletes after anterior cruciate ligament (ACL) reconstruction. PATIENT AND METHOD: We conducted a prospective follow-up study on athletes with ACL
reconstruction during several time periods between 2003 and 2009, we analyzed the
score validity, its reproducibility, its responsiveness to change and its
relevance in the follow-up and monitoring of ACL reconstructive surgeries.
RESULTS: The PPLP scoring scale was defined for the monitoring of ACL
reconstruction in athletes. The PPLP tool is made of two parts: the first one
(PPLP1) with a total of 100 points for postoperative follow-up and the second one
also with a total of 100 points (PPLP2) adding up to the first score for
determining a final post-op monitoring score of 200 points. The PPLP2 scoring
scale is administered at a distance from the initial ACL reconstruction. For
construct validity, we showed the differences in items' characteristics
(coefficient r of 0.20 in 763 patients), and adequate correlation of the PPLP
score to other scoring scales found in the literature (OAK, Lysholm, Tegner, Knee
injury and Osteoarthritis Outcome Score [KOOS], Arpege, IKDC Subjective Knee
Evaluation Form and Psychovitality Test). The intra/interexaminer reproducibility
is excellent going from 0.92 to 1. The PPLP scoring scale shows a statistically
significant responsiveness to change during the hospital stay, according to the
postoperative delay but with great variations. Complicated clinical evolutions
(among 3296 ACL reconstructions with postoperative follow-up) are well identified
by a low PPLP score, mainly for complex regional pain syndrome Type 1 (CRPS1:
1.9%) with a mean PPLP1 score of 80.33 whereas uncomplicated clinical evolutions
(80.8%) have a mean score of 94.28 with a significant difference (p<0.0001). PPL2
scoring scale is significantly correlated to the possibility of getting back to
competition (p=0.012) and a high score is linked to a faster return to
competition (follow-up of 258 patients). The optimal threshold score is 176, and
not 170/200, as previously suggested. However, this score remains poorly
discriminating in regards to sensitivity (79.7%), specificity (49.3%) and the
percentage of athletes returning to competition 2.5 months after completing the
PPL2 scoring tool (37.9%). CONCLUSION: The PPLP scoring scale was validated in
the French language in terms of construct validity, reproducibility and
sensitivity. This scoring scale is used for the follow-up and monitoring of ACL
reconstruction in athletes, providing useful information on the quality of their
recovery particularly during the postoperative phase and the possibilities of
getting back to competition.
CI - Copyright 2010 Elsevier Masson SAS. All rights reserved.

Langue : ANGLAIS ; FRANCAIS