Functional assessments for decision-making regarding return to sports following ACL reconstruction. Part I: development of a new test battery

Objectives: Second ACL injuries (defined as a graft rupture or contralateral ACL rupture) are common after ACL reconstruction. It is postulated that this observation could reflect a premature attempt to return to sports (RTS) and that delaying RTS until certain quality indicators or rehabilitation milestones are met could reduce the risk. There is consequently considerable interest in the application of RTS criteria. Multiple authors have reported that patients who passed a battery of tests prior to RTS, had a lower risk of re-injury and an increased rate of return to sport. However, factors influencing RTS scores have not been well studied. Therefore, the aim of this study was to determine the key factors that influence RTS test scores. Methods: A retrospective analysis of consecutive patients who underwent primary ACL reconstruction between March 2016 and May 2017, who also had a documented RTS evaluation with K-STARTS, (a validated, composite psychological and functional RTS test battery (Fig 1)) at 6 months following surgery, was undertaken. All patients underwent the same standardized rehabilitation program (Table 1) but in addition to this they were offered the opportunity to participate in a separate individualized RTS program (Table 2). If patients chose to participate in the RTS program, this would occur in addition to the standard program and not instead of it. The first session would typically occur 3 months post-operatively and comprised of ten sessions that took place over a 12-week period. Demographic data and characteristics including the frequency of pre-injury sports participation, Tegner score, time from injury to surgery, graft type, the presence of meniscal lesions, whether a lateral tenodesis was performed, and whether patients participated in the specific RTS program in addition to physiotherapy were recorded. To identify factors influencing the K-STARTS score at six months postoperatively, an analysis of variances was performed. When a significant effect was found, post hoc comparisons were made using Tukey’s HSD tests with Bonferroni’s correction. Results: 676 patients were included in the study. Outcomes of the analysis of the influence of factors on the K-STARTS score is comprehensively presented in Table 3. The K-STARTS score was significantly higher in males than females (13.9 vs 12.4, p<0.001), in younger patients (those aged less than 30 vs older patients, 14.2 vs 12, p<0.001), ACL reconstructions performed with hamstring tendon autografts compared to bone-patellar tendon-bone (13.5 vs 13.1, p=0.03) and in those who completed a specific RTS program in addition to standard rehabilitation, compared to those who did not participate (17.1 vs 13.1, p<0.001). However, the only factor that significantly influenced the K-STARTS score beyond the minimal detectable change threshold (previously determined to be 3.3 points) was the completion of the additional RTS program. The pre-injury frequency of sports participation, whether the dominant limb was injured, time from injury to surgery, the presence of associated meniscal injuries and whether a lateral tenodesis was performed, did not significantly influence the K-STARTS score. Conclusions: Completion of a specific return to sports program, in addition to standard rehabilitation, was the most important factor influencing the K-STARTS composite functional and psychological return to sports test score at 6 months after ACL reconstruction.

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Development of a test battery to enhance decision making in return to sports after anterior cruciate ligament reconstruction

Sports Orthopaedics and Traumatology ◽

10.1016/j.orthtr.2016.03.011 ◽

2016 ◽

Vol 32 (2) ◽

pp. 195-196 ◽

Cited By ~ 1

Author(s):

A. Gokeler ◽

W. Welling ◽

S. Zaffagnini ◽

R. Seil ◽

D. Padua

Keyword(s):

Decision Making ◽

Anterior Cruciate Ligament ◽

Anterior Cruciate Ligament Reconstruction ◽

Ligament Reconstruction ◽

Cruciate Ligament ◽

Test Battery ◽

Return To Sports ◽

Cruciate Ligament Reconstruction ◽

Anterior Cruciate

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Return to sports following ACL reconstruction: where do we stand in 2020?

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00551 ◽

2020 ◽

Vol 8 (9_suppl7) ◽

pp. 2325967120S0055

Author(s):

Alli Gokeler ◽

Francesco Della Villa ◽

Wouter Welling ◽

Jochen Baumeister

Keyword(s):

Decision Making ◽

Acl Reconstruction ◽

Clinical Decision Making ◽

Meta Analysis ◽

Single Point ◽

Sport Activity ◽

Return To Sport ◽

Relevant Information ◽

Return To Sports ◽

And Training

Despite the development of return to sport (RTS) guidelines over recent years, there is a lack of a scientific consensus on the RTS criteria used to release a patient to unrestricted sport activity after ACL reconstruction (ACLR). A proportional meta-analysis, showed that only 23% of patients after ACLR passed RTS test batteries before RTS. Although passing RTS criteria reduce the risk of subsequent graft rupture by 60%, it increases the risk of a contralateral ACL rupture by 235%. These equivocal findings in terms of validity of RTS tests after ACLR leaves clinicians with high level of uncertainty in clinical decision-making. Dingenen & Gokeler proposed that RTS should be viewed as continuum after ACL injury and ACLR. Moreover, one of the possible solutions why patients do not meet the RTS criteria is simply due to the lack of implementation of evidence- based rehabilitation in terms of specificity and training load. Too often, the end phase of the rehabilitation is not extensive or specific enough, thereby exposing athletes to specific training loads and training characteristics that they cannot handle from a physical, neurocognitive as well as from a psychological perspective. Della Villa et al. introduced the concept of an On Field Rehabilitation (OFR) model to bridge the gap between standard rehabilitation and return to training. This allows for a gradual progression of each part and thus ensures correct function and that no adverse knee reaction is noted before moving on to the next level. Returning an athlete to full participation should be a graduated continuum and not based on a set of tests at one single point in time. The above findings pertaining to the high incidence of recurrent injuries, question whether the current RTS tests provide relevant information for guiding the decision making. There is a need for more ecological valid research approaches to test an athlete returning to sports after an ACLR in more complex sports-specific demanding tests, which are more reflective of the demands while on the field. Based on a RTS continuum approach, training and tests should include physical, cognitive and psychological loads in a gradual fashion that prepare the athlete for a safer RTS

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Using a multidisciplinary approach to reveal decision-making capacity within acute care for an individual with aphasia

SAGE Open Medical Case Reports ◽

10.1177/2050313x211027098 ◽

2021 ◽

Vol 9 ◽

pp. 2050313X2110270

Author(s):

Ruth Maxwell ◽

Michelle O’Brien ◽

Deirdre O’Donnell ◽

Lauren Christophers ◽

Thilo Kroll

Keyword(s):

Decision Making ◽

Multidisciplinary Team ◽

Team Approach ◽

Term Care ◽

Multidisciplinary Team Approach ◽

Decision Making Capacity ◽

Health And Social Care ◽

Functional Assessments ◽

Health Nursing ◽

Communication Approach

Formal assessments of cognition that rely on language may conceal the non-linguistic cognitive function of people with aphasia. This may have detrimental consequences for how people with aphasia are supported to reveal communicative and decision-making competence. This case report demonstrates a multidisciplinary team approach to supporting the health and social care decision-making of people with aphasia. The case is a 67-year-old woman with Wernicke’s type aphasia. As the issue of long-term care arose, the speech and language therapist used a supported communication approach with the patient who expressed her wish to go home. A multidisciplinary team functional assessment of capacity was undertaken which involved functional assessments and observations of everyday tasks by allied health, nursing, catering and medical staff. In this way, the patient’s decision-making capacity was revealed and she was discharged home. A collaborative multidisciplinary team approach using supported communication and functional capacity assessments may be essential for scaffolding the decision-making capacity of people with aphasia.

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Limited evidence for return to sport testing after ACL reconstruction in children and adolescents under 16 years: a scoping review

Journal of Experimental Orthopaedics ◽

10.1186/s40634-020-00298-8 ◽

2020 ◽

Vol 7 (1) ◽

Author(s):

Martijn Dietvorst ◽

Maarten H. Brzoskowski ◽

Marieke van der Steen ◽

Eugenie Delvaux ◽

Rob P. A. Janssen ◽

...

Keyword(s):

Children And Adolescents ◽

Acl Reconstruction ◽

Scoping Review ◽

Return To Sport ◽

Test Battery ◽

Ligament Injury ◽

Future Research ◽

Movement Quality ◽

Patient Reported ◽

Strength Tests

Abstract Specific return to sport criteria for children and adolescents after anterior cruciate ligament injury and reconstruction are unknown. The aim of this scoping review is to provide an overview of current tests regarding return to sport for children and adolescents. This scoping review was performed according to the PRISMA statement. A systematic search was performed on PubMed and EMBASE. The inclusion criteria were diagnostic and prognostic studies evaluating tests regarding return to sport after ACL injury and reconstruction in children/adolescents (age < 18 years). Twenty-six studies were included, of which 22 studies evaluated tests in the age category of 16 to 18 years. All studies evaluated tests after ACL reconstruction, no studies have been conducted in non-operative patients. Strength tests, movement quality and patient reported outcomes measures (PROMs) are investigated most frequently. Clearance for return to sport should be based on a test battery including strength tests, movement quality during sport-specific tasks and (paediatric) patient reported outcome measures. There are no recommendations on which specific tests regarding quantity and quality of movement should be used. Future research should aim at at developing and validating a test battery including movement quality and neuromotor control in a sport-specific context for both younger children and adolescents after both operative and non-operative treatment.

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HOP TEST AS A TOOL FOR THE ASSESSMENT AND PREVENTION OF INJURIES IN FOOTBALLERS DURING PRESEASON

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118s00044 ◽

2018 ◽

Vol 6 (6_suppl3) ◽

pp. 2325967118S0004

Author(s):

F García-Bol ◽

V Posada-Franco ◽

A Roldán-Valero ◽

R Del Caño-Espinel

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Reference Values ◽

Cruciate Ligament ◽

Return To Sport ◽

Performance Criteria ◽

Return To Sports ◽

Hop Tests ◽

Hop Test ◽

Anterior Cruciate

Hop Tests (unipodal horizontal jumps) have been recommended as one of the reliable assessment tests when allowing a return to competition for a sportsperson after an anterior cruciate ligament injury1,2,3,4. Currently, comparison is made of the results with the contralateral limb through the symmetry index, a method which might not provide sufficient security upon the return to competitive sport5. Hop tests can be used in preseason to gain reference values prior to a possible injury. The objective of this review is to analise the scientific literature such as the F-Marc6 (reference manual of FIFA) to confirm whether include said tests in preseason for football teams. A search was conducted in the Pubmed y Cochrane databases (17/04/17) with the search terms “Hop Test”, “Football”, “Soccer”, and “Preseason”. Articles in English and Spanish were both accepted. Articles excluded were those that did not make reference to the knee, to football, and those that did not conduct tests during preseason. From a total of 33 articles, 4 with these search criteria were included, 5 articles were added trough the bibliography of other studies, and the F-Marc manual was analised. 4 of the articles used the hop tests in preseason for some type of study, of which 3 were used as part of a prospective assessment for the season. On the other hand, the F-Marc does not consider Hop Tests as an assessment test. Hop tests were not found to be used in preseason as reference values prior to possible future injuries, data which could be beneficial for a safe return to sport. Harris J, Abrams G, Bach B, Williams D, Heidloff D, Bush-Joseph C, Verma N, Forsythe B, Cole B. Return to Sport After ACL Reconstruction. ORTHOPEDICS. 2014; 37: e103-e108. Barber-Westin SD, Noyes FR. Factors used to determine return to unrestricted sports activities after anterior cruciate ligament reconstruction. Arthroscopy. 2011 Dec;27(12):1697-705. Thomeé R, Kaplan Y, Kvist J, Myklebust G, Risberg MA, Theisen D, Tsepis E, Werner S, Wondrasch B, Witvrouw E. Muscle strength and hop performance criteria prior to return to sports after ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. 2011 Nov;19(11):1798-805. Bolgla LA, Keskula DR. Reliability of lower extremity functional performance tests. J Orthop Sports Phys Ther. 1997 Sep;26(3):138-42. Wellsandt E, Failla MJ, Snyder-Mackler L. Limb Symmetry Indexes Can Overestimate Knee Function After Anterior Cruciate Ligament Injury. J Orthop Sports Phys Ther. 2017 Mar 29:1-18. F-MARC. Football Medicine Manual. 2nd Edition. Available from: http://f-marc.com . 2017.

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