scholarly journals Who Passes Return-to-Sport Tests, and Which Tests Are Most Strongly Associated With Return to Play After Anterior Cruciate Ligament Reconstruction?

2020 ◽  
Vol 8 (12) ◽  
pp. 232596712096942
Author(s):  
Kate E. Webster ◽  
Julian A. Feller
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Quadriceps Strength ◽  
Activity Level ◽  
Self Report ◽  
Return To Play ◽  
Functional Tests ◽  
Younger Patients ◽  
Anterior Cruciate

Background: Return-to-sport (RTS) testing after anterior cruciate ligament (ACL) reconstruction (ACLR) surgery has become popular. It has been recommended that such testing should incorporate several domains, or set of tests, but it is unclear which are most associated with a successful RTS. Purpose: To determine (1) the proportion of patients who can pass a set of self-report and functional tests at 6 months after ACLR; (2) age, sex, and activity level differences between patients who pass and those who do not; and (3) whether specific types of tests are associated with a return to competitive sport at 12 months. Study Design: Cohort study; Level of evidence, 2. Methods: This was a prospective longitudinal study of 450 patients who had primary ACLR. At 6 months postoperatively, patients completed 2 self-report measures, the International Knee Documentation Committee (IKDC) subjective knee form and ACL–Return to Sport after Injury (ACL-RSI) scale, and 3 functional measures: single hop and triple crossover hop for distance and isokinetic quadriceps strength. Limb symmetry index scores of ≥90 for functional tests, IKDC scores ≥85, and ACL-RSI scores ≥65 were considered indicators of satisfactory recovery. Proportional statistics and contingency analysis were used to determine associations between age, sex, preinjury sports level, and (1) meeting test thresholds and (2) RTS at 12 months. Results: Only 17 (3.8%) patients met all 5 test criteria at 6 months, and 95 (21%) patients did not pass any test. More of the younger patients (<21 years) passed all of the functional tests ( P < .01), and more male patients met the IKDC threshold ( P = .03). Patients who played level I sports before injury had the same pass rates as those who played level II/III sports. Patients who passed the thresholds for the ACL-RSI and IKDC scales had 4 and 3 times the odds, respectively, of RTS at 12 months (both P < .0001). Meeting the threshold for quadriceps strength or either of the hop tests at 6 months was not associated with RTS. Conclusion: At 6 months after ACLR, few patients met all of the thresholds of the common tests used to assess RTS ability, although younger patients had higher rates of passing the functional tests. Self-perceived symptoms/function and psychological readiness were associated with a return at 12 months.

scholarly journals When Is It Safe to Return to Sport After ACL Reconstruction? Reviewing the Criteria

2019 ◽  
Vol 11 (4) ◽  
pp. 301-305 ◽  
Author(s):  
Yonatan Kaplan ◽  
Erik Witvrouw
Keyword(s):  
Risk Factors ◽  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Return To Play ◽  
Free Text ◽  
Functional Tests ◽  
Medical Subject Headings ◽  
Level Of Evidence ◽  
Anterior Cruciate

Context: There is an ever-increasing trend toward sports, fitness, and recreation activities, so the incidence of anterior cruciate ligament sports injuries has increased. Perhaps the greatest challenge for sports clinicians is to return the injured athlete back to his/her original sport at an even greater level of functional ability than preinjury. For this, rigorous and well-researched criteria are needed. Evidence Acquisition: Using medical subject headings and free-text words, an electronic search was conducted up to October 2018. Subject-specific search was based on the terms return to play and return to sport in combination with guidelines, criteria, and anterior cruciate ligament reconstruction. Study Design: Descriptive review. Level of Evidence: Level 2. Results: Five principal criteria were found, including psychological factors, performance/functional tests, strength tests, time, and modifiable and nonmodifiable risk factors. Conclusion: The psychological readiness of the player is a major factor in successful safe return to sport (SRTS) decision making. Although strength, performance, and functional tests presently form the mainstay of SRTS criteria, there exists very little scientific evidence for their validity. More protection should be provided to athletes with known risk factors. Movement quality is important, if not more important than the quantifiable measures. As a result of the significantly high rerupture rate in young individuals, delayed SRTS should be considered preferably beyond 9 months postsurgery.

scholarly journals Energy Absorption Contribution and Strength in Female Athletes at Return to Sport After Anterior Cruciate Ligament Reconstruction: Comparison With Healthy Controls

2018 ◽  
Vol 6 (3) ◽  
pp. 232596711875952 ◽  
Author(s):  
Marie E. Boo ◽  
J. Craig Garrison ◽  
Joseph P. Hannon ◽  
Kalyssa M. Creed ◽  
Shiho Goto ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Energy Absorption ◽  
Cruciate Ligament ◽  
Vertical Jump ◽  
Return To Sport ◽  
Quadriceps Strength ◽  
Activity Level ◽  
Group Differences ◽  
Hip Abduction ◽  
Anterior Cruciate

Background: Female patients are more likely to suffer a second anterior cruciate ligament (ACL) injury after ACL reconstruction (ACLR) and return to sport (RTS) compared with healthy female controls. Few studies have examined the energy absorption contribution (EAC) that could lead to this subsequent injury. Hypothesis: The ACLR group would demonstrate an altered EAC between joints (hip, knee, and ankle) but no difference in quadriceps, hip abduction, or hip external rotation (ER) strength at the time of RTS. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 34 female participants (ACLR: n = 17; control: n = 17) were enrolled in the study and matched for age and activity level. Jump landing performance for the initial 50 milliseconds of landing of a lateral-vertical jump was assessed using a 10-camera 3-dimensional motion capture system and 2 force plates. Isokinetic quadriceps strength was measured using a Biodex machine, and hip abduction and ER isometric strength were measured using a handheld dynamometer. All values were normalized to the participant’s height and weight. A 1-way multivariate analysis of variance was used to assess between-group differences in the EAC at the hip, knee, and ankle. Two 1-way analyses of variance were used to independently examine quadriceps, hip abduction, and hip ER strength between the groups. Results: Significant differences in the EAC were found between the groups for the involved hip ( P = .002), uninvolved hip ( P = .005), and involved ankle ( P = .023). There were no between-group differences in the EAC for the involved or uninvolved knee or the uninvolved ankle. Patients who underwent ACLR demonstrated significantly decreased quadriceps strength on the involved limb ( P = .02) and decreased hip ER strength on both the involved ( P = .005) and uninvolved limbs ( P = .002). No significant strength differences were found between the groups for the uninvolved quadriceps or for involved or uninvolved hip abduction. Conclusion: At RTS, patients who underwent ACLR utilized a greater hip EAC bilaterally and a decreased involved ankle EAC during a lateral-vertical jump. Furthermore, quadriceps strength on the involved limb and hip ER strength of bilateral lower extremities remained decreased. This could place greater stress on the ACL graft and ultimately lead to an increased injury risk.

scholarly journals Who passes return to sport tests and which tests are most associated with a return to play after anterior cruciate ligament reconstruction?

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0036
Author(s):  
Kate Webster Julian Feller
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Quadriceps Strength ◽  
Self Report ◽  
Functional Tests ◽  
Reconstruction Surgery ◽  
Level I ◽  
Anterior Cruciate ◽  
And Function

Objectives: Although return to sport (RTS) testing has become popular following anterior cruciate ligament (ACL) reconstruction surgery, its utility is still questioned. The purpose of this study was to determine if there are age, sex and activity level differences between patients who pass a battery of self-report and functional tests at 6 months following surgery and to determine which tests are associated with a return to competition sport at 12 months. Methods: This was a prospective longitudinal study in which 450 patients who had undergone a primary ACL reconstruction were assessed at 6- and 12-months following surgery. Patients with a prior contralateral ACL injury, or who did not regularly participate in sport prior to injury were not included. There were 176 females and 274 males with a mean age of 25 (SD = 4) years. Six return to sport tests were conducted at 6 months and included two patient self-report measures: IKDC subjective knee form to measure symptoms and function and the ACL-RSI scale to measure psychological readiness to RTS; and four functional measures: single and triple hop for distance and isokinetic quadriceps strength measured at 60 and 180 deg/sec. Limb symmetry index scores of ≥90 for functional tests and IKDC scores of ≥85 and ACL-RSI scores ≥65 were considered indicators of satisfactory recovery. Proportional statistics and contingency analysis were used to determine associations between age (<21 vs. ≥21 years), sex, sport level (Level I vs. Levels II/III sports) and meeting test criteria and return to sport. Results: Only 13 (3%) patients met all 6 of the test criteria at 6 months following ACL reconstruction surgery and 83 (18%) patients did not pass any of the tests. A significantly greater proportion of younger patients passed all the functional tests (p<0.01). A greater proportion of males passed the IKDC threshold for symptoms and function (30% vs. 21% p=0.03) but there were no other sex differences. Patients who had played Level I sports before injury had the same pass rates as those who played Level II or III sports. Patients who passed the threshold for the IKDC and ACL-RSI scales had 4 (95% CI 3-6) times the odds of returning to competition sport at 12 months (p<0.0001). Conversely, meeting the threshold for either quadriceps strength test or either hop test at 6 months was not associated with a return to sport at 12 months. Conclusion: Few patients pass all the thresholds of common tests which are used to assess the ability to return to sport at 6 months following ACL reconstruction surgery although younger patients have higher rates of passing functional tests. This has implications for the utility of such testing and when patients should be cleared to return to sport. Patients may base their decision to return to sport on self-perceived symptoms and psychological readiness more than physical performance and muscle strength. These findings have implications for how return to sport testing may be used to facilitate a return to sport following this surgery.

scholarly journals Confidence to Return to Play After Anterior Cruciate Ligament Reconstruction Is Influenced by Quadriceps Strength Symmetry and Injury Mechanism

2021 ◽  
pp. 194173812097637
Author(s):  
Francesco Della Villa ◽  
Rachel K. Straub ◽  
Bert Mandelbaum ◽  
Christopher M. Powers
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Quadriceps Strength ◽  
Injury Mechanism ◽  
Return To Play ◽  
Cruciate Ligament Reconstruction ◽  
Anterior Cruciate

Background: Although the restoration of quadriceps strength symmetry is a primary rehabilitation goal after anterior cruciate ligament reconstruction (ACLR), little is known about the potential relationship between quadriceps strength symmetry and psychological readiness to return to play (RTP). Hypothesis: Quadriceps strength symmetry will be associated with psychological readiness to RTP after ACLR. Secondarily, injury mechanism will influence the association between quadriceps strength and psychological readiness to RTP. Study Design: Retrospective cohort. Level of Evidence: Level 3 (cohort study). Methods: A total of 78 female patients completed strength testing and the Injury–Psychological Readiness to Return to Sport (I-PRRS) scale at an outpatient clinical facility as part of return to sport testing after ACLR. Linear regression analysis was used to assess the relationship between the I-PRRS and the independent variables of interest (quadriceps strength symmetry and injury mechanism). Results: For all patients combined, a significant symmetry × mechanism interaction was found. When split by injury mechanism, a significant linear relationship was found between quadriceps strength symmetry and the I-PRRS score in patients who experienced a noncontact injury (n = 55; P = 0.01; R2 = 0.24). No such relationship was found for those who experienced a contact injury (n = 23; P = 0.97; R2 = 0.01). Conclusion: Greater quadriceps strength symmetry was associated with greater psychological readiness to RTP in female athletes after ACLR. This relationship, however, was present only in those who experienced a noncontact injury. Clinical Relevance: Clinicians should consider both the physical and the psychological factors in assessing a patient’s readiness to RTP. This may be particularly important for those who have experienced an ACL tear through a noncontact mechanism.

scholarly journals Clinical Outcome Measures and Return-to-Sport Timing in Adolescent Athletes After Anterior Cruciate Ligament Reconstruction

2018 ◽  
Vol 53 (5) ◽  
pp. 442-451 ◽  
Author(s):  
Julie P. Burland ◽  
Regina O. Kostyun ◽  
Kyle J. Kostyun ◽  
Matthew Solomito ◽  
Carl Nissen ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
International Knee Documentation Committee ◽  
Quadriceps Strength ◽  
Return To Play ◽  
Adolescent Athletes ◽  
Anterior Cruciate ◽  
Clinical Measures

Context: Multiple factors are likely associated with an adolescent athlete's ability to return to play after anterior cruciate ligament (ACL) reconstruction (ACLR).Objective: To investigate the relationship between self-reported and functional outcome measures on return-to-play timing in an adolescent population, in athletes who returned and those who did not return to sport, and to identify a cutoff value for isometric quadriceps strength that could serve as a clinical target for maximizing the odds of returning to play after ACLR.Design: Cross-sectional study.Setting: Outpatient clinic.Patients or Other Participants: Adolescent athletes who underwent ACLR and completed clinical measures at their 3- and 6-month follow-up appointments were included.Main Outcome Measure(s): Clinical measures included functional outcomes of isometric and isokinetic strength tests and the Anterior Cruciate Ligament Return to Sport After Injury scale and the pediatric version of the International Knee Documentation Committee subjective form. Physician clearance dates for return to play were obtained from patient records.Results: Higher strength measures were associated with better scores on the Anterior Cruciate Ligament Return to Sport After Injury and the pediatric version of the International Knee Documentation Committee instruments at each follow-up. Differences were found in isometric extension strength (P = .001) and isokinetic extension strength at 180°/s (P = .03) and 300°/s (P = .002) between patients who returned to sports and those who did not. A 6-month isometric extension deficit (mean Limb Symmetry Index = 85.48 ± 23.15) displayed high accuracy (area under the curve = 0.82, 95% confidence interval = 0.68, 0.95) for identifying patients who returned to play after ACLR.Conclusions: Higher strength measures at both 3 and 6 months after ACLR were associated with greater self-reported knee function and greater readiness to return to functional activities at 6 months and ultimately earlier return to sport in adolescent athletes. These results provide evidence that self-reported outcome scores should be used as an additional screening tool in conjunction with quadriceps strength testing to help provide realistic recovery timeframes for adolescent patients.

Altered Knee Laxity and Stiffness in Response to a Soccer Match Simulation in Players Returning to Sport Within 12 Months After Anterior Cruciate Ligament Reconstruction

2021 ◽  
pp. 036354652110130
Author(s):  
Stefano Nuccio ◽  
Luciana Labanca ◽  
Jacopo Emanuele Rocchi ◽  
Pier Paolo Mariani ◽  
Paola Sbriccoli ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Knee Laxity ◽  
Activity Level ◽  
Soccer Players ◽  
Control Group ◽  
Soccer Match ◽  
Anterior Cruciate ◽  
Anterior Knee

Background: The acute effects of exercise on anterior knee laxity (AKL) and anterior knee stiffness (AKS) have been documented in healthy participants, but only limited evidence has been provided for athletes cleared to return to sports after anterior cruciate ligament (ACL) reconstruction (ACLR). Purpose/Hypothesis: The purpose was to determine if 45 minutes of a soccer match simulation lead to acute changes in AKL and AKS in soccer players returning to sport within 12 months after ACLR. We hypothesized that the reconstructed knee of the ACLR group would exhibit an altered response to sport-specific exercise. Study Design: Controlled laboratory study. Methods: A total of 13 soccer players cleared to return to sport after ACLR and 13 healthy control soccer players matched for age, physical activity level, limb dominance, and anthropometric characteristics were recruited. To assess the effects of a standardized soccer match simulation (Soccer Aerobic Field Test [SAFT45]) on AKL and AKS, an arthrometric evaluation was carried out bilaterally before and immediately after SAFT45. To conduct a comprehensive examination of the force-displacement curve, the absolute and side-to-side difference (SSD) values of both AKL and AKS were extracted at 67, 134, and 200 N. Results: The ACLR and control groups showed similar AKL and AKS at baseline ( P > .05). In response to SAFT45, laxity increased bilaterally at all force levels by 14% to 17% only in the control group ( P < .025). Similarly, AKS at 134 and 200 N decreased in response to SAFT45 only in the control group (10.5% and 20.5%, respectively; P < .025). After SAFT45, the ACLR group had 1.9 and 2.5 times higher SSDs of AKS at 67 and 134 N compared with the control group, respectively ( P < .025), as well as a 1.9 times higher SSD of AKS at 134 N compared with baseline ( P = .014). Conclusion: Soccer players at the time of return to sport after ACLR showed an altered mechanical response to a sport-specific match simulation consisting of bilaterally unchanged AKL and AKS. Clinical Relevance: Soccer players showing altered AKL and AKS in response to exercise after ACLR may not be ready to sustain their preinjury levels of sport, thus potentially increasing the risk of second ACL injuries.

scholarly journals The hybrid anterior cruciate ligament reconstruction surgical technique does permit an accelerated early functional recovery and return to sport.

2017 ◽  
Vol 5 (5_suppl5) ◽  
pp. 2325967117S0017
Author(s):  
Peter Annear ◽  
Ebert Jay
Keyword(s):  
Anterior Cruciate Ligament ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Quadriceps Strength ◽  
Hamstring Graft ◽  
Cruciate Ligament Reconstruction ◽  
Hop Tests ◽  
Anterior Cruciate ◽  
Tegner Score

Objectives: A major reason for undergoing anterior cruciate ligament reconstruction (ACLR) for patients is to return to high demand activity and sport. Published literature supports a return to sport (RTS) at 6-12 months, though the recovery of lower limb strength and functional symmetry is critical and is linked with a patient’s ability to RTS, as well as reducing the incidence of secondary re-tear. This study aimed to compare clinical outcomes and RTS between patients undergoing ACLR utilizing a hamstring graft and those undergoing a hybrid technique which augments the hamstring graft with a synthetic LARS ligament. Methods: A non-randomized study design was used to compare clinical outcomes at 10-12 months post-surgery, in 82 patients undergoing conventional ACLR via a hamstring graft (HG) and 35 patients undergoing a hybrid hamstring/LARS graft (HLG). All patients were assessed using a range of patient-reported outcome (PRO) scores (IKDC, KOOS, Cinncinati, Lysholm, SF-36, Tegner, Noyes, Global Rating of Change – GRC). Limb symmetry indices (LSIs) presenting the operated limb as a percentage of the unaffected limb were calculated for several strength/functional assessments (peak isokinetic quadriceps and hamstring strength, the single, triple and triple crossover hop for distance, and the 6 m timed hop). Results: There were no group differences (p>0.05) in patient demographics and the majority of PROs. The HLG group perceived themselves to be significantly ‘more recovered’ (p=0.046) on the GRC scale (HLG = 3.2, HG = 2.2), and also reported a significantly greater (p=0.004) Tegner score (HLG = 7.2, HG = 5.9). For the HG group, 62% of patients had returned to Noyes Level 1 or 2 activities, versus 80% of the HLG group. For the Tegner score, 57% of patients reported a score >6, versus 77% of the HLG group. There were no significant differences (p>0.05) in LSIs between groups for the strength and functional hop tests. However, the HLG group demonstrated a mean LSI above 90% for all four hop tests, while all four were below 90% in the HG group. Both groups demonstrated mean hamstring strength LSIs above 90%, while the quadriceps strength LSI was 81.9% and 85.8% for the HG and HLG groups, respectively. Conclusion: Patients in the HLG group perceived themselves to be more recovered, and had returned to a higher level of activity/sport, compared with the HG group. While not significant, the HLG group did demonstrate more favorable functional hop and quadriceps strength LSIs, which has been linked with the ability to RTS and the incidence of ACL re-tear. A larger patient cohort and follow-up is required to observe long-term outcomes.

scholarly journals Bioaugmentation in the surgical treatment of anterior cruciate ligament injuries: A review of current concepts and emerging techniques

2020 ◽  
Vol 8 ◽  
pp. 205031212092105
Author(s):  
Austin MacFarland Looney ◽  
Joseph Daniel Leider ◽  
Andrew Ryan Horn ◽  
Blake Michael Bodendorfer
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Return To Play ◽  
Cruciate Ligament Reconstruction ◽  
Anterior Cruciate Ligament Injuries ◽  
Anterior Cruciate Ligament Repair ◽  
Anterior Cruciate

Injuries involving the anterior cruciate ligament are among the most common athletic injuries, and are the most common involving the knee. The anterior cruciate ligament is a key translational and rotational stabilizer of the knee joint during pivoting and cutting activities. Traditionally, surgical intervention in the form of anterior cruciate ligament reconstruction has been recommended for those who sustain an anterior cruciate ligament rupture and wish to remain active and return to sport. The intra-articular environment of the anterior cruciate ligament makes achieving successful healing following repair challenging. Historically, results following repair were poor, and anterior cruciate ligament reconstruction emerged as the gold-standard for treatment. While earlier literature reported high rates of return to play, the results of more recent studies with longer follow-up have suggested that anterior cruciate ligament reconstruction may not be as successful as once thought: fewer athletes are able to return to sport at their preinjury level, and many still go on to develop osteoarthritis of the knee at a relatively younger age. The four principles of tissue engineering (cells, growth factors, scaffolds, and mechanical stimuli) combined in various methods of bioaugmentation have been increasingly explored in an effort to improve outcomes following surgical treatment of anterior cruciate ligament injuries. Newer technologies have also led to the re-emergence of anterior cruciate ligament repair as an option for select patients. The different biological challenges associated with anterior cruciate ligament repair and reconstruction each present unique opportunities for targeted bioaugmentation strategies that may eventually lead to better outcomes with better return-to-play rates and fewer revisions.

scholarly journals The effectiveness of preoperative rehabilitation programmes on postoperative outcomes following anterior cruciate ligament (ACL) reconstruction: a systematic review

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Hayley M. Carter ◽  
Chris Littlewood ◽  
Kate E. Webster ◽  
Benjamin E. Smith
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Quadriceps Strength ◽  
Psychological Outcomes ◽  
Risk Of Bias ◽  
Assessment System ◽  
Trial Registration ◽  
Perturbation Training ◽  
Anterior Cruciate

Abstract Background To explore the effectiveness of preoperative rehabilitation programmes (PreHab) on postoperative physical and psychological outcomes following anterior cruciate ligament reconstruction (ACLR). Method A systematic search was conducted from inception to November 2019. Randomised controlled trials (RCTs) published in English were included. Risk of bias was assessed using Version 2 of the Cochrane risk-of-bias tool, and the Grading of Recommendations Assessment system was used to evaluate the quality of evidence. Results The search identified 739 potentially eligible studies, three met the inclusion criteria. All included RCTs scored ‘high’ risk of bias. PreHab in all three RCTs was an exercise programme, each varied in content (strength, control, balance and perturbation training), frequency (10 to 24 sessions) and length (3.1- to 6-weeks). Statistically significant differences (p < 0.05) were reported for quadriceps strength (one RCT) and single leg hop scores (two RCTs) in favour of PreHab three months after ACLR, compared to no PreHab. One RCT reported no statistically significant between-group difference for pain and function. No RCT evaluated post-operative psychological outcomes. Conclusion Very low quality evidence suggests that PreHab that includes muscular strength, balance and perturbation training offers a small benefit to quadriceps strength and single leg hop scores three months after ACLR compared with no PreHab. There is no consensus on the optimum PreHab programme content, frequency and length. Further research is needed to develop PreHab programmes that consider psychosocial factors and the measurement of relevant post-operative outcomes such as psychological readiness and return to sport. Trial registration PROSPERO trial registration number. CRD42020162754.

Sign in / Sign up

Export Citation Format

Share Document