Development of a test battery to enhance safe return to sports after anterior cruciate ligament reconstruction.

  • Sports Medicine Research Laboratory
January 01, 2017 By:
  • Gokeler A
  • Welling W
  • Zaffagnini S
  • Seil R
  • Padua D.

PURPOSE: There is a lack of consensus regarding the appropriate criteria for releasing patients to return to sports (RTS) after anterior cruciate ligament reconstruction (ACLR). A test battery was developed to support decision-making. METHODS: Twenty-eight patients (22 males and 6 females) with a mean age of 25.4 +/- 8.2 years participated and were 6.5 +/- 1.0 months post-ACLR. All patients followed the same rehabilitation protocol. The test battery used consisted of the following: isokinetic test, 3 hop tests and the jump-landing task assessed with the LESS. The isokinetic tests and single-leg hop tests were expressed as a LSI (involved limb/uninvolved limb x 100 %). In addition, patients filled out the IKDC and ACL-Return to Sport after Injury (ACL-RSI) scale. RTS criteria to pass were defined as a LSI > 90 % on isokinetic and hop tests, LESS < 5, ACL-RSI > 56 and a IKDC within 15th percentile of healthy subjects. RESULTS: Two out of 28 patients passed all criteria of the test protocol. The pass criterion for the LESS < 5 was reached by 67.9 % of all patients. For the hop tests, 78.5 % of patients passed LSI > 90 % for SLH, 85.7 % for TLH and 50 % for the SH. For the isokinetic test, 39.3 % of patients passed criteria for LSI peak torque quadriceps at 60 degrees /s, 46.4 % at 180 degrees /s and 42.9 at 300 degrees /s. In total, 35.7 % of the patients passed criterion for the peak torque at 60 degrees /s normalized to BW (>3.0 Nm) for the involved limb. The H/Q ratio at 300 degrees /s > 55 % for females was achieved by 4 out of 6 female patients, and the >62.5 % criterion for males was achieved by 75 %. At 6 months post-ACLR, 85.7 % of the patients passed the IKDC score and 75 % the ACL-RSI score >56 criteria. CONCLUSION: The evidence emerging from this study suggests that the majority of patients who are 6 months after ACLR require additional rehabilitation to pass RTS criteria. The RTS battery described in this study may serve as a framework for future studies to implement multivariate models in order to optimize the decision-making regarding RTS after ACLR with the aim to reduce incidence of second ACL injuries. LEVEL OF EVIDENCE: III.

2017 Jan. Knee Surg Sports Traumatol Arthrosc.25(1):192-199. Epub 2016 Jul 16.
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