Purpose -The purpose of this article is to present recommendations for new muscle strength and hop performance criteria prior to a return to sports after anterior cruciate ligament (ACL) reconstruction.Methods -A search was made of relevant literature relating to muscle function, self-reported questionnaires on symptoms, function and knee-related quality of life, as well as the rate of re-injury, the rate of return to sports and the development of osteoarthritis (OA) after ACL reconstruction. The literature was reviewed and discussed by the European Board of Sports Rehabilitation (EBSR) in order to reach consensus on criteria for muscle strength and hop performance prior to a return to sports.Results -The majority of athletes that sustain an (ACL) injury do not successfully return to their pre-injury sport, even though most athletes achieve what is considered to be acceptable muscle function. On self-reported questionnaires, the athletes report high ratings for fear of re-injury, low ratings for their knee function during sports and low ratings for their kneerelated quality of life.Conclusion -The conclusion is that the muscle function tests that are commonly used are not demanding enough or not sensitive enough to identify differences between injured and noninjured sides. Recommendations for new criteria are given for the sports medicine community to consider, before allowing an athlete to return to sports after an ACL reconstruction. Level of evidence: Level IV

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.

Study Design Narrative literature review. Objectives First, to explore the differences and outcomes between individuals who have had anterior cruciate ligament (ACL) reconstruction and those who did not undergo surgical intervention, following a tear of the ACL. Second, to review the evidence related to the ability to identify individuals who may or may not need surgery after an ACL rupture. Finally, to describe the differences between copers and noncopers. Background ACL rupture may result in increased tibiofemoral laxity and impaired neuromuscular function, which ultimately may lead to knee instability and dysfunction. Individuals who opt to choose surgery due to these changes may be defined as “noncopers.” Conversely, those individuals who have an ACL-deficient knee without functional impairment and instability and successfully resume preinjury activity levels without surgical intervention may be defined as “copers.” Methods An electronic search was conducted up to April 2011, using medical subject headings and free-text words. The subject-specific search was based on the terms “anterior cruciate ligament reconstruction versus conservative treatment,” “copers,” “noncopers.” Results A similar percentage of copers and noncopers return to sporting activity. Three papers used an algorithm and screening examination involving individuals with ACL injuries. Evidence suggests that, as opposed to copers, noncopers have deficits in quadriceps strength, vastus lateralis atrophy, quadriceps activation deficits, altered knee movement patterns, reduced knee flexion moment, and greater quadriceps/hamstring cocontraction. Conclusion ACL screening examination showed preliminary evidence for detecting potential copers. Objective differences exist between copers and noncopers. Individuals with ACL injury should be informed of the possibility of good knee function following a nonoperative rehabilitation program. J Orthop Sports Phys Ther 2011;41(10):758–766. doi:10.2519/jospt.2011.3384

Dette er siste tekst-versjon av artikkelen, og den kan inneholde små forskjeller fra forlagets pdf-versjon. Forlagets pdf-versjon finner du på journals.lww.com: http://dx.doi.org/10.1097/JSM.0b013e3182694870 This is the final text version of the article, and it may contain minor differences from the journal's pdf version. The original publication is available at journals.lww.com: http://dx.doi.org/10.1097/JSM.0b013e3182694870 Main Outcome Measures: All time-loss injuries sustained in game sessions were recorded by the off-the-field medical personnel and followed up by a more detailed phone injury surveillance questionnaire.Results: One hundred sixty-three injuries were reported, comprising 1 533 776 athletic exposures (AEs). The incidence rate was 0.11 [95% confidence interval (CI), 0.09-0.12] per 1000 AEs, and incidence proportion was 10.66% (95% CI, 9.10-12.22). Seventy-six percent of the injuries were extrinsic in nature. Thirty percent of the injuries were to the fingers, thumb, and wrist, 17% to the knee, 17% to the head/face, 13% to the ankle, and 11% to the shoulder.Conclusions: Contact flag football results in a significant amount of moderate to severe injuries. These data may be used in the development of a formal American flag football injury database and in the development and implementation of a high-quality, randomized, prospective injury prevention study. This study should include the enforcement of the nopocket rule, appropriate headgear, self-fitting mouth guards, the use of ankle braces, and changing the blocking rules of the game.

Dette er siste tekst-versjon av artikkelen, og den kan inneholde små forskjeller fra forlagets pdf-versjon. Forlagets pdf-versjon finner du på journals.lww.com: http://dx.doi.org/10.1097/JSM.0b013e3182694870 This is the final text version of the article, and it may contain minor differences from the journal's pdf version. The original publication is available at journals.lww.com: http://dx.doi.org/10.1097/JSM.0b013e3182694870 Main Outcome Measures: All time-loss injuries sustained in game sessions were recorded by the off-the-field medical personnel and followed up by a more detailed phone injury surveillance questionnaire.Results: One hundred sixty-three injuries were reported, comprising 1 533 776 athletic exposures (AEs). The incidence rate was 0.11 [95% confidence interval (CI), 0.09-0.12] per 1000 AEs, and incidence proportion was 10.66% (95% CI, 9.10-12.22). Seventy-six percent of the injuries were extrinsic in nature. Thirty percent of the injuries were to the fingers, thumb, and wrist, 17% to the knee, 17% to the head/face, 13% to the ankle, and 11% to the shoulder.Conclusions: Contact flag football results in a significant amount of moderate to severe injuries. These data may be used in the development of a formal American flag football injury database and in the development and implementation of a high-quality, randomized, prospective injury prevention study. This study should include the enforcement of the nopocket rule, appropriate headgear, self-fitting mouth guards, the use of ankle braces, and changing the blocking rules of the game.