ACL Return to Sport Testing: It’s Time to Step up Our Game

Unverzagt, Casey; Andreyo, Evan; Tompkins, Jeff

doi:10.26603/001c.25463

Cited by 13 publications

(5 citation statements)

References 39 publications

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“…Anatomic single-bundle footprint is the most common point for the femoral tunnel creation ( 35 ). One of the most controversial issues in this field is the comparison of clinical outcomes between anatomic single-bundle ACLR and anatomic double-bundle ACLR ( 36 ). Femoral tunnel shapes, including oval-shaped tunnels and rectangular ones, are relatively new research topics based on the theory that the ACL is connected to the femur with a ribbon-like attachment ( 37 ).…”

Section: Discussionmentioning

confidence: 99%

Global research status of anterior cruciate ligament reconstruction: a bibliometric analysis

Zhou

Zhang

et al. 2022

EFORT Open Reviews

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Purpose The aim of this study is to comprehensively analyze the publications of anterior cruciate ligament reconstruction (ACLR) research and display the current research status in this field. Methods Articles regarding ACLR research published before October 7, 2021, were downloaded from the Web of Science Core Collection. Excel 2016 and Bibliometric website were used to analyze the annual article trends and international cooperation network. CiteSpace V and VOSviewer were used to perform co-occurrence and citation analyses for journals, institutions, authors, cocitation authors and keywords. Burst keyword detection was also performed with CiteSpace V. Results A total of 12 223 ACLR articles were identified. The American Journal of Sports Medicine (1636 publications, 92,310 citations), the Pennsylvania Commonwealth System of Higher Education (624 publications, 25,304 citations) and Freddie H. Fu (321 publications, 15,245 citations) were journals, institutions and authors with the most publications and citations, respectively. Patellar tendon was the keyword with the most occurrences (1618 times) and return to sport was the keyword with the most burst strength (burst strength: 46.99). Conclusion ACLR-related publications showed a rapid increasing trend since 1990. A large number of articles have been published by authors from different institutions and countries, some of which have gained great academic influence. Based on keyword analysis, patellar tendon is identified as the research hotspot and return to sport is identified as the current research frontier.

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Section: Discussionmentioning

confidence: 99%

Global research status of anterior cruciate ligament reconstruction: a bibliometric analysis

Zhou

Zhang

et al. 2022

EFORT Open Reviews

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“…Even though 62 features were incorporated in the methodology, we did not meet the demand on incorporating the multiple aspects of RTS decision making such as range of motion/ exibility, neuromuscular control, agility and psychological readiness, cutting tasks, landing tasks. [43,44,45] Another limitation of the present study is that the participants' rehabilitation was neither supervised nor guided following standardized procedures like previous studies did. [46][47][48][49] Therefore, high inter-individual differences between athletes are plausible due to varying quantity and quality of rehabilitative measures.…”

Section: Limitations Andmentioning

confidence: 96%

Finding the needle in the haystack of isokinetic knee data: Random Forest modelling improves return-to-sport information

Nolte

Gerharz

Jaitner

et al. 2023

Preprint

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Background: The difficulties of rehabilitation after anterior cruciate ligament (ACL) injuries, subsequent return-to-sport (RTS) let alone achieving pre-injury performance are well known. Isokinetic testing is often used to assess strength capacities during that process. The aim of the present applied machine learning (ML) approach was to examine which isokinetic data differentiates athletes post ACL reconstruction and healthy controls. Data from unilateral concentric and eccentric knee flexor and extensor tests (30°/s, 150°/s) was used to train Random Forest models from 366 male (63 post ACL reconstruction) and 183 female (72 post ACL reconstruction) athletes. Via a cross validation predictive performance was evaluated and accumulated local effects plots analysed the features of the models. Results: Random Forest showed outstanding predictive performance for male (AUC=0.90, sensitivity=0.76, specificity=0.88) and female (AUC=0.92, sensitivity=0.85, specificity=0.89) athletes. For both male and female athletes, the ten most impactful features on the predictive likelihood of the model either referred to the disadvantageous (injured, non-dominant in control group) leg or to lateral differences. The eccentric hamstring work at 150°/s was identified as the most impactful single parameter. Conclusion: A ML model trained with parameters from isokinetic knee data discriminated between athletes 6 to 24 months post ACL reconstruction and healthy athletes with high accuracy. We see potential for improving RTS decision making by incorporating and combining measures, which focus on hamstring strength, leg symmetry and contractional work.

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“…28 In athletes recovering from lower extremity injuries, the passing of physical performance tests (e.g., hop testing, agility testing) has been found to be effective in decreasing reinjury. [29][30][31][32] However, current evidence on return to sport outcomes following upper extremity injury is comparatively lacking and limited to case series and clinical commentary. 23,33 It is possible that this lack of outcomes research on the utility of upper extremity physical performance tests may be attributed to a lack of clinical use.…”

Section: Introductionmentioning

confidence: 99%

Missing The Forest For The Trees: A Lack Of Upper Extremity Physical Performance Testing In Sports Physical Therapy

Gauthier

Unverzagt

Mendonça

et al. 2023

International Journal of Sports Physical Therapy

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Background Despite shoulder and elbow injuries being common in athletics, return to sport and reinjury rates are less than ideal. These outcomes may be driven by the absence of evidence-informed testing to determine an athlete’s readiness for sport. Purpose The purpose of this study was to explore the reported frequency of physical performance testing for return to sport readiness by physical therapists treating athletes with upper extremity injuries and to identify potential barriers that may limit use of these tests. A secondary aim was to compare practice patterns of clinicians with sports physical therapy specialty certification to clinicians without. Study Design International, cross-sectional survey using purposive sampling. Methods A survey instrument was created to assess the frequency of use of physical performance tests by physical therapists treating athletes with upper extremity injuries, as well as the barriers limiting the use of these tests. The 19-question online survey was distributed via email and Twitter among sports physical therapists. Independent t-tests and Chi Square analyses were conducted to determine differences in practice patterns between physical therapists with and without specialization and the frequency of potential barriers that may limit the use of these tests. Results Four hundred ninety-eight participants met study eligibility and completed the survey. Fewer than half of participants reported using any physical performance test in making return to sport decisions for athletes with upper extremity injuries. The greatest barriers to the use of physical performance tests were a lack of equipment followed by lack of understanding of the literature, lack of time, and lack of supporting literature. Sports specialist clinicians were significantly more likely (p<0.001) to use physical performance tests than non-specialist clinicians (71.6% versus 36.3%). Conclusion In this survey of physical therapists (n=498), the majority admit to not using physical performance tests when making return to sport decisions for athletes with upper extremity injuries regardless of specialization. Physical therapists have an opportunity to improve the utilization physical performance testing in the upper extremity athlete in hopes of reducing injury recurrence and enhance return to sport rates. Level of Evidence Level 3b

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ACL Return to Sport Testing: It’s Time to Step up Our Game

Cited by 13 publications

References 39 publications

Global research status of anterior cruciate ligament reconstruction: a bibliometric analysis

Global research status of anterior cruciate ligament reconstruction: a bibliometric analysis

Finding the needle in the haystack of isokinetic knee data: Random Forest modelling improves return-to-sport information

Missing The Forest For The Trees: A Lack Of Upper Extremity Physical Performance Testing In Sports Physical Therapy

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