Clinical Decision Algorithm Associated With Return to Sport After Anterior Cruciate Ligament Reconstruction

Abstract

Context Understanding the factors that predict return to sport (RTS) after anterior cruciate ligament reconstruction facilitates clinical decision making. Objective To develop a clinical decision algorithm that could predict RTS and non-RTS based on the differences in the variables after anterior cruciate ligament reconstruction. Design Cross-sectional study. Setting University laboratory. Patients or Other Participants A total of 150 athletes in any sport involving deceleration, jumping, cutting, or turning enrolled in the study. All participants answered the International Knee Documentation Committee and Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) questionnaires and performed balance and isokinetic tests. Main Outcome Measure(s) The classification and regression tree (CART) was used to determine the clinical decision algorithm associated with RTS at any level and RTS at the preinjury level. The diagnostic accuracy of the CART was verified. Results Of the 150 participants, 57.3% (n = 86) returned to sport at any level and 12% (n = 18) returned to sport at the preinjury level. The interactions among the peak torque extension at 300°/s >93.55 Nm, ACL-RSI score at >27.05 (P = .06), and postoperative time at >7.50 months were associated with RTS at any level identified by CART and were factors associated with RTS. An ACL-RSI score >72.85% was the main variable associated with RTS at the preinjury level. The interaction among an ACL-RSI score of 50.40% to 72.85%, agonist:antagonist ratio at 300°/s ≤63.6%, and anteroposterior stability index ≤2.4 in these participants was the second factor associated with RTS at the preinjury level. Conclusions Athletes who had more quadriceps strength tended to return to sport at any level more quickly. even with less-than-expected psychological readiness. Regarding a return at the preinjury level, psychological readiness was the most important factor in not returning, followed by a better agonist:antagonist ratio and better balance.

Arthroscopic Bankart Repair Versus Open Latarjet for Recurrent Shoulder Instability in Athletes

“…The SIRSI was adapted from the Anterior Cruciate Ligament–Return to Sport after Injury (ACL-RSI), in which several studies indicated a higher score in those who achieved full RTP. 1 , 3 , 27 , 32 Psychological recovery has shown to be an independent factor of a patient’s physical recovery, as the ACL-RSI score does not correlate with an athlete’s strength and power measures. 34 However, a higher ACL-RSI score may be predictive of further injury.…”

Arthroscopic Bankart Repair Versus Open Latarjet for First-Time Dislocators in Athletes

“…The SIRSI is an adaptation of the Anterior Cruciate Ligament-Return to Sport after Injury Scale (ACL-RSI), with several studies demonstrating a higher score in those who are able to successfully RTP. 1,3,24,29 Additionally, psychological recovery has been shown to be independent of a patient's physical recovery, as the ACL-RSI score does not correlate with athletes' strength and power measures. 31 However, a higher ACL-RSI score has been shown to be predictive of further injury.…”

Quantitative assessment of postural balance in patients with chronic anterior cruciate ligament injury- A controlled study

“…Moreover, assessment of balance dysfunction and appropriate remedial measures are critical in ACLD subjects. 29 The importance of psychological preparedness along with good postural balance and better agonist-antagonist ratio for return to sports are highlighted by Albano et al 30 If balance issues are not addressed during the rehabilitation phase, then, they might continue to persist and increase the risk of re-injury. 31 Limitations of the study: Remarkable gender difference between stydy and control group might have created a gender bias in this study.…”