Current criteria for return to play after anterior cruciate ligament reconstruction: an evidence-based literature review

Flagg, Kala Y.; Karavatas, Spiridon G.; Thompson, Sam; Bennett, Craig

doi:10.21037/atm.2019.08.23

Cited by 27 publications

(30 citation statements)

References 11 publications

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“… 2 , 8 , 11 , 16 , 18 , 40 , 41 The above-noted findings indicate that patients are receiving the majority of their PT in the early postoperative period after ACLR, when the primary goals of rehabilitation include increasing range of motion, decreasing knee effusion, and quadriceps activation exercises. 2 , 17 , 30 , 39 Based on typical rehabilitation guidelines, and data from previous studies 2 , 12 , 41 detailing rehabilitation after ACLR, this distribution of PT visits suggests that later-stage therapy goals (sports-specific training) may not be sufficiently addressed.…”

Section: Discussionmentioning

confidence: 99%

“… 19 , 36 However, with improved understanding of the entire biological and biomechanical recovery process after ACLR, this critical return-to-sport timepoint has been questioned. 12 Recently, the time to return to unrestricted sport has been proposed to take much longer, with times ranging from 9 months 16 to 2 years. 5 , 9 …”

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confidence: 99%

“…The early phase of rehabilitation aims to aid in the recovery from the impairments of surgery, namely, reducing pain and effusion while restoring range of motion and quadriceps activation. 12 The middle phase of rehabilitation focuses on the restoration of function of the lower extremity, including strengthening and balance exercises, with the inclusion of sport-specific exercises when appropriate. 2 , 12 , 34 , 40 , 41 Finally, the late phase involves neuromuscular training and optimization of movement patterns and strength, with the goal of minimizing the risk of reinjury upon return to Level I activities.…”

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confidence: 99%

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Temporal Utilization of Physical Therapy Visits After Anterior Cruciate Ligament Reconstruction

Burroughs

Kahan

Moore

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Physical therapy (PT) rehabilitation is critical to successful outcomes after anterior cruciate ligament reconstruction (ACLR). Later-stage rehabilitation, including sport-specific exercises, is increasingly recognized for restoring high-level knee function. However, supervised PT visits have historically been concentrated during the early stages of recovery after ACLR. Purpose/Hypothesis: To assess the number and temporal utilization of PT visits after ACLR in a national cohort. We hypothesized that PT visits would be concentrated early in the postoperative period. Study Design: Descriptive epidemiological study. Methods: The Humana PearlDiver database was searched to identify patients who underwent ACLR between 2007 and 2017. Patients with additional structures treated were excluded. The mean ± SD, median and interquartile range (IQR), and range of number of PT visits for each patient were determined for the 52 weeks after ACLR. PT visits over time were also assessed in relation to patient age and sex. Results: In total, 11,518 patients who underwent ACLR met the inclusion criteria; the mean age was 32.62 ± 13.70 years, and 42.7% were female patients. Of this study cohort, 10,381 (90.4%) had documented PT postoperatively; the range of PT visits was 0 to 121. On average, patients had 16.90 ± 10.60 PT visits (median [IQR], 16 [9-22]) after ACLR. Patients completed a mean of 52% of their PT visits in the first 6 weeks, 75% in the first 10 weeks, and 90% in the first 16 weeks after surgery. Patients aged 10 to 19 years had the highest number of PT visits (mean ± SD, 19.67 ± 12.09; median [IQR], 18 [12-25]), significantly greater than other age groups ( P < .001). Conclusion: PT after ACLR is concentrated in the early postoperative period. Physicians, therapists, and patients may consider adjusting the limited access to PT to optimize patient recovery. Clinical Relevance: As supervised PT visits may be limited, the appropriate temporal utilization of supervised PT visits must be maximized. Strategies to ensure sessions for later neuromuscular and activity-specific rehabilitation are needed.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Temporal Utilization of Physical Therapy Visits After Anterior Cruciate Ligament Reconstruction

Burroughs

Kahan

Moore

et al. 2021

Orthopaedic Journal of Sports Medicine

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“…An advantage of the MuscleBoard ® compared to other recently introduced portable, externally fixed dynamometers, is its ability to measure the strength of knee extensors and plantarflexors. Specifically, knee extension strength has been repeatedly shown to be essential in monitoring the rehabilitation process following anterior cruciate ligament reconstruction [28,29], while plantarflexor strength is associated with mid-portion Achilles tendinopathy [30]. The current study showed moderate to high intra-and inter-session reliability of testing strength of these muscle groups, suggesting that MuscleBoard ® has the potential to be used in clinical settings related to knee and Achilles tendon injuries.…”

Section: Discussionmentioning

confidence: 55%

Reliability of a New Portable Dynamometer for Assessing Hip and Lower Limb Strength

2021

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The purpose of this study was to evaluate intra- and inter-session reliability of the new, portable, and externally fixated dynamometer called MuscleBoard® for assessing the strength of hip and lower limb muscles. Hip abduction, adduction, flexion, extension, internal and external rotation, knee extension, ankle plantarflexion, and Nordic hamstring exercise strength were measured in three sessions (three sets of three repetitions for each test) on 24 healthy and recreationally active participants. Average and maximal value of normalized peak torque (Nm/kg) from three repetitions in each set and agonist:antagonist ratios (%) were statistically analyzed; the coefficient of variation and intra-class correlation coefficient (ICC2,k) were calculated to assess absolute and relative reliability, respectively. Overall, the results display high to excellent intra- and inter-session reliability with low to acceptable within-individual variation for average and maximal peak torques in all bilateral strength tests, while the reliability of unilateral strength tests was moderate to good. Our findings indicate that using the MuscleBoard® dynamometer can be a reliable device for assessing and monitoring bilateral and certain unilateral hip and lower limb muscle strength, while some unilateral strength tests require some refinement and more extensive familiarization.

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“…If the involved knee is the back, we suggest tee hitting may initiated at 17 weeks after ACL reconstruction. sisting of quadriceps strength, series of functional hop tests, and subjective reported outcome measures are used with a cutoff of 90 % symmetry between limbs to indicate readiness to RTP [14][15][16]. Despite the variability in sports and levels of activity athletes are returning to, there are few sport specific testing measures indicating when specific tasks may be initiated.…”

Section: Introductionmentioning

confidence: 99%

Knee Kinetics in Baseball Hitting and Return to Play after ACL Reconstruction

et al. 2020

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The purpose of this study was to describe the knee kinetics of baseball hitting, develop a tool to predict knee kinetics from easily obtainable measures, and to compare knee kinetics to other exercises along the rehabilitation continuum to determine a timeline for when hitting may resume after ACL reconstruction. Nineteen high school baseball athletes (16.3±0.8 yrs, 180.6±5.7 cm, 78.4±10.8 kg) participated. Participants took ten swings off a tee. Kinetic data were recorded using an electromagnetic tracking system. Data from swings with the top three exit velocities were averaged for analysis. Linear regressions were used to determine if predictors of height, mass, age and exit velocity could predict the following torques: bilateral knee net, extension, internal and external rotation, valgus and varus torque; and anterior force. Backwards regression models revealed independent variables could significantly predict front knee net, internal and external rotation, extension, and varus torque, and anterior force; and back knee net and valgus torque. Based on the kinetics of baseball hitting compared to those of rehabilitation exercises, if the involved knee is the front, we suggest tee hitting may be initiated at 13 weeks after ACL reconstruction. If the involved knee is the back, we suggest tee hitting may initiated at 17 weeks after ACL reconstruction.

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Current criteria for return to play after anterior cruciate ligament reconstruction: an evidence-based literature review

Cited by 27 publications

References 11 publications

Temporal Utilization of Physical Therapy Visits After Anterior Cruciate Ligament Reconstruction

Temporal Utilization of Physical Therapy Visits After Anterior Cruciate Ligament Reconstruction

Reliability of a New Portable Dynamometer for Assessing Hip and Lower Limb Strength

Knee Kinetics in Baseball Hitting and Return to Play after ACL Reconstruction

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