Ecological and Specific Evidence-Based Safe Return To Play After Anterior Cruciate Ligament Reconstruction In Soccer Players: A New International Paradigm

Abstract

Existing return to play (RTP) assessments have not demonstrated the ability to decrease risk of subsequent anterior cruciate ligament (ACL) injury after reconstruction (ACLR). RTP criteria are standardized and do not simulate the physical and cognitive activity required by the practice of sport. Most RTP criteria do not include an ecological approach. There are scientific algorithms as the “5 factor maximum model” that can identify risk profiles and help reduce the risk of a second anterior cruciate ligament injury. Nevertheless, these algorithms remain too standardized and do not include the situations experienced in games by soccer players. This is why it is important to integrate ecological situations specific to the environment of soccer players in order to evaluate players under conditions closest to their sporting activity, especially with high cognitive load. One should identify high risk players under two conditions: Clinical analyses commonly include assessments such as isokinetic testing, functional tests (hop tests, vertical force-velocity, profile), running, clinical assessments (range of motion and graft laxity), proprioception and balance (Star Excursion Balance Test modified, Y-Balance, stabilometry) and psychological parameters (kinesophobia, quality of life and fear of re-injury). Field testing usually includes game simulation, evaluation under dual-task conditions, fatigue and workload analysis, deceleration, timed-agility-test and horizontal force-velocity profiles. Although it seems important to evaluate strength, psychological variables and aerobic and anaerobic capacities, evaluation of neuromotor control in standard and ecological situations may be helpful for reducing the risk of injury after ACLR. This proposal for RTP testing after ACLR is supported by the scientific literature and attempts to approximate the physical and cognitive loads during a soccer match. Future scientific investigation will be required to demonstrate the validity of this approach. Level of Evidence 5

Interpersonal Coordination between Female Soccer Players: Leader-Follower Roles within a Collision-Avoidance Task

“…25 These findings challenge the construct validity of rehabilitation and return to sport protocols that fail to recreate the complex sport environment or elicit comparable behavioral demands. 13,[25][26][27][28] This protocol shortfall may be a contributor to the elevated risk of re-injury upon returning to sport after rehabilitation. Return to sport decision-making may be improved with a screening tool to assess an athlete's ability to control interpersonal dynamics in a continuously evolving task, and to determine whether psychological factors influence interpersonal dynamics.…”

“…Return to sport decision-making may be improved with a screening tool to assess an athlete's ability to control interpersonal dynamics in a continuously evolving task, and to determine whether psychological factors influence interpersonal dynamics. 13,27 Therefore, this investigation focused on whether factors such as injury history and psychological readiness associate with interpersonal dynamics. To do so, interpersonal interactions were examined during a novel agility-based task during which participant dyads coordinated their movements along intersecting paths.…”

“…To quantify the predictability (i.e., "strength") and duration (i.e., "stability") of interpersonal coordination during a collision avoidance task, this study used cross-recurrence quantification analysis (CRQA), an analytic approach used to describe distinct dynamics between two interacting people. 27 The authors hypothesized that participants would naturally assume de facto leader-follower roles within dyads and would develop and retain a highly coordinated movement pattern. Additionally, it was hypothesized that external perturbations would disrupt the strength and stability of their coordinated movement, and that individuals with a history of injury would be less likely to recover coordinated movement than controls.…”