Functional performance 6 months after ACL reconstruction can predict return to participation in the same preinjury activity level 12 and 24 months after surgery

Nawasreh, Zakariya H.; Logerstedt, David; Cummer, Kathleen; Axe, Michael J.; Risberg, May Arna; Snyder‐Mackler, Lynn

doi:10.1136/bjsports-2016-097095

Cited by 97 publications

(100 citation statements)

References 52 publications

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“…Several studies have reported that many patients were unable to pass strength, balance, and neuromuscular tests in the time period when many authors allow RTS, typically 6 to 9 months postoperative. 6,16,21,35,43,61,62,81,92,99,103 Boyle et al 16 tested 39 adolescents and 16 adults who underwent transphyseal hamstring ACLR 9 months postoperatively with the functional movement screen and lower quarter Y-Balance tests. An increased risk for lower extremity injury was reported based on an inferior active straight-leg raise score on the functional movement screen.…”

Section: Discussionmentioning

confidence: 99%

One in 5 Athletes Sustain Reinjury Upon Return to High-Risk Sports After ACL Reconstruction: A Systematic Review in 1239 Athletes Younger Than 20 Years

Barber-Westin

Noyes

2020

Sports Health: A Multidisciplinary Approach

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Context: Anterior cruciate ligament (ACL) reconstruction (ACLR) is frequently performed in patients younger than 20 years whose goal is to return to sport (RTS). Varying reinjury rates have been reported, and the factors responsible are unclear. Studies differ with regard to age, graft type, surgical techniques, postoperative rehabilitation, RTS guidelines, and methods used to determine ACL failures. Objective: To determine RTS rates; the effect of participation in high-risk sports, sex, and graft type on ACL reinjury rates; and whether objective test criteria before RTS correlate with lower reinjury rates. Data Sources: A systematic review of the literature from inception to May 31, 2019, was conducted using the PubMed and Cochrane databases. Study Selection: Studies on transphyseal ACLR in athletes <20 years old with a minimum mean follow-up of 2 years that reported reinjury rates, the number that RTS, and detailed the type of sport were included. Study Design: Systematic review. Level of Evidence: Level 4. Results: A total of 1239 patients in 8 studies were included; 87% returned to sport and 80% resumed high-risk activities. Of the patients, 18% reinjured the ACL graft and/or the contralateral ACL. Nine percent of patellar tendon autografts and 15% of hamstring autografts failed (odds ratio [OR], 0.52; P = 0.002). Of reinjuries, 90% occurred during high-risk sports. Male patients had a significantly higher rate of ACL graft failure than female patients (OR, 1.64; P = 0.01). There was no sex-based effect on contralateral ACL injuries. Only 1 study cited objective criteria for RTS. Conclusion: A high percentage of athletes returned to sport, but 1 in 5 suffered reinjuries to either knee. Male patients were more likely to reinjure the ACL graft. Objective criteria for RTS were rarely mentioned or not detailed. The need for testing of knee stability, strength, neuromuscular control, agility, and psychological measures before RTS remains paramount in young athletes.

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Section: Discussionmentioning

confidence: 99%

One in 5 Athletes Sustain Reinjury Upon Return to High-Risk Sports After ACL Reconstruction: A Systematic Review in 1239 Athletes Younger Than 20 Years

Barber-Westin

Noyes

2020

Sports Health: A Multidisciplinary Approach

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“…In another report from the same Delaware-Oslo ACL cohort, passing the same RTS criteria accurately predicted return to previous level of play at 1 and 2 years postoperatively with good sensitivity and specificity. 30,52 Of those patients passing the RTS test at 6 months, 81% and 84% returned to the previous level of play at 1 and 2 years postoperatively, respectively, while 44% and 46% of patients who failed at 6 months returned to the previous level at 1 and 2 years postoperatively after passing subsequent RTS testing, respectively. Although the evidence is mounting for objective RTS testing, further research is needed to validate these results and clearly define the best methods of testing.…”

Section: Rts Decision-making Must Include Objective Physical Examinatmentioning

confidence: 99%

Return to Sport After Anterior Cruciate Ligament Injury: Panther Symposium ACL Injury Return to Sport Consensus Group

Meredith

Rauer

Chmielewski

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: A precise and consistent definition of return to sport (RTS) after anterior cruciate ligament (ACL) injury is lacking, and there is controversy surrounding the process of returning patients to sport and their previous activity level. Purpose: The aim of the Panther Symposium ACL Injury Return to Sport Consensus Group was to provide a clear definition of RTS after ACL injury and a description of the RTS continuum as well as provide clinical guidance on RTS testing and decision-making. Study Design: Consensus statement. Methods: An international, multidisciplinary group of ACL experts convened as part of a consensus meeting. Consensus statements were developed using a modified Delphi method. Literature review was performed to report the supporting evidence. Results: Key points include that RTS is characterized by achievement of the preinjury level of sport and involves a criteria-based progression from return to participation to RTS and, ultimately, return to performance. Purely time-based RTS decision-making should be abandoned. Progression occurs along an RTS continuum, with decision-making by a multidisciplinary group that incorporates objective physical examination data and validated and peer-reviewed RTS tests, which should involve functional assessment as well as psychological readiness. Consideration should be given to biological healing, contextual factors, and concomitant injuries. Conclusion: The resultant consensus statements and scientific rationale aim to inform the reader of the complex process of RTS after ACL injury that occurs along a dynamic continuum. Research is needed to determine the ideal RTS test battery, the best implementation of psychological readiness testing, and methods for the biological assessment of healing and recovery.

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“…Passing a test battery including a series of single leg hop and isokinetic tests was associated with lower rerupture rates following RTS, 1 2 and an increased likelihood of returning to previous sporting levels. 3 However, hop and isokinetic tests do not consistently predict successful outcomes following ACL rehabilitation. Losciale et al 4 reported no associations between the use of RTS discharge tests and greater risk of reinjury, stating the low quality of evidence affects our ability to make definitive conclusions.…”

Section: Introductionmentioning

confidence: 99%

Better reporting standards are needed to enhance the quality of hop testing in the setting of ACL return to sport decisions: a narrative review

et al. 2020

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Background/aimThere is a lack of consistency in return to sport (RTS) assessments, in particular hop tests to predict who will sustain a reinjury following anterior cruciate ligament (ACL) reconstruction. Inconsistent test battery content and methodological heterogeneity might contribute to variable associations between hop test performance and subsequent injury. Our aim was to investigate whether commonly used hop tests are administered in a consistent manner and in accordance with reported guidelines.MethodsWe conducted a narrative review of studies that examined whether hop testing could differentiate RTS pass rates, reinjury and rerupture in athletes after ACL reconstruction. Our specific focus was on the methodological procedures of hop testing as this component is widely used to evaluate patients’ function and readiness to RTS.Main findingsSubstantial variation exists in RTS hop test administration, scoring and interpretation. Authors often failed to report important details of methods such as warm up activities, randomisation, number of trials, rest periods and landing requirements.ConclusionWe recommend researchers provide clearer descriptions of how hop tests are performed to increase standardisation and promote accurate data collection. Absence of reporting to describe test methods and using different test procedures makes it difficult to compare study findings.

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Functional performance 6 months after ACL reconstruction can predict return to participation in the same preinjury activity level 12 and 24 months after surgery

Cited by 97 publications

References 52 publications

One in 5 Athletes Sustain Reinjury Upon Return to High-Risk Sports After ACL Reconstruction: A Systematic Review in 1239 Athletes Younger Than 20 Years

One in 5 Athletes Sustain Reinjury Upon Return to High-Risk Sports After ACL Reconstruction: A Systematic Review in 1239 Athletes Younger Than 20 Years

Return to Sport After Anterior Cruciate Ligament Injury: Panther Symposium ACL Injury Return to Sport Consensus Group

Better reporting standards are needed to enhance the quality of hop testing in the setting of ACL return to sport decisions: a narrative review

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