Meeting movement quantity or quality return to sport criteria is associated with reduced second ACL injury rate

Abstract

The purposes of this prospective cohort study were (1) to assess if second anterior cruciate ligament (ACL) injury rate 2 years after ACL reconstruction (ACLR) in those who returned to pivoting sport was associated with meeting (a) quantitative return to sport (RTS) criteria, (b) qualitative RTS criteria, and (c) combined quantitative and qualitative RTS criteria, and (2) to determine why athletes did not return to their preinjury (level of) sport. Athletes after ACLR performed RTS tests immediately before RTS: seven movement quantity (strength and hop test battery) and two movement quality (countermovement jump with LESS score and hop-and-hold test) tests. A 2-year postoperative questionnaire asked for RTS, reasons for not returning to the same (level of) sport and second ACL injuries. One hundred and forty-four athletes (82%) completed the questionnaire and 97 of them returned to a pivoting sport. Seven of these athletes had a second ACL injury. Meeting the hop test battery RTS criterion (absolute risk reduction 11%; p = .047) and hop-and-hold test RTS criterion (absolute risk reduction 15%; p = .031) were both significantly associated with a reduced second ACL injury rate. Meeting combined RTS criteria were not significantly associated with second ACL injury rate. Therefore, RTS tests after ACLR should at least comprise a hop test battery or the hop-and-hold test to reduce second ACL injury risk after return to pivoting sport. Also, one-third of all athletes mentioned fear of reinjury as the main reason for not returning to their preinjury (level of) sport. This psychological component should be taken seriously and discussed during rehabilitation.

‘I was young, I wanted to return to sport, and re-ruptured my ACL’ – young active female patients’ voices on the experience of sustaining an ACL re-rupture, a qualitative study

“…Therefore, based on the experiences of the patients in our study, the clinical tests we use to assess whether patients are ready to RTS after an ACL reconstruction, do not necessarily comply with whether patients feel ready to RTS. The difference between passing clinical tests and patients' subjective feelings has recently been highlighted in previous publications, as patients state fear of re-injury as a main component for not returning to sport, [33]. At the same time, RTS criteria seldom comprise the assessment of fear, and may not identify a subset of patients at risk of sustaining an ACL re-rupture [34,35].…”

‘I Was Young, I Wanted to Return to Sport, and Re-Ruptured My ACL’ – Young Female Patients’ Voices on the Experience of Sustaining an ACL Re-Rupture, a Mixed Method Study

“…Therefore, based on the experiences of the patients in our study, the clinical tests we use to assess whether patients are ready to RTS after an ACL reconstruction, do not necessarily comply with whether patients feel ready to RTS. The difference between passing clinical tests and patients' subjective feelings has recently been highlighted in previous publications, as patients state fear of re-injury as a main component for not returning to sport, [30]. Parallelly, RTS criteria seldom comprise the assessment of fear, and may not identify a subset of patients at risk of sustaining an ACL re-rupture [31,32].…”

The Non-injured Leg Can Be Used as a Reference for the Injured Leg in Single-legged Hop Tests

“…The physical therapists gave clearance for RTS according to the definition by Ardern et al 37 : "Returning to the defined sport, but not performing at the desired performance level" regardless of whether this was based on objective criteria or not. 38,39 In order to have a real-life presentation of RTS-decisions in the usual care of physical therapists, the researchers were not involved in the rehabilitation process and RTS decisionmaking. 40 After RTS clearance, RTS athletes were eligible for participation if they met the following criteria: 18-45 years of age and participating at least twice a week in highimpact sports before the injury.…”