Muscle strength and hop performance criteria prior to return to sports after ACL reconstruction

Abstract

Purpose -The purpose of this article is to present recommendations for new muscle strength and hop performance criteria prior to a return to sports after anterior cruciate ligament (ACL) reconstruction.Methods -A search was made of relevant literature relating to muscle function, self-reported questionnaires on symptoms, function and knee-related quality of life, as well as the rate of re-injury, the rate of return to sports and the development of osteoarthritis (OA) after ACL reconstruction. The literature was reviewed and discussed by the European Board of Sports Rehabilitation (EBSR) in order to reach consensus on criteria for muscle strength and hop performance prior to a return to sports.Results -The majority of athletes that sustain an (ACL) injury do not successfully return to their pre-injury sport, even though most athletes achieve what is considered to be acceptable muscle function. On self-reported questionnaires, the athletes report high ratings for fear of re-injury, low ratings for their knee function during sports and low ratings for their kneerelated quality of life.Conclusion -The conclusion is that the muscle function tests that are commonly used are not demanding enough or not sensitive enough to identify differences between injured and noninjured sides. Recommendations for new criteria are given for the sports medicine community to consider, before allowing an athlete to return to sports after an ACL reconstruction. Level of evidence: Level IV

Persistent Neuromuscular and Corticomotor Quadriceps Asymmetry After Anterior Cruciate Ligament Reconstruction

“…These alterations in quadriceps function have been related to altered gait patterns and reduced physical performance throughout rehabilitation and well after return to activity. 3,4 This persistent dysfunction may reduce the ability of individuals with ACLR to adapt to the demands of physical activity, resulting in abnormal knee-joint loading. [5][6][7] Researchers 8,9 have hypothesized that the combination of joint trauma from initial injury and surgery, along with long-term functional adaptation due to persistent lower extremity neuromuscular dysfunction, may predispose individuals with ACLR to higher rates of reinjury and knee-joint osteoarthritis.…”

“…Between-limbs differences, often referred to as limb asymmetry, have been proposed as a more effective manner to assess lower extremity dysfunction after knee-joint injury. 18,19 Reductions in quadriceps strength, 4,20 functional performance, 21,22 and gait symmetry 23 have been reported after anterior cruciate ligament (ACL) injury and ACLR. To date, the magnitude of asymmetry, or between-limbs differences, in quadriceps motor-neuron-pool excitability, quadriceps activation, and quadriceps cortical excitability has not been studied in patients with ACLR.…”

Return to Sport after Anterior Cruciate Ligament Reconstruction: A Literature Review

“…Consequently, patients have to go through each phase of ACL rehabilitation, and move from one phase to the other by setting specific criteria and not by time. A well designed late phase rehabilitation and return to sports training program can reduce the risk of reinjury, prepare the athlete to perform at the same preinjury level [6,41,75,108,109] and secure the safe transition of the player from physiotherapy to normal training [104]. On-field rehabilitation programs must be based on measurable outcomes and in that way the complete functional recovery of the individual can be reassured [71,110].…”

“…There is a battery of different tests that have to be used in order to have a more complete image of the athlete. These tests must be as demanding as possible [104] and it is preferred if they can be performed under fatigue [105]. The most common outcome measures examined in the literature are, quadriceps-hamstrings strength deficit, LSI deficits, anterior-posterior tibial displacement, pain, effusion, swelling, patellar mobility and range of motion [9][10][11]104,106].…”

The isokinetic evaluation of the knee joint function following the autoplastic correction of its anterior cross-shaped ligament

“…Через 2 года после операции по восстановлению ПКС без полноценной реабилитации сила мышц-разгибателей голени имеет выраженный дефицит [8].…”