Passing return‐to‐sport criteria and landing biomechanics in young athletes following anterior cruciate ligament reconstruction

Losciale, Justin M; Ithurburn, Matthew P.; Paterno, Mark V.; Schmitt, Laura C.

doi:10.1002/jor.25110

Cited by 16 publications

(7 citation statements)

References 44 publications

(110 reference statements)

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“…Indeed, among young individuals post-ACLR, a high level of symmetry between limbs in movement patterns or functional performance was often attained by reduced loading or performance, respectively, of the uninvolved limb. 10,31 In our analysis, 79% to 84% of the ACLR group met the traditional 90% LSI values on the individual hop tests, while only 43% to 69% met the newly derived hop test LSI target values (target values of 94% to 96%). This demonstrates that the traditional 90% criterion for performance symmetry between limbs during functional performance is likely too low; however, using the LSI target values alone does not address the potential shortcomings of using measures of symmetry to evaluate functional performance.…”

Section: Discussionmentioning

confidence: 69%

“…90%) and successful RTS participation (at 12 months). Several sets of researchers 10,[30][31][32] studies characterized further shortcomings of the current single-leg hop LSI recommendations, including the use of the uninvolved limb as the reference standard, which may have led to an overestimation of involved limb functional performance post-ACLR and erroneous interpretation. Indeed, among young individuals post-ACLR, a high level of symmetry between limbs in movement patterns or functional performance was often attained by reduced loading or performance, respectively, of the uninvolved limb.…”

Section: Discussionmentioning

confidence: 99%

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Identification and Predictors of Age-Relevant and Activity-Relevant Hop Test Targets in Young Athletes After Anterior Cruciate Ligament Reconstruction

Schmitt

Brunst

Ithurburn

et al. 2022

Journal of Athletic Training

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Context Performance symmetry between limbs (limb symmetry index [LSI] ≥ 90%) on a battery of single-leg hop tests is recommended to inform return-to-sport (RTS) decisions after anterior cruciate ligament (ACL) reconstruction (ACLR). Achieving current hop test symmetry values has not been associated with future clinical outcomes. The identification of age-relevant and activity-relevant target values to benchmark the hop test performance of young athletes post-ACLR may provide greater specificity and clinical relevance for interpretation of hop test data. Objective To identify single-leg hop test-target values for individual-limb performance and symmetry between limbs for athletes without a history of ACL injury and evaluate the proportion of young athletes post-ACLR who met the newly derived target values at the time of RTS clearance. The secondary objective was to test the hypothesis that better function and strength would be associated with achieving the newly derived hop test target values. Design Cross-sectional study. Setting Pediatric medical center and academic medical center. Patients or Other Participants A total of 159 young athletes (age = 16.9 ± 2.2 years) at the time of RTS clearance after primary, unilateral ACLR and 47 uninjured control athletes (age = 17.0 ± 2.3 years). Main Outcome Measure(s) All participants completed a single-leg hop test battery (single hop, triple hop, and crossover hop for distance [cm], and 6-m timed hop [seconds]). Raw distance values were normalized by body height, and LSI (%) was calculated for each hop test. Target values were defined as the lower bound of the 95% CI for each hop test, using control group data. Participants with ACLR also completed the Knee injury and Osteoarthritis Outcome Score subscales and a quadriceps femoris strength (newton meters/kilogram) assessment. Logistic regression determined predictors of achieving hop test target values in the ACLR group among injury, function, and strength data (P < .05). Results In the ACLR group, 79% to 84% of participants met the 90% LSI threshold on each hop test. They achieved the target values for surgical-limb performance in the following proportions (% participants): single hop = 29%, triple hop = 24%, crossover hop = 30%, 6-m timed hop = 18%, all hops= 12%. Also, they met the target values for LSI in the following proportions: single hop = 43%, triple hop = 48%, crossover hop = 50%, 6-m timed hop = 69%, all hops = 25%. The only predictor of achieving all hop test targets for surgical-limb performance was greater surgical-limb quadriceps femoris strength (odds ratio = 4.10, P = .007). We noted a trend toward quadriceps femoris strength LSI ≥ 90% (odds ratio = 2.44, P = .058) as a predictor for meeting all hop test symmetry targets. Conclusions At the time of RTS post-ACLR, only a small proportion of young athletes achieved the age-relevant and activity-relevant single-leg hop test targets for surgical-limb performance or symmetry between limbs, even though a majority met the traditionally recommended 90% LSI threshold on hop tests.

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Section: Discussionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 99%

Identification and Predictors of Age-Relevant and Activity-Relevant Hop Test Targets in Young Athletes After Anterior Cruciate Ligament Reconstruction

Schmitt

Brunst

Ithurburn

et al. 2022

Journal of Athletic Training

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“…Therefore, specialized pre-return-to-sport rehabilitation programs should be implemented to strengthen the hamstring muscles of ACLR athletes. By doing so, following passing the return-to-sport criteria, ACLR athletes could have a more successful return-to-sport with a low risk of ACL re-injury [53].…”

Section: Discussionmentioning

confidence: 99%

Discriminative sEMG-based features to assess damping ability and interpret activation patterns in lower-limb muscles of ACLR athletes

Hatamzadeh

Sharifnezhad²,

Hassannejad

et al. 2023

Biomedical Signal Processing and Control

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“…Although research on high versus low-volume clinics with respect to rehabilitation clinics is limited, it is tempting to generalize findings from previous research on volume effects on rehabilitation. However, ACL rehabilitation is complex to measure as it is individualized, with different rehabilitation phases in which patients face both psychological [ 28 ] and physical challenges [ 29 ] over a considerable time (commonly > 9 months) [ 30 ]. Based on our results, clinical volumes do not appear to be directly related to rehabilitation outcomes during the first or second year of rehabilitation or to the odds of a second ACL injury.…”

Section: Discussionmentioning

confidence: 99%

A comparison between physical therapy clinics with high and low rehabilitation volumes of patients with ACL reconstruction

Simonsson,

Högberg,

Lindskog

et al. 2023

J Orthop Surg Res

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Background Treatment volume can impact outcomes after surgical procedures of the knee between surgeons with high- and low-patient-volumes. However, the difference between physical therapeutic clinics with high- and low-volumes has not been widely researched. This registry study aims to investigate how patient volume affects knee function outcomes after anterior cruciate ligament (ACL) reconstruction at physical therapy (PT) clinics in terms of odds for a second ACL injury, return to pre-injury level of activity, perceived knee function, and recovery of strength and hop performance. Method Data were extracted from the Project ACL, a local rehabilitation registry. High- and low-volume clinics were defined based on the number of patients who attended different clinics. High-volume clinics were defined as those with > 100 patient registrations in Project ACL during the study period while low-volume clinics were those with ≤ 100 patient registrations. High- and low-volume clinics were compared, based on muscle function and patient-reported outcomes across 4 follow-ups, 2-, 4-, 8-, and 12 months, during the first year after ACL reconstruction, and odds of second ACL injury up to 2 years after ACL reconstruction. Result Of the 115 rehabilitation clinics included, 111 were classified as low-volume clinics and included 733 patients, and 4 as high-volume clinics which included 1221 patients. There were 31 (1.6%) second ACL injuries to the ipsilateral or contralateral side within the first 12 months and 68 (4.0%) within 2 years. No difference in the incidence of a second ACL injury, within 12 months follow-up odds ratio (OR) 0.95 [95% CI 0.46–1.97] or within 2 years follow-up OR 1.13 [95% CI 0.68–1.88], was found between high- and low-volume clinics. There were early (2 months) and non-clinically relevant differences in patient-reported outcomes (PROs) and physical activity levels early after ACL reconstruction in favor of high-volume clinics. One year after ACL reconstruction, no differences were observed between high- and low-volume clinics in terms of PROs, muscle function, and return to pre-injury level of activity. Conclusion No clinically relevant difference in the incidence of secondary ACL injuries in patients who underwent rehabilitation after ACL reconstruction at high- or low-volume physical therapist clinics was found. In addition, no clinically relevant differences in outcomes were found during the first year in terms of patient-reported outcomes, recovery of muscle function, or return to pre-injury level of activity.

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Passing return‐to‐sport criteria and landing biomechanics in young athletes following anterior cruciate ligament reconstruction

Cited by 16 publications

References 44 publications

Identification and Predictors of Age-Relevant and Activity-Relevant Hop Test Targets in Young Athletes After Anterior Cruciate Ligament Reconstruction

Identification and Predictors of Age-Relevant and Activity-Relevant Hop Test Targets in Young Athletes After Anterior Cruciate Ligament Reconstruction

Discriminative sEMG-based features to assess damping ability and interpret activation patterns in lower-limb muscles of ACLR athletes

A comparison between physical therapy clinics with high and low rehabilitation volumes of patients with ACL reconstruction

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