Return to sport after ACL reconstruction: a survey between the Italian Society of Knee, Arthroscopy, Sport, Cartilage and Orthopaedic Technologies (SIGASCOT) members

Grassi, Alberto; Vascellari, Alberto; Combi, Alberto; Tomaello, Luca; Canata, Gian Luigi; Zaffagnini, Stefano

doi:10.1007/s00590-016-1756-0

Cited by 26 publications

(30 citation statements)

References 28 publications

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“…7 The difference between the varied reports of RTS rates and patients' subjective evaluation may be because a precise and consistent definition of RTS is lacking. 6,9,24,29,62 Terms like "return to play," "return to sport," "return to participation," and "return to unrestricted physical activity" are used interchangeably and cause confusion in the literature. 5,6,24,29 Moreover, the definition of a successful RTS remains unclear.…”

Section: Consensus Statements and Discussionmentioning

confidence: 99%

“…6,9,24,29,62 Terms like "return to play," "return to sport," "return to participation," and "return to unrestricted physical activity" are used interchangeably and cause confusion in the literature. 5,6,24,29 Moreover, the definition of a successful RTS remains unclear. 66 Multiple factors must be taken into consideration for determination of a successful RTS because of the differences in competition and reinjury risk.…”

Section: Consensus Statements and Discussionmentioning

confidence: 99%

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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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Section: Consensus Statements and Discussionmentioning

confidence: 99%

Section: Consensus Statements and Discussionmentioning

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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“…The probability of a patient completing rehabilitation to discharge was significantly associated with a longer duration of physiotherapy, an increased number of attended sessions, and the CONTROL model of care ( Table 6 ). There is currently no ideal duration or dose of physiotherapy identified in the literature 9,13,16,21 . In this study, 'completion' of physiotherapy indicated that the treating physiotherapist discharged the patient from the service.…”

Section: Logistic Regressionsmentioning

confidence: 99%

Evolution of Service Metrics and Utilisation of Evidence-Based Outcome Measures in Anterior Cruciate Ligament Reconstruction Rehabilitation: An Observational Review of Two Cohorts in a Public Hospital Physiotherapy Department

Tuckerman

Potts

Ebrahimi³

et al. 2020

Preprint

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Objective: Determine in patients undergoing supervised rehabilitation post ACL reconstruction in a public hospital, whether a new model of care incorporating a phase-based program, compared to standard care, increased physiotherapist utilisation of outcome measures, improved service metrics such as attendance and rehabilitation completion rates, as well as increased self-reported knee function and activity levels. Methods: Patients attending outpatient physiotherapy after ACL reconstruction at a metropolitan public hospital (N = 132) were included in retrospective chart review to assess utilisation of outcomes such as quadriceps and hamstrings strength assessment, patient attendance and rehabilitation completion. Phone followup (minimum one year) was conducted to retrieve patient-reported measures of knee function (IKDC) and activity (Tegner Activity Scale). Patients were categorised by rehabilitation model of care (contemporary - time based [N = 93] vs new - phase based [N = 39]) and logistic regression used to assess the influence of patient factors and model of care on outcomes. Results: Patients included for analysis were aged 25 years at surgery (IQR 20.3 - 30.8), with 42.4% of non-Australia country of origin. Compliance was equivalent between models of care and completion rates (formally discharged by therapist) were low (30-38%). The probability of a patient receiving strength assessment was significantly associated with model of care, sex, BMI and the number of sessions attended. The probability of a patient being recorded as discharged from the program was significantly associated with the model of care, as well as the duration and number of sessions. Conclusion: The transition to a new model of care incorporating a phase-based rehabilitation program increased physiotherapist utilisation of certain evidence-based outcome measures, increased total duration of rehabilitation and increased the total number of sessions attended. Despite this, rehabilitation completion rates remained low, and no change was demonstrated with respect to self-reported knee function and activity levels.

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“…The majority of the literature [7-12, 13•, 14•, [15][16][17][18][19][20][21][22] indicates a battery of tests is necessary to assess various outcome parameters and establish criterionbased clinical reasoning for RTS. This review acknowledges multiple tests that should be done aside from medical approval and clearance by the physician to verify a successful RTS such as follows: range of motion, KT1000/KT2000, Lachman's test, Pivot shift test, isotonic strength tests, isokinetic strength tests, maximum force/peak torque, angle-specific torque testing, rate of force development, hop tests, jump landing tasks (LESS), knee proprioception/kinesthesia/joint position sense testing, quality of movement tests, kinematic analysis, psychological factors/tests based on the anterior cruciate ligament-return to sport after injury (ACL-RSI) scale, PROs: anterior cruciate ligament-return to sport after injury (ACL-RSI) scale, IKDCs, KOOSs, ADL scales, Sport scales, knee self efficacy scale, Quality of Scales, ACL-RSI, Tegner Activity Scale (TAS), Lysholm Scale, and Tampa Kinesiophobia Index.…”

Section: This Article Is Part Of the Topical Collection On Acl Rehabmentioning

confidence: 99%

ACL Return to Sport Guidelines and Criteria

Davies

McCarty

Provencher

et al. 2017

Curr Rev Musculoskelet Med

142

102

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Purpose of Review Because of the epidemiological incidence of anterior cruciate ligament (ACL) injuries, the high reinjury rates that occur when returning back to sports, the actual number of patients that return to the same premorbid level of competition, the high incidence of osteoarthritis at 5-10-year follow-ups, and the effects on the long-term health of the knee and the quality of life for the patient, individualizing the return to sports after ACL reconstruction (ACL-R) is critical. However, one of the challenging but unsolved dilemmas is what criteria and clinical decision making should be used to return an athlete back to sports following an ACL-R. This article describes an example of a functional testing algorithm (FTA) as one method for clinical decision making based on quantitative and qualitative testing and assessment utilized to make informed decisions to return an athlete to their sports safely and without compromised performance. The methods were a review of the best current evidence to support a FTA. Recent Findings In order to evaluate all the complicated domains of the clinical decision making for individualizing the return to sports after ACL-R, numerous assessments need to be performed including the biopsychosocial concepts, impairment testing, strength and power testing, functional testing, and patient-reported outcomes (PROs). Summary The optimum criteria to use for individualizing the return to sports after ACL-R remain elusive. However, since this decision needs to be made on a regular basis with the safety and performance factors of the patient involved, this FTA provides one method of quantitatively and qualitatively making the decisions. Admittedly, there is no predictive validity of this system, but it does provide practical guidelines to facilitate the clinical decision making process for return to sports. The clinical decision to return an athlete back into competition has significant implications ranging from the safety of the athlete, to performance factors and actual litigation issues. By using a multifactorial FTA, such as the one described, provides quantitative and qualitatively criteria to make an informed decision in the best interests of the athlete.

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Return to sport after ACL reconstruction: a survey between the Italian Society of Knee, Arthroscopy, Sport, Cartilage and Orthopaedic Technologies (SIGASCOT) members

Abstract: Level V, expert opinion.

Cited by 26 publications

References 28 publications

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

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

Evolution of Service Metrics and Utilisation of Evidence-Based Outcome Measures in Anterior Cruciate Ligament Reconstruction Rehabilitation: An Observational Review of Two Cohorts in a Public Hospital Physiotherapy Department

ACL Return to Sport Guidelines and Criteria

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