Return to Sport for Skeletally Immature Athletes After ACL Reconstruction: Preventing a Second Injury Using a Quality of Movement Assessment and Quantitative Measures to Address Modifiable Risk Factors

Abstract

Background:Reinjury rates after anterior cruciate ligament reconstruction (ACLR) are highest among young athletes, who consequently suffer from low rates of return to play. Historically, quantitative measures have been used to determine readiness to return to sport; however, they do not assess modifiable risk factors related to the quality of movement.Purpose:To determine the effectiveness of a criteria-based rehabilitation progression and return-to-sport criteria on efficient return to activity and prevention of second injury in young athletes post-ACLR.Study Design:Case series; Level of evidence, 4.Methods:Between December 2010 and 2013, 42 skeletally immature athletes (mean chronologic age, 12 years; range, 10-15 years) who underwent ACLR using ipsilateral hamstring tendon autograft were prospectively evaluated. All athletes progressed through a criteria-based rehabilitation progression; were assessed at specific time frames for strength, biomechanical, and neuromuscular risk factors predictive of injury; and were provided targeted interventions. The final return to sport phase consisted of quantitative testing as well as a quality of movement assessment of several functional movements with progressive difficulty and sports-specific loading. Clearance for unrestricted activity was determined by achieving satisfactory results on both qualitative and quantitative assessments with consideration for the demands of each sport.Results:The mean time for return to unrestricted competitive activity was 12 months. All but 3 (7%) athletes returned to their primary sport. Thirty-five athletes (83%) returned to unrestricted activity. Of the 6 (14%) who sustained a second injury, 3 (50%) were injured in sports they were not cleared for. All ACL reinjuries occurred in a cutting sport. Half of reinjuries occurred within 1 year of surgery, while the remaining occurred between 1 and 2 years. Eighty-three percent of reinjuries involved highly competitive cutting athletes.Conclusion:In our cohort, the combination of qualitative and quantitative data served as a good indicator for reducing risk and determining readiness to return to sport.

A research update on the state of play for return to sport after anterior cruciate ligament reconstruction

“…Five prospective studies have been conducted to investigate the association between return to sport testing and subsequent injury [56–60]. Two of these have shown a significant effect of passing criteria and subsequent ACL injury, but with conflicting results.…”

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

“…The primary aim of this narrative review was to provide an overview of the RTS testing batteries of the studies included [8][9][10][11][12][13][14][15][16][17][18][19][20] in the 2019 synthesis of the literature 6 (table 1), and the cited studies in the methods sections of these manuscripts [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] (table 2). Our focus was applied to hop testing methods and administration procedures following ACL reconstruction.…”

Comparison of Ligament Isometry and Patellofemoral Contact Pressures for Medial Patellofemoral Ligament Reconstruction Techniques in Skeletally Immature Patients

“…If, on the other hand, the graft is placed proximal to the growth plate, or “too high,” the graft may tighten in flexion leading to loss of motion, pain, graft stretching, and failure. 4,5,14,15,19,30,48…”