Test Batteries After Primary Anterior Cruciate Ligament Reconstruction: A Systematic Review

Abstract

Context: There is a lack of consensus regarding test batteries for return to sport (RTS) after anterior cruciate ligament reconstruction (ACLR). Objective: To report the RTS test batteries for individuals after ACLR and to examine alignment with the American Academy of Orthopaedic Surgeons (AAOS) Appropriate Use Criteria (AUC). Finally, to examine how published RTS batteries prior to the AAOS AUC (2010-2015) compared with those after publication of the AUC (2016-2020). Data Source: A systematic search of PubMed (2010-2020). Study Selection: Studies were included if they were published from 2010 to 2020, patients underwent primary ACLR and were tested between 6 months and 2 years postoperatively and included a minimum of 2 assessments. Studies were excluded if patients were tested outside the designated time; had undergone a revision, contralateral, or multiligament injury; included healthy participants; were level 5 evidence or the study was a systematic review. A total of 1012 articles were reviewed and 63 met the criteria. Study Design: Systematic review. Level of Evidence: Level 4. Data Extraction: Information regarding the RTS batteries and patient demographics were extracted from the included articles. Results: A total of 63 studies met the inclusion and exclusion criteria (22 from 2010-2015 and 41 from 2016-2020). The most common RTS batteries included the hop test, quadriceps strength test, and patient-reported outcome measures. No study met all 7 AUC; the most common criteria met were functional skills (98.4%), followed by confidence (22.2%), then range of motion and knee stability (20.6%). Conclusion: The test batteries in the current literature show high variability and a lack of essential components necessary for RTS. No study met the AUC guidelines, suggesting a disconnect between recommended guidelines and clinical practice. Test battery research has expanded over the past decade; however, standardized, clinically applicable batteries that encompass all criteria are needed.

Unilateral tests of lower-limb function as prognostic indicators of future knee-related outcomes following anterior cruciate ligament injury: a systematic review and meta-analysis of 13 150 adolescents and adults

“…Systematic review evidence is also conflicting. Passing a return to sport test battery (including hop tests) is shown to lower future reinjury risk in some reviews20 21 but not others,22 though it is hard to compare findings due to variability in the components of such batteries as well as their criteria for ‘passing’ 23. The prognostic capacity of tests of lower-limb function on future knee-related outcomes has not been synthesised systematically.…”

Aspetar clinical practice guideline on rehabilitation after anterior cruciate ligament reconstruction

“…[11][12][13][14] Importantly, there is no agreement on the objective progression criteria, or the discharge criteria before return to sport. [14][15][16][17][18] A recent systematic review summarised the recommendations and appraised the quality of the available clinical practice guidelines for rehabilitation after ACLR. 14 Also, recent published work provided an overview of systematic reviews on the effectiveness of rehabilitation interventions after ACLR.…”

Low percentage of patients passed the ‘Back in Action’ test battery 9 months after bone-patellar tendon-bone anterior cruciate ligament reconstruction

“…8,18 However to date no standardized criteria are available to predict a safe RTS. 12,19 Recently, a standardized test battery for decision-making regarding RTS was introduced. 20 This test battery (Back in Action CoRehab srl, Trento, Italy) consists of seven subtests and allows for comparison of results with age and gender matched healthy control subjects.…”