Criteria for return to running after anterior cruciate ligament reconstruction: a scoping review

Rambaud, Alexandre; Ardern, Clare L; Thoreux, Patricia; Regnaux, Jean‐Philippe; Édouard, Pascal

doi:10.1136/bjsports-2017-098602

Cited by 111 publications

(102 citation statements)

References 66 publications

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“…We also suggest individualizing clearance to return to sporting activities at each step of the RTS-continuum. In agreement with a recent scoping review [7] , we suggest that for RTS-1, patients with ACLR could start to run between 12 and 16 weeks postoperatively if they present a clean clinical exam (i. e. full ROM or 95 % of the non-injured knee, no effusion, no pain or pain < 2 on the visual analogue scale), normal gait and an LSI of quadriceps strength greater than 70 %. However, we do not concur with the scoping review [7] regarding LSIs greater than 70 % and suggest that higher LSI values (LSIs of SHT and THT greater than 85 %) seem fairer and safer.…”

Section: Discussionsupporting

confidence: 89%

“…12-16 weeks postoperatively [6,7]. RTS-2, which includes contact and side cutting activities, usually starts 26-39 weeks postoperatively [8][9][10].…”

Section: Evolution Of Functional Recovery Using Hop Test Assessment Amentioning

confidence: 99%

“…The most recent recommendations regarding the criteria for RTS-2 [8,10,12] include the One-leg hop tests in their test batteries, but their thresholds for RTS-2 are variable, with LSI ranging from 90 % to 100 % [12]. In contrast with RTS-2, there is little information available on LSI values for hop tests during the RTS-1 phase [7]. Although these are important steps in the RTS-continuum after ACLR, RTS-1 and RTS-2 are most often guided by a standard rehabilitation protocol that does not use objective criteria [7], and many clinicians using only a time-based criterion for the RTS-continuum [11] to aid their decision-making.…”

Section: Evolution Of Functional Recovery Using Hop Test Assessment Amentioning

confidence: 99%

“…In contrast with RTS-2, there is little information available on LSI values for hop tests during the RTS-1 phase [7]. Although these are important steps in the RTS-continuum after ACLR, RTS-1 and RTS-2 are most often guided by a standard rehabilitation protocol that does not use objective criteria [7], and many clinicians using only a time-based criterion for the RTS-continuum [11] to aid their decision-making.…”

Section: Evolution Of Functional Recovery Using Hop Test Assessment Amentioning

confidence: 99%

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Evolution of Functional Recovery using Hop Test Assessment after ACL Reconstruction

et al. 2020

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The purpose of this study was to evaluate improvements in functional performance through the use of the Limb Symmetry Index of Single and Triple Hop tests between 12 and 52 weeks after anterior cruciate ligament reconstruction, and to compare these values with usual time-based and performance-based criteria used during the return to sport continuum. Repeated functional assessments using Single and Triple Hop Tests at 12, 16, 22, 26, 39 and 52 postoperative weeks were evaluated. At each session, the median and interquartile range of Limb Symmetry Index of tests were calculated and compared with the usual criteria: return to participation:≥85%, between 12–16 w; return to play:≥90%, between 26–39 w. The results indicate that the median increased over time to 39 postoperative weeks and then stabilized. For Single Hop Test, wide variability was seen at 12 and 16 weeks (interquartile range=20%); this was lower from 22 to 52 weeks (interquartile range=8–6%). At 12 weeks for Single Hop Test, the median was 83.6% and did not meet>85% criteria for return to participation. Hop tests could be interesting functional tests to follow the functional recovery and help decision-making regarding return to participation and return to play.

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Section: Discussionsupporting

confidence: 89%

“…12-16 weeks postoperatively [6,7]. RTS-2, which includes contact and side cutting activities, usually starts 26-39 weeks postoperatively [8][9][10].…”

Section: Evolution Of Functional Recovery Using Hop Test Assessment Amentioning

confidence: 99%

Section: Evolution Of Functional Recovery Using Hop Test Assessment Amentioning

confidence: 99%

Section: Evolution Of Functional Recovery Using Hop Test Assessment Amentioning

confidence: 99%

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Evolution of Functional Recovery using Hop Test Assessment after ACL Reconstruction

et al. 2020

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“…3 The days of rehabilitation and RTS progressions solely governed by time (eg, at 3 months the athlete starts running, at 5 months the athlete starts training and at 6 months the athlete starts unrestricted sport) should be long behind us. 62 However, tempering aggressive rehabilitation and RTS progression 40 63 to account for biology-healing of the ACL graft and recovery of neuromuscular function-is important because of the link between time since surgery and knee reinjury risk. 64 Criterion-based rehabilitation and RTS progressions should be evaluated with appropriate tests of impairments, activities, participation and contextual factors and combined with a minimum 9-month time criterion.…”

Section: Finding a Balance Between Respecting Biology And Increasing mentioning

confidence: 99%

Which criteria are used to clear patients to return to sport after primary ACL reconstruction? A scoping review

Burgi¹,

Peters²,

et al. 2019

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ObjectiveTo describe the criteria used to clear athletes to return to sport (RTS) following primary ACL reconstruction.DesignScoping review.Data sourcesMEDLINE, Embase, CINAHL and SPORTDiscus electronic databases were searched using keywords related to ACL and RTS.Eligibility criteriaProspective or retrospective studies reporting at least one RTS criterion for athletes who had primary ACL reconstruction with an autograft.ResultsIn total, 209 studies fulfilled the inclusion criteria. RTS criteria were categorised into six domains: time, strength, hop testing, clinical examination, patient-report and performance-based criteria. From the 209 included studies, time was used in 178 studies (85%), and in 88 studies (42%) was the sole RTS criterion. Strength tests were reported in 86 studies (41%). Sixteen different hop tests were used in 31 studies (15%). Clinical examination was used in 54 studies (26%), patient report in 26 studies (12%) and performance-based criteria in 41 studies (20%).SummaryTime and impairment-based measures dominated RTS criteria, despite sport being a complex physical and biopsychosocial activity with demands across all aspects of function. Time was included as a criterion in 85% of studies, and over 80% of studies allowed RTS before 9 months. Whether RTS tests are valid—do they predict successful RTS?—is largely unknown.

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Knee flexor strength at 6 months after anterior cruciate ligament reconstruction using hamstring tendon can be predicted from that at 3 months

Sengoku,

Nakase,

Mizuno

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThis study aimed to identify factors influencing persistent muscle weakness in knee flexor strength after anterior cruciate ligament (ACL) reconstruction using the hamstring tendon and establish a clear cut‐off value at 3 months postoperatively for the limb symmetry index (LSI) to exceed 90% at 6 months postoperatively.MethodsOne hundred forty‐eight patients undergoing ACL reconstruction were included and categorised into two groups based on knee flexor strength at 6 months postoperatively: patients with LSI of 90% or greater (achieved group: n = 114) and patients with LSI less than 85% (nonachieved group: n = 34). Items with significant differences between the two groups (preoperative waiting period, LSI to body weight ratio of knee flexor and extensor strength at 3 months postoperatively and peak torque angle of knee flexor muscle) were included in the multiple logistic regression analysis. Additionally, a receiver operating characteristic curve was used to calculate the cut‐off value of the LSI at 3 months postoperatively, which was required to achieve the LSI criteria for knee flexor strength 6 months postoperatively.ResultsMultiple logistic regression analysis extracted the preoperative waiting period and LSI for knee flexor strength at 3 months postoperatively. The cut‐off value at 3 months postoperatively was 76.9% (area under the curve value, 0.82; sensitivity, 0.76; and specificity, 0.81) of the LSI.ConclusionThe LSI of at least 76.9% for knee flexor strength at 3 months after ACL reconstruction was an indicator for achieving the 6 months postoperatively. This is a criterion to aim for, considering the stress on the graft and the regeneration process of the semitendinosus tendon.Level of evidenceLevel III.

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Criteria for return to running after anterior cruciate ligament reconstruction: a scoping review

Cited by 111 publications

References 66 publications

Evolution of Functional Recovery using Hop Test Assessment after ACL Reconstruction

Evolution of Functional Recovery using Hop Test Assessment after ACL Reconstruction

Which criteria are used to clear patients to return to sport after primary ACL reconstruction? A scoping review

Knee flexor strength at 6 months after anterior cruciate ligament reconstruction using hamstring tendon can be predicted from that at 3 months

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