Deficits in Contralateral Limb Strength Can Overestimate Limb Symmetry Index After Anterior Cruciate Ligament Reconstruction

Moran, Thomas E.; Ignozzi, Anthony J.; Burnett, Zachary; Bodkin, Stephan; Hart, Joseph M.; Werner, Brian C.

doi:10.1016/j.asmr.2022.06.018

Cited by 7 publications

(4 citation statements)

References 30 publications

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“… 5 , 6 Using the TSA to determine physical readiness may overcome some of the limitations associated with RTS testing. First, the TSA avoids the need for passing tests using symmetry alone, reducing the overestimation of recovery rates (using the potentially deteriorated contralateral limb), 29 , 53 and includes comparative data from matched healthy controls. Furthermore, this approach avoids the normal reduction in the probability of passing when there is a requirement to obtain a specific score across multiple tests.…”

Section: Discussionmentioning

confidence: 99%

Total Score of Athleticism: Profiling Strength and Power Characteristics in Professional Soccer Players After Anterior Cruciate Ligament Reconstruction to Assess Readiness to Return to Sport

Maestroni,

Turner,

Papadopoulos

et al. 2023

Am J Sports Med

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Background: There is no consensus on the optimal testing procedure to determine return-to-sport (RTS) readiness after anterior cruciate ligament (ACL) reconstruction. Current approaches use limb symmetry across a range of tests, but this does not consider a patient’s level of athleticism or benchmarks relative to his or her noninjured counterparts. Purpose: To examine the utility of the Total Score of Athleticism (TSA), a composite scale including strength, power, and reactive strength assessments, to aid RTS decision-making. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 95 professional soccer players (60 who underwent ACL reconstruction [mean age, 25.1 ± 12.6 years] and 35 who were uninjured [mean age, 23.8 ± 2.8 years]) completed a battery of tests including isokinetic knee extension and flexion torque, bilateral and unilateral countermovement jump height, relative peak power, and reactive strength index–modified. The TSA score (derived from Z scores) was calculated, and we (1) examined differences between the ACL-reconstructed and uninjured groups at the time of RTS, (2) assessed the predictive ability of the TSA to identify the player’s status (ACL reconstruction vs uninjured control), and (3) included a case series to discuss the characteristics of players who sustained a subsequent injury within 4 months after RTS. Results: A large difference between the ACL-reconstructed and uninjured groups in the TSA score ( d = 0.84; P < .0001) was evident. For every additional increase of 1 unit in the TSA score, the odds of belonging to the ACL-reconstructed group decreased by 74% (95% CI, 0.19-0.56). By visual inspection, the frequency of reinjured players was higher in the low (4/7) TSA tertile compared with the medium (2/7) and high (1/7) TSA tertiles. Conclusion: Preliminary evidence indicates that the TSA may be a useful RTS readiness tool, as the composite score derived from strength and power measures was different in soccer players at the time of RTS after ACL reconstruction compared with healthy matched controls. There was also a higher frequency of low TSA scores in players who sustained a second injury after RTS. Therefore, it is recommended to routinely administer RTS tests encompassing strength, power, and reactive strength qualities each season across the largest possible number of players (ideally teammates).

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Section: Discussionmentioning

confidence: 99%

Total Score of Athleticism: Profiling Strength and Power Characteristics in Professional Soccer Players After Anterior Cruciate Ligament Reconstruction to Assess Readiness to Return to Sport

Maestroni,

Turner,

Papadopoulos

et al. 2023

Am J Sports Med

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“…These results suggest that caution should be applied when using the contralateral uninjured limb as a measure of "normal" performance. Previous research has identified the potential flaw of between-limb comparisons after ACLR, as the contralateral uninjured limb has been shown to have deficits in strength and activation (92)(93)(94)(95). It is possible that this relationship extends to measures of jump performance, which future research should aim to investigate.…”

Section: Discussionmentioning

confidence: 99%

Vertical Jump Testing after Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis

DUTAILLIS,

DIAMOND,

LAZARCZUK

et al. 2023

Medicine &Amp; Science in Sports &Amp; Exercise

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Introduction Recently, there has been a call for vertical jump testing via force-plate analysis to be included in the assessment of individuals following anterior cruciate ligament reconstruction (ACLR) and as part of return to play criteria. However, a synthesis of current literature is needed to help guide clinicians on what tests to perform, which force-plate metrics to assess and how these may change over the time-course of rehabilitation. Methods Four online databases were searched from inception to July 2022. The Downs and Black checklist was used to assess study quality. Multilevel meta-analyses and meta-regressions were undertaken in conjunction with a best evidence synthesis. Results Forty-two articles were included, capturing 2375 participants with a history of ACLR. Reconstructed limbs displayed 1) lower peak eccentric forces, concentric forces, landing forces, and lower eccentric and concentric impulses (SMD = -1.84 to -0.46) than uninjured contralateral limbs during bilateral countermovement jumps (CMJ) and drop vertical jumps (DVJ); 2) lower jump heights and reactive strength indices (RSI), and longer contact times than uninjured contralateral limbs during unilateral CMJ and DVJ (SMD = -0.86 to 0.26); and 3) lower jump heights, RSI and longer contact times during bilateral and unilateral CMJ, and unilateral DVJ, than uninjured controls (SMD = -1.19 to 1.08). Meta-regression revealed that time post-surgery was a significant moderator (P < 0.05) for, 1) bilateral CMJ height, peak concentric force and peak landing force; 2) between-limb differences in unilateral CMJ height; and 3) differences in unilateral DVJ height, RSI and contact time between reconstructed limbs and healthy controls with no history of injury. Conclusions Individuals with a history of ACLR display chronic deficits in vertical jumping performance during a range of bilateral and unilateral tasks, which may have implications for return to play criteria and the design of interventions targeted at restoring long-term deficits in explosive lower limb strength following ACLR.

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“…28,50,52,53 Therefore, it remains questionable whether interlimb symmetry is a reliable marker for a RTS decision. 54,55 Also, the ratio between the extremities does not consider absolute performance results. Normalized data for jump and hop tests are necessary.…”

Section: Functional Tests Reveal Major Deficits In Knee Capability Me...mentioning

confidence: 99%

Evaluation of the Back-in-Action test Battery In Uninjured High School American Football Players

Rohde

Rühlemann

Busch

et al. 2023

International Journal of Sports Physical Therapy

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Background Return to sport testing is an established routine, especially for athletes who have ruptured their anterior cruciate ligament (ACL). Various tests are performed, often combined in test batteries, such as the Back-in-action (BIA) test battery. Unfortunately, pre-injury performance is often unknown, and only few athletes pass the high demands of these test batteries. Purpose The aim of the study was to determine the performance of under 18 American football players on the BIA to establish pre-injury sport specific benchmarks for future RTS testing and to compare these values to data from an age-matched reference group. Methods Fifty-three healthy male American football players underwent a functional assessment using the “Back-in-action” test battery evaluating agility, speed (Parkour-Jumps and Quick-Feet test), balance (using a PC based balance board), and power (Counter-Movement-Jump [CMJ]) as objective measures. Their results were compared with a previously tested reference group (RP) and within the american football players (AF) through three subgroups according to field playing position. Results Overall, the American football (AF) athletes showed lower balance scores for both legs (AF: 3.71/3.57/3.61; RP: 3.4/3.2/3.2; p<0.002) compared to the reference population (RP). CMJ height and Quick-Feet results were not statistically different (p>0.05), Parkour-Jump times (AF: 8.18/ 8.13 sec.; RP: 5.9/5.9sec.; p<0.001) were significantly slower. Power output in all CMJ’s (AF: 46.86/36.94/37.36 W/kg; RP: 43.2/29.5/29 W/kg; p<0.001) was significantly higher than the RP. Passing and running game involved players (G2 & G3) showed significantly better balance scores (G2+G3: 3.36/3.27/3.33; G1: 4.22/4.06/4.10; p<0.001), higher jump height (G2&G3: 38.87/24.02/24.96 cm; G1: 32.03/19.50/18.96 cm; p<0.001) and more watts/kg (G2&G3: 48.83/37.21/37.64 W/kg; G1: 43.95/36.88/36.53 W/kg; p<0.001) compared to blocking players like Linemen (G1) and to the age matched reference population (RP). Conclusion Only 53% of the healthy athletes would have been cleared for sport using the BIA test criteria, which highlights the challenging passing criteria. Despite significantly greater power measurements, scores of balance and agility were poorer compared to the reference group, especially for linemen. These data may serve as sport and position specific reference for high school American football players, instead of using the non-specific reference group data. Study design cross-sectional study- Level of evidence IIb

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Deficits in Contralateral Limb Strength Can Overestimate Limb Symmetry Index After Anterior Cruciate Ligament Reconstruction

Cited by 7 publications

References 30 publications

Total Score of Athleticism: Profiling Strength and Power Characteristics in Professional Soccer Players After Anterior Cruciate Ligament Reconstruction to Assess Readiness to Return to Sport

Total Score of Athleticism: Profiling Strength and Power Characteristics in Professional Soccer Players After Anterior Cruciate Ligament Reconstruction to Assess Readiness to Return to Sport

Vertical Jump Testing after Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis

Evaluation of the Back-in-Action test Battery In Uninjured High School American Football Players

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