Low Rate of Return to Preinjury Tegner Activity Level Among Recreational Athletes: Results at 1 Year After Primary ACL Reconstruction

Abstract

Background: There is limited information about the functional recovery and rate of return to preinjury levels of sports among recreational athletes after anterior cruciate ligament reconstruction (ACLR). Purpose: To investigate the recovery of quadriceps or hamstring strength, assess functional performance, and determine the rate of return to preinjury sports levels among recreational athletes at 1 year after ACLR. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 91 recreational-level athletes who underwent anatomic single-bundle ACLR were enrolled. We evaluated the limb symmetry index (LSI) of the quadriceps and hamstring peak torque strength at 60°, in addition to hop test performance (single-leg, triple, crossover, and 6-m timed), patient-reported outcomes, and pre- versus postoperative Tegner activity levels. Outcomes were compared between younger (age <25 years) and older patients (age ≥25 years). Results: There were 48 patients in the younger group and 43 patients in the older group. At 1-year follow-up, the overall LSIs for quadriceps strength and hamstring strength were 77% and 86%, respectively, and the LSIs of the hop tests were 79% for single-leg, 81% for triple, 84% for crossover, and 85% for 6-m timed hop. Overall, only 24% patients returned to their preinjury Tegner level, and only 8% of patients met the criteria for return to pivoting, cutting, and jumping sports. At 1-year follow-up, the younger group showed significantly more quadriceps strength than the older group (85% vs 64%; P = .0001), better single, triple, crossover, and 6-m timed hop test results (85% vs 69%, P = .003; 84% vs 75%, P = .046; 91% vs. 74%, P < .001; and 91% vs 76%, P = .003, respectively), higher Lysholm score (87 vs 74; P < 0.001) and International Knee Document Committee score (82 vs 66; P < .001), and a higher rate of return to preinjury Tegner level (35% vs 12%; P = .009). Conclusion: Only 24% of patients returned to the preinjury Tegner level at 1 year after ACLR (35% younger group vs 12% older group; P = .009). This information might be helpful in setting realistic expectations for recreational athletes after surgery.

Evidence for isokinetic and functional testing in return to sport decisions following ACL surgery

“…The rate of return to sport is higher in athletes younger than 19 years, at all levels of participation 12 . Elite athletes show the highest rate of return to preinjury level sport (83%) but with decreased performance 13,14 whereas recreational athletes show a low return rate after 1 year 15 . The rate of return to the same preinjury‐level of sports participation may be higher in athletes with high motivation and excellent resources such as professional athletes 16,17 …”

Dynamic balance and explosive strength appears to better explain single leg hop test results among young elite female basketball athletes

“…Indeed, the hop test is a widely used tool to assess the functional capacity of the lower limb, requesting a propulsive action to perform a horizontal jump and landing 7 . Its results have a functional implication, since they are useful in predicting the risk of lower limb injuries 8 , detecting functional improvements 9 , and guiding return-to sport decisions 10 . The study of its psychometric properties has demonstrated that it is a valid and reliable tool for functional assessment 11 , 12 , which has led to its recommended used in the field of sports in the context of both prevention and recovery from injuries 7 .…”

“…Indeed, the hop test is a widely used tool to assess the functional capacity of the lower limb, requesting a propulsive action to perform a horizontal jump and landing 7 . Its results have a functional implication, since they are useful in predicting the risk of lower limb injuries 8 , detecting functional improvements 9 , and guiding return-to sport decisions 10 . The study of OPEN 1 Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Calle Gascó Oliag 5, 46010 Valencia, Spain.…”

Explosive strength and dynamic balance as determinants of the single leg hop test: cross-sectional study among young elite female basketball athletes

“…Indeed, the hop test is a widely used tool to assess the functional capacity of the lower limb, requesting a propulsive action to perform a horizontal jump and landing [7]. Its results have a functional implication, since they are useful in predicting the risk of lower limb injuries [8], detecting functional improvements [9], and guiding return-to sport decisions [10]. The study of its psychometric properties has demonstrated that it is a valid and reliable tool for functional assessment [11,12], which has led to its recommended used in the eld of sports in the context of both prevention and recovery from injuries [7].…”