Low rates of patients meeting return to sport criteria 9 months after anterior cruciate ligament reconstruction: a prospective longitudinal study

Abstract

PurposeThe purpose of the current prospective study was to assess the changes over time in patients tested at 6 months and 9 months after anterior cruciate ligament reconstruction (ACLR) with a return to sport (RTS) test battery. It was hypothesized that more patients passed RTS criteria at 9 months compared to 6 months.MethodsSixty-two ACLR patients performed a test battery at an average of 6.5 ± 0.7 and 9.5 ± 0.9 months after ACLR. All patients underwent a standardized rehabilitation protocol. The test battery consisted of the following tests: a jump-landing task assessed with the Landing Error Scoring System (LESS), three single-leg hop tasks (single-leg hop test, triple-leg hop test, side hop test), isokinetic quadriceps and hamstring strength at 60, 180 and 300°/s and two questionnaires (IKDC and ACL–RSI). Cut off criteria were set as Limb Symmetry Index (LSI) > 90% (for isokinetic strength and for single-leg hop tasks), LESS < 5, IKDC score within 15th percentage of healthy subjects and ACL–RSI > 56 respectively.ResultsAt 6 months, two patients (3.2%) passed all criteria. At 9 months, seven patients (11.3%) passed all criteria. Patients improved in all RTS criteria over time except for the IKDC score. Twenty-nine patients (46.8%) did not pass the strength criterion at 60°/s at 9 months after ACLR.ConclusionsThe percentages of patients passing all RTS criteria were low at both 6 and 9 months after ACLR. Quadriceps strength revealed persistent deficits and the lack of improvement in the IKDC score questionnaires shows insufficient self-reported knee function for RTS.Level of evidenceIII.

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

“…Patient-report criteria were used in 26 (12%) of the 209 studies and included the subcategories patient-reported outcome measures (PROMs), subjective statements and reports of pain (table 7). Six studies [37][38][39][40][41][42] (3%) used one outcome measure, and two studies 43 44 (1%) used two measures. One study 45 reported pain and subjective reports as RTS criteria and one study 40 used PROMs and subjective statements as RTS criteria.…”

“…In at least one recent study, a movement quality test (Landing Error Scoring System) was used as part of a RTS test battery along with the International Knee Documentation Committee subjective knee form and the ACL-Return to Sport after Injury scale. 42 All of the studies included in our scoping review were focused on the RTS element of the RTS continuum (figure 4). 9 However, for many athletes, return to performance-the third element of the RTS continuum-is their primary focus.…”

Contractile rate of force development after anterior cruciate ligament reconstruction—a comprehensive review and meta‐analysis

“…35 Among young active ACLR individuals, less than half may fulfill a ≥90% LSI criterion for quadriceps strength. 7,36,37 Within ACLinjured adults, Welling et al 38 reported that only 13 patients out of 62 (21%) reached ≥90% LSI criterion for quadriceps strength 9 months after ACLR. In a study by Cristiani et al 8 where 4093 patients were assessed 6 months after ACLR, 36% and 47% reached the ≥90% LSI criterion for quadriceps and hamstring strength, respectively.…”

Hop tests and psychological PROs provide a demanding and clinician-friendly RTS assessment of patients after ACL reconstruction, a registry study.

“…Results from only hop performance can be insufficient as RTS criteria. Furthermore, as demands increase by adding more MF tests, the passing rate (the proportion of patients reaching a given cutoff value) is reduced [16][17][18]. It is, however, unknown if adding an assessment of psychological outcome to MF tests will result in different passing rates, resulting in a better foundation for decisions on RTS.…”