Return to Sport After ACL Reconstruction

Abstract

Objective guidelines permitting safe return to sport following anterior cruciate ligament (ACL) reconstruction are infrequently used. The purpose of this study was to determine the published return to sport guidelines following ACL reconstruction in Level I randomized controlled trials. A systematic review was performed using Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Level I randomized controlled trials were included if they reported a minimum 2-year follow-up after ACL reconstruction and return to sport criteria. Outcomes analyzed were the timing of initiation of return to sport, follow-up duration, and use of quantitative/qualitative criteria to determine return to sport. Forty-nine studies were included (N=4178; 68% male; mean patient age, 27.5±3.2 years; mean follow-up, 3.0±1.9 years; mean time from injury to reconstruction, 379±321 days). Ninety-six percent of reconstructions used autograft and 87% were single-bundle reconstructions. Lysholm score, single-leg hop, isokinetic strength, and KT-1000 or KT-2000 arthrometer (MEDmetric, San Diego, California) testing were performed in 67%, 31%, 31%, and 82% of studies, respectively. Only 5 studies reported whether patients were able to successfully return to sport. Ninety percent and 65% of studies failed to use objective criteria or any criteria, respectively, to permit return to sport. Description of permission/allowance to return to sport was highly variable and poor. Twenty-four percent of studies failed to report when patients were allowed return to sport without restrictions. Overall, 39%, 45%, and 51% of studies permitted running at 3 months, return to cutting/pivoting sports at 6 months, and return to sport without restrictions at 6 months, respectively. Further research into validated return to sport guidelines is necessary to fill the existing void in contemporary literature and to guide clinical practice.

Asymmetrical Lower Extremity Loading Early After Anterior Cruciate Ligament Reconstruction Is a Significant Predictor of Asymmetrical Loading at the Time of Return to Sport

“…Six months is often reported as the time for return to sports. 15 We hypothesized that LSI of STS may predict LSI of CMJ even after accounting for deficits in knee joint range of motion and LSI of maximal isometric strength, which are other early determinants for the recovery of lower extremity loading symmetry.…”

ACL Return to Sport Guidelines and Criteria

“…Moreover, weight bearing or nonweight bearing angular joint replication testing can also be performed to measure proprioception of the knee. As a result of the report loss of proprioception following an ACL injury, angular joint replication testing is absolutely key [25]. Several recent studies [26][27][28][29] have also discussed and stressed the importance of knee proprioception following an ACL injury for the long-term health of the knee.…”

Biomechanical Adaptations After Fatiguing Exercise in Healthy and ACL Reconstructed Individuals

“…48,91 The single-leg hop test is one of the most popular tests for assessing functional performance, 35 however the hop test is unable to predict injury and is not able to track meaningful gains in function as time from surgery increases. 71,79 Therefore, return to play decision-making should include a number of other factors other than just patient-reported outcomes and laboratory measures of functional outcomes. 36 These measures should include sport-specific outcomes 16 as well as appreciation for sport risk modifiers and decision modifiers.…”

“…There is a need for a clinic-friendly measure that is easy to perform, affordable, and can be done in a variety of settings, to evaluate performance deterioration in individuals with ACLR. The most common methods of evaluating readiness to return to sport after ACLR are quadriceps strength and functional performance on hopping tests, 2,71 however is it unclear if symmetry on these tests predict changes in running gait after exercise when injury risk is highest.…”

“…120 Knee extensor strength is one of the most commonly used assessments in return to play decisions. 71 Quadriceps strength of the ACLR limb is often evaluated in comparison to the contralateral limb for a measure of limb symmetry index. 24,168 Quadriceps strength asymmetry is present after initial ACL injury and increases six months after reconstruction.…”