Return to sport after anterior cruciate ligament injury: Panther Symposium ACL Injury Return to Sport Consensus Group

Abstract

ObjectivesA precise and consistent definition of return to sport (RTS) after anterior cruciate ligament (ACL) injury is lacking, and there is controversy surrounding the process of returning patients to sports and their previous activity level. The aim of the Panther Symposium ACL Injury RTS Consensus Group was to provide a clear definition of RTS after ACL injury and description of the RTS continuum, as well as provide clinical guidance on RTS testing and decision-making.MethodsAn international, multidisciplinary group of ACL experts convened as part of a consensus meeting. Consensus statements were developed using a modified Delphi method. Literature review was performed to report the supporting evidence.ResultsKey points include that RTS is characterised by achievement of the preinjury level of sport and involves a criteria-based progression from return to participation to RTS, and ultimately return to performance. Purely time-based RTS decision-making should be abandoned. Progression occurs along an RTS continuum with decision-making by a multidisciplinary group that incorporates objective physical examination data and validated and peer-reviewed RTS tests, which should involve functional assessment as well as psychological readiness. Consideration should be given to biological healing, contextual factors and concomitant injuries.ConclusionThe resultant consensus statements and scientific rationale aim to inform the reader of the complex process of RTS after ACL injury that occurs along a dynamic continuum. Research is needed to determine the ideal RTS test battery, the best implementation of psychological readiness testing and methods for the biological assessment of healing and recovery.

Reduced performance after return to competition in ACL injuries: an analysis on return to competition in the ‘ACL registry in German Football’

“…While professionals can hold their level of play in around 50% of the cases in the first three years after ACL injury, semi-professionals and amateur players suffer from low rates of players in the same league (semi-professional 22.4%; amateur 23.0%). The Panther Symposium on ACL Injuries described in a Consensus Statement as one main goal of the return to sport after ACL rupture the restorage of the previous performance level [ 20 ]. The high difference between professional and semi-professional or amateur players highlights the differences in rehabilitation capacity and medical support of the athletes.…”

“…The final decision regarding full return to play should be made in a multidisciplinary manner with orthopaedic surgeons, therapists and coaches involved and should be based on objective criteria (e.g. examinations, RTS test batteries) [ 19 , 20 ].…”

Reinjury Following Return to Play

“…52 Standardization of rehabilitation programs and consensus on how to prepare patients for successful RTP is lacking; however, current evidence points toward the benefits of individualized RTP processes. 53 According to a recent consensus statement, the RTP decision is multifactorial and should consider not only time from injury but also treatment, clinical exam, RTP testing, assessment of psychological readiness, and sport-specific conditions. 54 This consensus group acknowledged that time to RTP is variable and based on individual differences in biological healing, resolution of impairment, neuromuscular control, functional skills, and psychological readiness.…”

Tips and Tricks for Anatomic ACL Reconstruction With Soft-Tissue Quadriceps Tendon and Remnant Repair

“…Return to sport following ACL-R is really a continuum, as published in 2021 from our 2019 Panther Symposium. 4,5 There is usually about 9 to 12 months of return to play time based on return to sport testing performance.…”