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

Abstract

Background: A 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 sport and their previous activity level. Purpose: The aim of the Panther Symposium ACL Injury Return to Sport Consensus Group was to provide a clear definition of RTS after ACL injury and a description of the RTS continuum as well as provide clinical guidance on RTS testing and decision-making. Study Design: Consensus statement. Methods: An 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. Results: Key points include that RTS is characterized 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 timebased 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. Conclusion: The 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.

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

“…More tests, thus, increase the demands on the patient's recovery after ACL reconstruction. When 5 MF tests with or without 2 PROs were used, the passing rate, compared with only 2 hop tests, the passing rates decreased from 47% to approximately 13% and 29%, Current recommendations for RTS evaluation are strongly supported by results from the present study, suggesting that batteries of tests should comprise strength and hop tests, as well as PROs [36,37]. In our cohort, a very small proportion of patients met our recommended RTS criteria at 1 year after ACL reconstruction.…”

Clinical Outcomes After Anterior Cruciate Ligament Injury: Panther Symposium ACL Injury Clinical Outcomes Consensus Group

“…A consensus statement related to assessment and reporting of RTS was similarly reached at the ACL Consensus Meeting Panther Symposium 2019 and is provided in a separate publication. 67 …”

“…A consensus statement related to assessment and reporting of RTS was similarly reached at the ACL Consensus Meeting Panther Symposium 2019 and is provided in a separate publication. 67 A comprehensive assessment also implies that the contralateral knee should be examined and assessed for each outcome. Outcome tools such as the IKDC Knee Ligament Standard Evaluation Form 45 require a comparison with the contralateral knee for the standardized reporting.…”

Clinical outcomes after anterior cruciate ligament injury: Panther Symposium ACL Injury Clinical Outcomes Consensus Group

“…A consensus statement related to assessment and reporting of RTS was similarly reached at the ACL Consensus Meeting Panther Symposium 2019 and is provided in a separate publication. 50 A comprehensive assessment also implies that the contralateral knee should be examined and assessed for each outcome. Outcome tools such as the IKDC Knee Ligament Standard Evaluation Form 20 require a comparison with the contralateral knee for the standardised reporting.…”