Young Athletes Cleared for Sports Participation After Anterior Cruciate Ligament Reconstruction: How Many Actually Meet Recommended Return-to-Sport Criterion Cutoffs?

Abstract

Rupture of the anterior cruciate ligament (ACL) is a devastating injury that occurs with high frequency among individuals who participate in cutting and pivoting sports. 24,48 Anterior cruciate ligament reconstruction is commonly performed with the goal of facilitating return to sports activities. However, recent metaanalysis data from over 7000 participants following ACL reconstruction demonstrated that 65% returned to their previous level of sport and only 55% returned to competitive sports.3 Factors associated with a higher rate of return to preinjury level of sport participation were younger age, male sex, positive psychological U U STUDY DESIGN: Prospective cohort study. U U BACKGROUND: While meeting objective criterion cutoffs is recommended prior to return to sports following anterior cruciate ligament (ACL) reconstruction, the number of young athletes who meet recommended cutoffs and the impact of cutoffs on longitudinal sports participation are unknown. U U OBJECTIVES:To test the hypothesis that a higher proportion of young athletes who meet recommended cutoffs will maintain the same level of sports participation over the year following return-to-sport clearance compared to those who do not meet recommended cutoffs. U U METHODS:At the time of return-to-sport clearance, the International Knee Documentation Committee Subjective Knee Evaluation Form (IKDC), quadriceps and hamstring strength limb symmetry index (LSI), and single-leg hop test LSI were assessed. Proportions of participants who met individual (IKDC score of 90 or greater; strength and hop test LSIs of 90% or greater) and combined cutoffs were calculated. Proportions of participants who continued at the same level of sports participation over the year following returnto-sport clearance (assessed using the Tegner activity scale) were compared between those who met and did not meet cutoffs. U U RESULTS:Participants included 115 young athletes (88 female). The proportions meeting individual cutoffs ranged from 43.5% to 78.3%. The proportions meeting cutoffs for all hop tests, all strength tests, and all combined measures were 53.0%, 27.8%, and 13.9%, respectively. A higher proportion of participants who met cutoffs for both strength tests maintained the same level of sports participation over the year following return-tosport clearance than those who did not (81.3% versus 60.2%, P = .02). U U CONCLUSION:The proportions of young athletes after ACL reconstruction recently cleared for return to sports who met the combined criterion cutoffs were low. Those who met the criterion cutoffs for both strength tests maintained the same level of sports participation at higher proportions than those who did not. U U LEVEL OF EVIDENCE: Prognosis, level 2b.

Younger age and greater preoperative function predict compliance with 2-year follow-up visits after ACL reconstruction: an analysis of the PIVOT multicentre trial

“…This lack of follow-up is particularly concerning considering high rates of second ACL injury in younger, more active patients,10 and because only a minority of patients successfully fulfil return to sport battery testing when attempting to return to sport earlier than 1 year 11. Furthermore, continued follow-up may be necessary to fulfil objective strength tests associated with a return to same level of sports participation 12. Considering low rates of return to the same competitive level sport after ACLR (55%),13 it may be important for orthopaedic surgeons and/or physical therapists to continue follow-up past sport clearance, in order to assess deficiencies and optimise postsurgical rehabilitation.…”

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.…”

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.…”