WHAT IS THE EVIDENCE FOR AND VALIDITY OF RETURN-TO-SPORT TESTING AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION SURGERY? A SYSTEMATIC REVIEW AND META-ANALYSIS

Review written by Dr Bart Dingenen info

BACKGROUND & OBJECTIVE

When can I return to sport (RTS) after my anterior cruciate ligament (ACL) reconstruction? This is probably the most frequently asked question of patients after ACL reconstruction. Different RTS test batteries have been proposed in the literature (1). However, there is currently no gold standard for evaluating return to sport (RTS) readiness after anterior cruciate ligament reconstruction (2). Time and impairment-based measures continue to dominate RTS criteria, despite suggestions to use a multifactorial approach within a biopsychosocial perspective (2). In addition, the risk of sustaining a second ACL injury after RTS is relatively high, especially in young athletes (3).

The objective of this systematic review and meta-analysis was to determine:

(1) what proportion of patients pass RTS test batteries (2) whether passing RTS test batteries is associated with increased rates of RTS (3) whether passing a RTS test battery reduces the risk of subsequent knee or second ACL injury.

While the risk of sustaining an ipsilateral ACL re-injury decreased by 60% from passing RTS tests, the risk of sustaining a contralateral ACL injury increased by 235%.

METHODS

Different electronic databases were searched up to May 2018. In addition, a detailed manual search strategy was employed to make sure no studies were missed. Studies were included if they met the following criteria:

(1) English language (2) included participants who had undergone ACL reconstruction (3) used a RTS test battery (4) reported the number of participants passing the test battery

Two reviewers applied the search strategy and applied the selection criteria. A specific checklist was used to assess the methodological quality of the included studies. The data from each study were extracted in order to answer the objectives of this review.

RESULTS

18 studies were finally included in one or more of the meta-analyses. A variety of RTS tests were used. The most commonly used criteria were quadriceps strength and hop tests. A limb symmetry index of ≥90% was the most commonly

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