YOUNG ATHLETES AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION CLEARED FOR SPORTS PARTICIPATION: HOW MANY ACTUALLY MEET RECOMMENDED RETURN-TO-SPORT CRITERIA CUTOFFS?

Review written by Dr Bart Dingenen info

BACKGROUND & OBJECTIVE

A 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. No gold standard exists to evaluate return-to-sport (RTS) readiness after ACL reconstruction (ACLR). Long-term outcomes are often disappointing with low RTS rates and high re-injury rates. The objectives of this study were to describe the proportion of athletes after ACLR cleared for sports participation who met individual and combined recommended RTS criteria cutoffs, and to test the hypothesis that a higher proportion of athletes who met recommended RTS criteria cutoffs would maintain the same level of sports participation from the time of RTS clearance to one year post-RTS clearance compared to athletes who did not meet cutoffs.

METHODS

Participants included 115 young high-level athletes (mean age at RTS clearance: 17.1 ± 2.5 years; 88 females and 27 males). Mean time from ACLR to baseline testing at RTS clearance was 8.2 ± 2.4 months. All participants had a primary unilateral ACLR, completed rehabilitation and were cleared for unrestricted sports participation by their surgeon and treating rehabilitation specialist. Quadriceps strength, hamstrings strength (isokinetic dynamometer at 180°/s), single-leg hop tests, the IKDC subjective knee form score and sport participation (Tegner activity scale) were assessed. Proportions of participants meeting individual (IKDC ≥90; strength and hop test Limb Symmetry Index (LSI) ≥90%) and combined cutoffs were calculated. Proportions of participants who continued at the same level of sports participation over the year following RTS clearance were compared between those who met and did not meet cutoffs.

RESULTS

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

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