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Radwan A1,2, Schilling D1
1Utica College, Doctor of Physical Therapy Program, Utica, United States, 2Utica College, Center for Ergonomics Analysis and Research (CEAR), Utica, United States
Background: The decision to return to sports after completing rehabilitation related to anterior cruciate ligament (ACL) reconstruction surgery is often based on medical clearance and the rehabilitation teams' decision regarding the level of physical readiness of the athlete. The majorities of the currently available assessment tools used with these athletes focus on the athlete's lower extremity performance and compare the operated and non-operated sides. Unfortunately, even with medical clearance and successful rehabilitation, re-injury rates and contralateral lower extremity injuries have been increasing and are approaching 25-30% respectively in certain cohorts like young female athletes.
Purpose: The purpose of this study is to incorporate a holistic assessment strategy to enable better assessment of the recovery of the athlete and determine how prepared they are to return to sports after being medically cleared.
Methods: Twenty one participants (7 males and 14 females) with ACL reconstruction who had completed rehabilitation and received medical clearance to return to sport were recruited for this study. The subjects mean age (20.3 ±1.7 years), mean weight (75.1 ±18.6 kg), mean height (1.7 ±.11 m) and the period following reconstruction ranged from 6 to 71 months.
The assessment of athletes performance included a detailed 2D motion analysis of the lower extremity and trunk joints while performing a single leg squat and landing activities, force plate assessment for their single-leg landing performance, balance testing utilizing the Y excursion balance test, core stability testing using the side plank test and double leg lowering test and functional knee performance testing utilizing the triple hop for distance.
Results: Following detailed within subject analysis of difference, there was a significant decrease in vertical ground reaction force of landing on the operated sides compared to the non-operated sides (t = 2.86, p = 0.01). Operated sides had less knee flexion and more knee valgus on landing compared to non-operated sides, however, the differences were not statistically significant. Similarly, the balance index scores were significantly lower on the operated sides (t = 3.95, p = 0.001), the triple hop functional knee test for distance was significantly reduced compared to the non-operated lower extremities (t = 2.57, p = 0.01). Participants had an average of grade 3 core stability as measured by the double leg lowering test.
Conclusion(s): Participants continued to show a reduction in the operated legs' balance abilities, functional performance, and landing force behaviors despite completing rehabilitation and being medically cleared to return to sports. Long lasting deficiencies in the athletes operated legs' function (despite medical clearance) may explain the increased tendencies for re-injury.
Implications: It is recommended that a thorough assessment of the athlete's performance through this battery of clinical tests be performed to identify deficiencies prior to competitive sports participation. Using such a performance evaluation tool will aide in objectifying the clinical decision-making used to determine the athletes' readiness to return to sport and attempt to reduce the chance of re-injuries
Keywords: ACL, Return to Sport, Clinical Assessment
Funding acknowledgements: NA
Purpose: The purpose of this study is to incorporate a holistic assessment strategy to enable better assessment of the recovery of the athlete and determine how prepared they are to return to sports after being medically cleared.
Methods: Twenty one participants (7 males and 14 females) with ACL reconstruction who had completed rehabilitation and received medical clearance to return to sport were recruited for this study. The subjects mean age (20.3 ±1.7 years), mean weight (75.1 ±18.6 kg), mean height (1.7 ±.11 m) and the period following reconstruction ranged from 6 to 71 months.
The assessment of athletes performance included a detailed 2D motion analysis of the lower extremity and trunk joints while performing a single leg squat and landing activities, force plate assessment for their single-leg landing performance, balance testing utilizing the Y excursion balance test, core stability testing using the side plank test and double leg lowering test and functional knee performance testing utilizing the triple hop for distance.
Results: Following detailed within subject analysis of difference, there was a significant decrease in vertical ground reaction force of landing on the operated sides compared to the non-operated sides (t = 2.86, p = 0.01). Operated sides had less knee flexion and more knee valgus on landing compared to non-operated sides, however, the differences were not statistically significant. Similarly, the balance index scores were significantly lower on the operated sides (t = 3.95, p = 0.001), the triple hop functional knee test for distance was significantly reduced compared to the non-operated lower extremities (t = 2.57, p = 0.01). Participants had an average of grade 3 core stability as measured by the double leg lowering test.
Conclusion(s): Participants continued to show a reduction in the operated legs' balance abilities, functional performance, and landing force behaviors despite completing rehabilitation and being medically cleared to return to sports. Long lasting deficiencies in the athletes operated legs' function (despite medical clearance) may explain the increased tendencies for re-injury.
Implications: It is recommended that a thorough assessment of the athlete's performance through this battery of clinical tests be performed to identify deficiencies prior to competitive sports participation. Using such a performance evaluation tool will aide in objectifying the clinical decision-making used to determine the athletes' readiness to return to sport and attempt to reduce the chance of re-injuries
Keywords: ACL, Return to Sport, Clinical Assessment
Funding acknowledgements: NA
Topic: Musculoskeletal: lower limb; Human movement analysis; Sport & sports injuries
Ethics approval required: Yes
Institution: Utica College, Utica, NY, USA
Ethics committee: Institutional Review Board (IRB)
Ethics number: 724
All authors, affiliations and abstracts have been published as submitted.
