Estimating Return to Sport Post-ACL injury

Authors

Affiliations

Nate Yomogida, B.S., SPT

Doctor of Physical Therapy

B.S. in Kinesiology

Chloë Kerstein, B.S., SPT

Doctor of Physical Therapy

B.A. in Neuroscience

Reading list

• The Need To Change Return to Play Testing in Athletes Following ACL Injury: A Theoretical Model¹
• Rehabilitation Principles of the Anterior Cruciate Ligament Reconstructed Knee: Twelve Steps for Successful Progression and Return to Play²

Limb Index Symmetry

Pros

• Better than pure strength assessment
  • Simonson (2023) found that an increased risk of a second ACL injury with every 1 N·m/kg increase in relative quadriceps strength on the ACL-reconstructed side³
  • No effect of relative quad strength on risk of second ACL injury when adjusting for symmetrical quadriceps strength³

Cons

• Limb Symmetry Indexes Can Overestimate Knee Function After Anterior Cruciate Ligament Injury⁴
• May not be effective at predicting reinjury
  • “quadriceps strength and symmetry at 6 months did not predict reinjury; however, every month that RTA was delayed decreased the probability of subsequent injury by 28%”⁵

Psychological Readiness

• ACL-RSI

References

1.

Wilk K, Thomas ZM, Arrigo CA, Davies GJ. The Need To Change Return to Play Testing in Athletes Following ACL Injury: A Theoretical Model. International Journal of Sports Physical Therapy. 2023;18(1):272-281. doi:10.26603/001c.67988

2.

Wilk KE, Arrigo CA. Rehabilitation Principles of the Anterior Cruciate Ligament Reconstructed Knee: Twelve Steps for Successful Progression and Return to Play. Clinics in Sports Medicine. 2017;36(1):189-232. doi:10.1016/j.csm.2016.08.012

3.

Simonson R, Piussi R, Högberg J, et al. Effect of Quadriceps and Hamstring Strength Relative to Body Weight on Risk of a Second ACL Injury: A Cohort Study of 835 Patients Who Returned to Sport After ACL Reconstruction. Orthopaedic Journal of Sports Medicine. 2023;11(4):23259671231157386. doi:10.1177/23259671231157386

4.

Wellsandt E, Failla MJ, Snyder-Mackler L. Limb Symmetry Indexes Can Overestimate Knee Function After Anterior Cruciate Ligament Injury. The Journal of Orthopaedic and Sports Physical Therapy. 2017;47(5):334-338. doi:10.2519/jospt.2017.7285

5.

Bodkin SG, Hertel J, Diduch DR, et al. Predicting Anterior Cruciate Ligament Reinjury From Return-to-Activity Assessments at 6 Months Postsurgery: A Prospective Cohort Study. Journal of Athletic Training. 2022;57(4):325-333. doi:10.4085/1062-6050-0407.20