Muscle strength and hop performance criteria prior to return to sports after ACL reconstruction

Department of Orthopaedics, Lundberg Laboratory for Orthopaedic Research, Sahlgrenska University Hospital, 413 45 Göteborg, Sweden.
Knee Surgery Sports Traumatology Arthroscopy (Impact Factor: 2.84). 09/2011; 19(11):1798-805. DOI: 10.1007/s00167-011-1669-8
Source: PubMed

ABSTRACT The purpose of this article is to present recommendations for new muscle strength and hop performance criteria prior to a return to sports after anterior cruciate ligament (ACL) reconstruction.
A search was made of relevant literature relating to muscle function, self-reported questionnaires on symptoms, function and knee-related quality of life, as well as the rate of re-injury, the rate of return to sports and the development of osteoarthritis after ACL reconstruction. The literature was reviewed and discussed by the European Board of Sports Rehabilitation in order to reach consensus on criteria for muscle strength and hop performance prior to a return to sports.
The majority of athletes that sustain an (ACL) injury do not successfully return to their pre-injury sport, even though most athletes achieve what is considered to be acceptable muscle function. On self-reported questionnaires, the athletes report high ratings for fear of re-injury, low ratings for their knee function during sports and low ratings for their knee-related quality of life.
The conclusion is that the muscle function tests that are commonly used are not demanding enough or not sensitive enough to identify differences between injured and non-injured sides. Recommendations for new criteria are given for the sports medicine community to consider, before allowing an athlete to return to sports after an ACL reconstruction.

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Available from: Barbara Wondrasch, Aug 01, 2015
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    • "However, asymmetry indexes are typically described as percentage values (Carpes et al., 2010). Typically, a benchmark of >90% concurrence of the injured limb measure relative to the uninjured limb is used to determine satisfactory recovery of function following an anterior cruciate reconstruction (Thomeé et al., 2011, 2012), though has been reported as low as 80% (Eastlack, Axe, & Snyder-Mackler, 1999; Holsgaard-Larsen, Jensen, Mortensen, & Aagaard, 2014) or as high as 95% (Thomeé et al., 2012). "
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    ABSTRACT: Lower limb dominance (or lateral preference) could potentially effect functional performance. Clinicians are often asked to make judgements as to when a patient has sufficiently "recovered" from an injury, typically using strength and dynamic performance outcome measures. The primary purpose of this study was to systematically review the literature in relation to limb dominance within active adult populations and discuss some limitations to current methods and relate this to current clinical practice. A search of MEDLINE and CINAHL and EMBASE databases and reference lists of those articles identified was performed. Eleven articles were selected for meta-analysis. There was no statistical effect of limb dominance for any of the functional tests: isokinetic quadriceps and hamstring tests, hamstring:quadriceps ratios, single-leg hop for distance, single-leg vertical jump and vertical ground reaction force following a single-leg vertical jump. Pooled symmetry values varied from 94.6% to 99.6% across the tests, above the clinically accepted benchmark of 90% used in clinical practice. Although the results of this study must be used with discretion, asymmetries in the tasks described in this analysis should be viewed as undesirable and remedied accordingly. Further research is needed to quantify asymmetries, particularly in relation to sport-specific contexts.
    Journal of Sports Sciences 07/2015; DOI:10.1080/02640414.2015.1050601 · 2.10 Impact Factor
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    • "cortical activation). Several studies have reported changes in the above different types of data for ACL injured and reconstructed subjects as compared to healthy subjects [4] [5] [10] [11] [12] [13]. "
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    ABSTRACT: This paper aims to investigate a gait pattern classification system for anterior cruciate ligament reconstructed (ACL-R) subjects based on the interval type-2 fuzzy logic (FL). The proposed system intends to model the uncertainties present in kinematics and electromyography (EMG) data used for gait analysis due to intra- and inter-subject stride-to-stride variability and nature of signals. Four features were selected from kinematics and EMG data recorded through wearable wireless sensors. The parameters for the membership functions of these input features were determined using the data recorded for 12 healthy and ACL-R subjects. The parameters for output membership functions and rules were chosen based on the recommendations from physiotherapists and physiatrists. The system was trained by using steepest descent method and tested for singleton and non-singleton inputs. The overall classification accuracy results show that the interval type-2 FL system outperforms the type-1 FL system in recognizing the gait patterns of healthy and ACL-R subjects.
    IEEE International Conference on Fuzzy Systems/IEEE World Congress of Computational Intelligence, Beijing, China; 07/2014
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    • "In the present study, three different types of jumps were chosen, which has been suggested to be more decisive for evaluation of functional performance (Gustavsson et al., 2006; Thomee et al., 2011). Both maximum jumps (e.g., vertical jump and one-leg hop) and hop tests that challenge endurance (e.g., side hop, triple jump, and stair hop) are recommend (Thomee et al., 2011). Studies that investigate jump capacity in the long term after ACL injury are few and have only tested the one-leg hop, showing that 8–35% of the subjects have an LSI less than 90% (Ageberg et al., 2007; Hui et al., 2011; Widuchowski et al., 2012; Gerhard et al., 2013; Stensbirk et al., 2013). "
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    ABSTRACT: Little is known about physical activity level and knee function including jump capacity and fear of movement/reinjury more than 20 years after injury of the anterior cruciate ligament (ACL). Seventy persons with unilateral ACL injury participated (23 ± 2 years post-injury): 33 treated with physiotherapy in combination with surgical reconstruction (ACLR ), and 37 treated with physiotherapy alone (ACLPT ). These were compared with 33 age- and gender-matched controls. Assessment included knee-specific and general physical activity level [Tegner activity scale, International Physical Activity Questionnaire (IPAQ)], knee function [Lysholm score, Knee injury and Osteoarthritis Outcome Score (KOOS)], jump capacity (one-leg hop, vertical jump, side hops), and fear of movement/reinjury [Tampa Scale for Kinesiophobia (TSK)]. Outcomes were related to degree of osteoarthritis (OA). ACL-injured had lower Lysholm, KOOS, and Tegner scores than controls (P < 0.001), while IPAQ score was similar. ACL-injured demonstrated inferior jump capacity in injured compared with noninjured leg (6-25%, P < 0.001-P = 0.010 in the different jumps), while noninjured leg had equal jump capacity as controls. ACL groups scored 33 ± 7 and 32 ± 7 of 68 on TSK. Lower scores on Lysholm and KOOS symptom were seen for persons with moderate-to-high OA than for no-or-low OA, while there were no differences for physical activity and jump capacity. Regardless of treatment, there are still negative knee-related effects of ACL injury more than 20 years later.
    Scandinavian Journal of Medicine and Science in Sports 03/2014; 24(6). DOI:10.1111/sms.12212 · 3.17 Impact Factor
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