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: 3.05). 09/2011; 19(11):1798-805. DOI: 10.1007/s00167-011-1669-8
Source: PubMed


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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    • "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.
    Full-text · Article · Jul 2015 · Journal of Sports Sciences
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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.
    Full-text · Conference Paper · Jul 2014
    • "Thomée et al. (2011) critically discussed the common muscle strength and hop/jump performance criteria used prior to return to sport, which may not be demanding and sensitive enough to detect side differences, and proposed new recommendations for muscle function tests in individuals after ACL reconstruction. When comparing the involved (operated knee) versus the uninvolved leg, the limb symmetry strength and hop indexes should target 100% in athletes returning to competitive pivoting and contact sports (Thomeé et al., 2011). "
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    ABSTRACT: Abstract Despite significant advances in the diagnostics and treatment of knee injuries over the last decade, several challenges related to the subject "return to sport" remain largely unknown. For example, how should "return to sport" be defined precisely? What is the optimal timing and progression to enable a return to sport? Which criteria should be used during this process? What type of training is indicated? Which measurements can support the decision-making process? How do we optimally prepare athletes for competition without risking re-injury? This paper critically addresses these questions, and proposes a return to play model to prepare football players to compete after major knee surgery (anterior cruciate ligament reconstruction, cartilage repair). The goal is to re-integrate the player gradually into the game, taking into account his individual characteristics. Several evidence-based and empirical criteria are needed to plan and monitor the efficient return to competitive football. Injury-prevention education should be part of this process to maximise the chance of a durable career and decrease the risk of re-injury. However, because of the paucity of research on "return to sport", further research is more than warranted.
    No preview · Article · May 2014 · Journal of Sports Sciences
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