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The evidence is of low or very low certainty because of the heterogeneity of results and the high risk of bias in the included studies. There was no difference in return-to-sport rates or activity levels when comparing anterior cruciate ligament reconstruction with rehabilitation alone for the management of anterior cruciate ligament injury.
This case series did not exclude participants based on graft type, single vs double bundle procedure, ACL revision surgeries, nor concomitant procedures or injuries. Level 4.
These help prepare athletes for the unpredictable and chaotic nature of the sporting environment and may facilitate a more effective return to sport for athletes, potentially mitigating the risk of re-injury. 5.
Sex differences and rehab considerations across the pre- and post-surgical ACLR timeline are also addressed. Level of Evidence: 5.
Additional testing to support RTS decision making is also presented. This paper contains important information for practitioners and researchers to support optimised late-stage rehabilitation and RTS programmes and RTS testing with a view to enhancing patient outcomes after ACL reconstruction.
Enhancing the consistency and clarity of terminal phase goals, particularly around functional testing and psychological readiness, may better support patients and providers in navigating the transition from rehabilitation to sport participation. LEVEL OF EVIDENCE: 3.
No significant differences were found between returners and nonreturners in knee self-efficacy, perceived percent recovery, and psychological distress. Our results suggest that reinjury anxiety and perceived limitations of ability are psychological constructs on which returners and nonreturners differ and therefore may be points of intervention to increase the likelihood of return to sport.
The results suggest that three months of public municipal rehabilitation improves patient-reported outcomes and lower extremity muscle strength in non-surgically treated patients with ACL injury. However, only one in every 10 patients passed all RTS criteria.
Among those who completed return-to-sport training after ACLR, subsequent quadriceps strength symmetry was not correlated with the persistent asymmetries in gait biomechanics. After a threshold of quadriceps strength is reached, restoring strength alone may not ameliorate gait asymmetries, and current clinical interventions and return-to-sport training may not adequately target gait.
CONCLUSION: Athletes with a BPTB autograft may take longer than athletes with an HT autograft or a soft tissue allograft to complete postoperative rehabilitation, recover quadriceps strength, and meet RTS criteria. .
About 76.2% recommended an ACL injury prevention program at discharge.ConclusionMost PTs in SA inconsistently follow evidence-based ACLR rehabilitation practices. Education and training programs are needed to bridge the evidence-to-practice gap in post-ACLR care.
A CF test battery can be as demanding to pass as a GS test battery, 1 year after ACL reconstruction. However, passing a CF test battery only gives patients a chance similar to a "coin flip" of also passing a GS RTS test battery.
Early QF strength symmetry <80 % was associated with increased risk of contralateral ACL injury after RTS. Greater QF strength deficits early in rehabilitation may be a biomarker of poor short- and long-term outcomes after ACLR.
However, optimal RTS criteria have yet to be determined. Future prospective studies should focus on comparing the different times and milestones currently available.
Many healthy individuals fail ACLR RTS tests, with some having an inherent variation from side to side that is >10%. The passing threshold for RTS testing should be a value that is practical yet helps reduce reinjury rates.
Strength evaluations, hop tests, agility tests, and the limb symmetry index are described, as well as the associations of quadriceps and hamstrings muscle strength and functional test results with successful return to sports and the risk of ACL graft rupture and contralateral knee injuries. Suggestions for future research directions are presented including the importance of presurgery testing, standardization of test batteries, and comparison of test results with normative data.
Median number of weekly physical activity sessions was similar between preinjury (4 [IQR, 2-6]) and at 9 to 36 months (4 [IQR, 1-6]). Achieving ≥90% single-forward hop limb symmetry following rehabilitation appears to be associated with greater likelihood of returning to sport.
Our study demonstrated improvements in all RTS criteria tests upon completing the 8-week rehabilitation program; however, few participants (8%) passed all RTS criteria. Psychological readiness is more closely related to patient-reported function than functional tests.
Positive predictors for return to preinjury levels included older age and low fear of reinjury. Retrospective Case-Series, level IV.
Completing rehabilitation and meeting objective criteria significantly increased the odds for male athletes to return to pivoting sports. Time to RTS did not impact the risk for a new knee or ACL injury if athletes met objective criteria.