Skip to main content
SpringerLink
Log in

Functional progression milestones following anterior cruciate ligament reconstruction are more appropriate than time-based criteria: a survey among the ESSKA

  • KNEE
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The aim of this study was to report current rehabilitation recommendations after ACL reconstruction in ESSKA community, with a particular focus on the specific criteria utilized to guide activity progression

Methods

A web-based survey was developed to investigate preferences between time-based and functional ACL reconstruction rehabilitation progression milestones of ESSKA community.

Results

Eight hundred and twenty completed questionnaires were received. Responders were from 86 different countries worldwide, 63% of them from European countries. Functional criteria were considered more appropriate to decide if a patient can start specific activities/exercises by 67% of the responders. Good core and lower extremity neuromuscular control were the most often used functional criteria for decision-making regarding readiness for sport-specific rehabilitation (66%), sport-specific drills without (65%) and with contact (66%). Strength assessed with an isokinetic dynamometer was considered by about half of the responders a determinant to initiate sport-specific drills without (51%—isokinetic strength, LSI > 80%) and with contact (58%—isokinetic strength, LSI > 85–90%). To determine readiness for sport-specific drills, hop tests were used by 40% of respondents for drills without contact and 48% of respondents for drills with contact.

Conclusion

The results of this survey involving mainly orthopaedic surgeons indicate that functional measures are considered more appropriate than milestones based on time from surgery to guide progression through the postoperative rehabilitation process after ACLR. The main clinical relevance of this study is that updated information on collective agreement could be useful for clinicians and physiotherapists to delineate their postoperative treatments after ACLR. These results should be interpreted with caution, as this sample represents only a small portion of ESSKA community involved in knee surgery and treating patients following ACLR.

Level of evidence

III.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Arundale AJH, Capin JJ, Zarzycki R, Smith AH, Snyder-Mackler L (2018) Two year ACL reinjury rate of 2.5%: outcomes report of the men in a secondary ACL injury prevention program (ACL-Sports). Int J Sports Phys Ther 13:422–431

    Article  PubMed Central  Google Scholar 

  2. Barber-Westin SD, Noyes FR (2011) Factors used to determine return to unrestricted sports activities after anterior cruciate ligament reconstruction. Arthroscopy 27:1697–1705

    Article  Google Scholar 

  3. Barfod KW, Feller JA, Hartwig T, Devitt BM, Webster KE (2019) Knee extensor strength and hop test performance following anterior cruciate ligament reconstruction. Knee 26(1):149–154

    Article  Google Scholar 

  4. Dingenen B, Gokeler A (2017) Optimization of the return-to-sport paradigm after anterior cruciate ligament reconstruction: a critical step back to move forward. Sports Med 47(8):1487–1500

    Article  Google Scholar 

  5. Ebert JR, Webster KE, Edwards PK, Joss BK, D'Alessandro P, Janes G, Annear P (2019) Current perspectives of Australian therapists on rehabilitation and return to sport after anterior cruciate ligament reconstruction: a survey. Phys Ther Sport 35:139–145

    Article  Google Scholar 

  6. Ebert JR, Edwards P, Yi L, Joss B, Ackland T, Carey-Smith R, Buelow JU, Hewitt B (2018) Strength and functional symmetry is associated with post-operative rehabilitation in patients following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 26:2353–2361

    Article  Google Scholar 

  7. Gokeler A, Neuhaus D, Benjaminse A, Grooms DR, Baumeister J (2019) Principles of motor learning to support neuroplasticity after ACL injury: implications for optimizing performance and reducing risk of second ACL injury. Sports Med 49(6):853–865

    Article  PubMed Central  Google Scholar 

  8. Gokeler A, Welling W, Zaffagnini S, Seil R, Padua D (2017) Development of a test battery to enhance safe return to sports after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 25(1):192–199

    Article  Google Scholar 

  9. Grassi A, Carulli C, Innocenti M, Mosca M, Zaffagnini S, Bait C, Arthroscopy Committee SIGASCOT (2018) New trends in anterior cruciate ligament reconstruction: a systematic review of national surveys of the last 5 years. Joints 6(3):177–187

    Article  PubMed Central  Google Scholar 

  10. Greenberg EM, Greenberg ET, Albaugh J, Storey E, Ganley TJ (2018) Rehabilitation practice patterns following anterior cruciate ligament reconstruction: a survey of physical therapists. J Orthop Sports Phys Ther 48(10):801–811

    Article  Google Scholar 

  11. Greenberg EM, Greenberg ET, Albaugh J, Storey E, Ganley TJ (2019) Anterior cruciate ligament reconstruction rehabilitation clinical practice patterns: a survey of the PRiSM society. Orthop J Sports Med 7(4):2325967119839041

  12. Hewett TE, Di Stasi SL, Myer GD (2013) Current concepts for injury prevention in athletes after anterior cruciate ligament reconstruction. Am J Sports Med 41:216–224

    Article  Google Scholar 

  13. Kim SG, Lee YS (2015) The intra- and inter-rater reliabilities of lower extremity muscle strength assessment of healthy adults using a hand held dynamometer. J Phys Ther Sci 27(6):1799–1801

    Article  PubMed Central  Google Scholar 

  14. Logerstedt DS, Scalzitti D, Risberg MA, Engebretsen L, Webster KE, Feller J, Snyder-Mackler L, Axe MJ, McDonough CM (2017) Knee stability and movement coordination impairments: knee ligament sprain revision 2017. J Orthop Sports Phys Ther 47(11):A1–A47

    Article  Google Scholar 

  15. Logerstedt D, Grindem H, Lynch A, Eitzen I, Engebretsen L, Risberg MA, Axe MJ, Snyder-Mackler L (2012) Single-legged hop tests as predictors of self-reported knee function after anterior cruciate ligament reconstruction: the Delaware–Oslo ACL cohort study. Am J Sports Med 40:2348–2356

    Article  PubMed Central  Google Scholar 

  16. Losciale JM, Bullock G, Cromwell C, Ledbetter L, Pietrosimone L, Sell TC (2019) Hop testing lacks strong association with key outcome variables after primary anterior cruciate ligament reconstruction: a systematic review. Am J Sports Med 48(2):511–522

    Article  Google Scholar 

  17. Makhni EC, Crump EK, Steinhaus ME, Verma NN, Ahmad CS, Cole BJ, Bach BR Jr (2016) Quality and variability of online available physical therapy protocols from academic orthopaedic surgery programs for anterior cruciate ligament reconstruction. Arthroscopy 32:1612–1621

    Article  Google Scholar 

  18. Nagai T, Schilaty ND, Laskowski ER, Hewett TE (2019) Hop tests can result in higher limb symmetry index values than isokinetic strength and leg press tests in patients following ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 28(3):816–822

    Article  Google Scholar 

  19. O'Neill S, Jaszczak SLT, Steffensen AKS, Debrabant B (2017) Using 4+ to grade near-normal muscle strength does not improve agreement. Chiropr Man Therap 10(25):28

    Article  Google Scholar 

  20. Reid A, Birmingham TB, Stratford PW, Alcock GK, Giffin JR (2007) Hop testing provides a reliable and valid outcome measure during rehabilitation after anterior cruciate ligament reconstruction. Phys Ther 87(3):337–349

    Article  Google Scholar 

  21. Thomeé R, Kaplan Y, Kvist J, Myklebust G, Risberg MA, Theisen D, Tsepis E, Werner S, Wondrasch B, Witvrouw E (2011) Muscle strength and hop performance criteria prior to return to sports after ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 19(11):1798–1805

    Article  Google Scholar 

  22. Undheim MB, Cosgrave C, King E, Strike S, Marshall B, Falvey É, Franklyn-Miller A (2015) Isokinetic muscle strength and readiness to return to sport following anterior cruciate ligament reconstruction: is there an association? A systematic review and a protocol recommendation. Br J Sports Med 49(20):1305–1310

    Article  Google Scholar 

  23. van Grinsven S, van Cingel RE, Holla CJ, van Loon CJ (2010) Evidence-based rehabilitation following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 18:1128–1144

    Article  Google Scholar 

  24. van Melick N, van Cingel RE, Brooijmans F, Neeter C, van Tienen T, Hullegie W, Nijhuis-van der Sanden MW (2016) Evidence-based clinical practice update: practice guidelines for anterior cruciate ligament rehabilitation based on a systematic review and multidisciplinary consensus. Br J Sports Med 2016(50):1506–1515

    Article  Google Scholar 

  25. Vascellari A, Grassi A, Combi A, Tomaello L, Canata GL, Zaffagnini S, Sports Committee SIGASCOT (2017) Web-based survey results: surgeon practice patterns in Italy regarding anterior cruciate ligament reconstruction and rehabilitation. Knee Surg Sports Traumatol Arthrosc 25(8):2520–2527

    Article  Google Scholar 

Download references

Acknowledgements

We would like to thank all responders who participated in our questionnaire and ESSKA office for the precious help.

Funding

No funding was received for the development of this manuscript.

Author information

Authors and Affiliations

  1. Policlinico Città di Udine, Viale Venezia 410, 33100, Udine, Italy

    Alberto Vascellari

  2. Sports Medicine and Science (LIROMS), Luxembourg Institute of Research in Orthopedics, Luxembourg, Luxembourg

    Alli Gokeler

  3. Department Exercise and Health, Exercise Science and Neuroscience, University of Paderborn, Paderborn, Germany

    Alli Gokeler

  4. Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

    Alli Gokeler

  5. 2nd Orthopaedic and Traumatology Clinic, Rizzoli Orthopaedic Institute, Bologna, Italy

    Alberto Grassi & Stefano Zaffagnini

  6. Centre of Sports Traumatology, Koelliker Hospital, Turin, Italy

    Gian Luigi Canata

  7. Orthopaedic and Sports Medicine Clinic, Montijo, Portugal

    Henrique Jones

  8. Lusofona University, Lisbon, Portugal

    Henrique Jones

Authors
  1. Alberto Vascellari
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alli Gokeler
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alberto Grassi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gian Luigi Canata
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Stefano Zaffagnini
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Henrique Jones
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alberto Vascellari.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (doc 68 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Vascellari, A., Gokeler, A., Grassi, A. et al. Functional progression milestones following anterior cruciate ligament reconstruction are more appropriate than time-based criteria: a survey among the ESSKA. Knee Surg Sports Traumatol Arthrosc 28, 3647–3654 (2020). https://doi.org/10.1007/s00167-020-05960-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-020-05960-3

Keywords

Search

Navigation