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Return to sports bridge program improves outcomes, decreases ipsilateral knee re-injury and contralateral knee injury rates post-ACL reconstruction

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To present the results of a return to sports bridge program designed to reduce knee injuries following ACL reconstruction and physical therapy.

Methods

One hundred and fifty (male = 83, female = 67) patients participated in a whole body neuromuscular control, progressive resistance strength and agility training program. Post-program testing included functional movement form, dynamic knee stability, lower extremity power, agility, and sports skill assessments. Participants completed the Knee Outcome Survey–Sports Activity Scale (KOS-SAS) before and after program initiation. Pre-participation scores were re-estimated following program completion.

Results

Global rating KOS-SAS score at program entry was 75 ± 13. Post-program global rating and calculated KOS-SAS were 91.0 ± 9.8 and 90.9 ± 9.7, respectively (p < 0.0001). Pre-participation KOS-SAS score re-estimates at program completion were 54.5 ± 23.3 and 57.3 ± 18.5, respectively. The approximately 20% lower pre-program KOS-SAS score re-estimates (p < 0.0001) observed at program completion suggests that subjects had inaccurately high sports readiness perceptions at program entry. Perceived overall sports activity knee function ratings improved from 2.9 ± 0.6 (abnormal) at program entry to 1.3 ± 0.5 (normal) at completion (p < 0.0001). Most subjects returned back to sports at or above their pre-injury performance skill/performance level (84%, 126/150). By 6.8 ± 3.2 years (range = 2–13 years) post-surgery, ten subjects had sustained an ipsilateral knee re-injury or contralateral knee injury (6.7%). The 2.7% non-contact contralateral and 1.3% non-contact ipsilateral knee injury rates observed were significantly lower than those cited in previous reports.

Conclusion

Supplementing primary ACL reconstruction and standard physical therapy with a return to sports bridge program prior to release to unrestricted sports performance was effective at improving patient outcomes and decreasing ipsilateral knee re-injury and contralateral knee injury rates.

Level of evidence

II.

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Author information

Authors and Affiliations

  1. Athletic Training Program, Kosair Charities College of Health and Natural Sciences, Spalding University, Louisville, KY, USA

    J. Nyland, J. Brey & R. Krupp

  2. Department of Orthopaedic Surgery, University of Louisville, Louisville, KY, USA

    J. Nyland, J. Greene, S. Carter, J. Brey, R. Krupp & D. Caborn

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  1. J. Nyland
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Correspondence to J. Nyland.

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This experimental research has been performed with the approval of the local ethics committee (Spalding University Research Ethics Committee REC #02-192020). Research is in compliance with the Helsinki Declaration.

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Nyland, J., Greene, J., Carter, S. et al. Return to sports bridge program improves outcomes, decreases ipsilateral knee re-injury and contralateral knee injury rates post-ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 28, 3676–3685 (2020). https://doi.org/10.1007/s00167-020-06162-7

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