Sports Medicine

, Volume 49, Issue 7, pp 1043–1058 | Cite as

Optimising the Late-Stage Rehabilitation and Return-to-Sport Training and Testing Process After ACL Reconstruction

  • Matthew BuckthorpeEmail author
Review Article


Despite increased knowledge on anterior cruciate ligament (ACL) injury mechanisms, improved surgical techniques, improved understanding of ACL biomechanics and enhanced knowledge in rehabilitation practice, return-to-sport (RTS) rates and subsequent second ACL re-injury rates after ACL reconstruction are not optimal. This narrative review discusses factors that may be highly relevant for RTS training and testing after ACL reconstruction, but which have received limited research attention to date or do not form part of the standard approach to rehabilitation. These factors include (1) explosive neuromuscular performance; (2) movement quality deficits associated with re-injury risk, particularly the need to re-train optimal sport-specific movement patterns; (3) the influence of fatigue; and (4) a lack of sport-specific re-training prior to RTS, with particular attention to an insufficient development of chronic training load. In addition, incorporating performance re-training and ensuring an athlete has restored their sport-specific profile is important. The relevance of these variables for RTS training and testing is discussed, with a new recommended model of late-stage rehabilitation and RTS training presented. 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.


Compliance with Ethical Standards


No sources of funding were used to assist in the preparation of this article.

Conflict of interest

Matthew Buckthorpe declares he has no conflicts of interest relevant to the content of this review.


  1. 1.
    Marx RG, Jones EC, Angel M, Wickiewicz TL, Warren RF. Beliefs and attitudes of members of the American Academy of Orthopaedic Surgeons regarding the treatment of anterior cruciate ligament injury. Arthroscopy. 2003;19(7):762–70.CrossRefPubMedGoogle Scholar
  2. 2.
    Ardern CL, Webster KE, Taylor NF, Fellar JA. Return to pre-injury level of competitive sport after anterior cruciate ligament reconstruction surgery: two-thirds of patients have not returned by 12 months after surgery. Am J Sports Med. 2011;39:538–43.CrossRefPubMedGoogle Scholar
  3. 3.
    Ardern CL. Anterior cruciate ligament reconstruction- not exactly a one-way ticket back to preinjury level: a review of contextual factors affecting return to sport after surgery. Sports Health. 2015;7(3):224–30.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Lai CC, Ardern CL, Feller JA, Webster KE. Eighty-three per cent of elite athletes return to preinjury sport after anterior cruciate ligament reconstruction: a systematic review with meta-analysis of return to sport rates, graft rupture rates and performance outcomes. Br J Sports Med. 2018;52(2):128–38.CrossRefPubMedGoogle Scholar
  5. 5.
    Zaffagnini S, Grassi A, Marcheggiani Muccioli GM, et al. Return to sport after anterior cruciate ligament reconstruction in professional soccer players. Knee. 2014;21(3):731–5.CrossRefPubMedGoogle Scholar
  6. 6.
    Wiggins AJ, Granhi RK, Schneider DK, Stanfield D, Webster KE, Myer GD. Risk of secondary injury in younger athletes after anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Am J Sports Med. 2016;44(7):1861–76.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Grindem H, Snyder-Mackler L, Moksnes H, Engebretsen L, Risberg MA. Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study. Br J Sports Med. 2016;50:804–8.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Paterno MV, Rauh MJ, Schmitt LC, Ford KR, Hewett TE. Incidence of second ACL injuries 2 years after primary ACL reconstruction and return to sport. Am J Sports Med. 2014;42(7):1567–73.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Webster KE, Feller JA. Exploring the high reinjury rate in younger patients undergoing anterior cruciate ligament reconstruction. Am J Sports Med. 2016;44(11):2827–32.CrossRefPubMedGoogle Scholar
  10. 10.
    Ardern CL, Kvist J, Webster KE. Psychological aspects of anterior cruciate ligament injuries. Oper Tech Sports Med. 2016;24(1):77–83.CrossRefGoogle Scholar
  11. 11.
    Ardern CL, Glasgow P, Schneiders A, et al. 2016 Consensus statement on return to sport from the first World congress in sports physical therapy, Bern. Br J Sports Med. 2016;50:853–64.CrossRefPubMedGoogle Scholar
  12. 12.
    Dingenen B, Gokeler A. Optimization of the return-to-sport paradigm after anterior cruciate ligament reconstruction: a critical step back to move forward. Sports Med. 2017;47(8):1487–500.CrossRefPubMedGoogle Scholar
  13. 13.
    Nagelli CV, Hewett TE. Should return to sport be delayed until 2 years after anterior cruciate ligament reconstruction? Biological and functional considerations. Sports Med. 2017;47(2):221–32.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Buckthorpe M, Roi GS. The time has come to incorporate a greater focus on rate of force development training in the sports injury rehabilitation process. Muscle Tendon Ligament J. 2017;7(3):435–41.CrossRefGoogle Scholar
  15. 15.
    Krosshaug T, Nakamae A, Boden BP, et al. Mechanisms of anterior cruciate ligament injury in basketball: video analysis of 39 cases. Am J Sports Med. 2007;35:359–67.CrossRefPubMedGoogle Scholar
  16. 16.
    Beneke R, Taylor MJ. What gives Bolt the edge-A.V. Hill knew it already! J Biomech. 2010;43(11):2241–3.CrossRefPubMedGoogle Scholar
  17. 17.
    Thorstensson A, Karlsson J, Viitasalo HT, Luhtanen P, Komi PV. Effect of strength training on EMG of human skeletal muscle. Acta Physiol Scand. 1976;98:232–6.CrossRefPubMedGoogle Scholar
  18. 18.
    Angelozzi M, Madama M, Corsica C, et al. Rate of force development as an adjunctive outcome measure for return-to-sport decisions after anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther. 2012;42(9):772–80.CrossRefPubMedGoogle Scholar
  19. 19.
    Folland JP, Buckthorpe M, Hannah R. Human capacity for explosive force production: Neural and contractile determinants. Scand J Med Sci Sports. 2014;24(6):894–906.CrossRefPubMedGoogle Scholar
  20. 20.
    Maffiuletti NA, Aagaard P, Blazevich AJ, Folland J, Tillin N, Duchateau J. Rate of force development: physiological and methodological considerations. Eur J Appl Physiol. 2016;116(6):1091–116.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Andersen LL, Aagaard P. Influence of maximal muscle strength and intrinsic muscle contractile properties on contractile rate of force development. Eur J Appl Physiol. 2006;96:46–52.CrossRefPubMedGoogle Scholar
  22. 22.
    Andersen LL, Andersen JL, Zebis MK, Aagaard P. Early and late rate of force development: differential adaptive responses to resistance training? Scand J Med Sci Sports. 2010;20(1):e162–9.CrossRefPubMedGoogle Scholar
  23. 23.
    Tillin NA, Pain MTG, Folland JP. Short-term unilateral resistance training affects the agonist-antagonist but not the force-agonist activation relationship. Muscle Nerve. 2011;43:375–84.CrossRefPubMedGoogle Scholar
  24. 24.
    Del Balso C, Cafarelli E. Adaptations in the activation of human skeletal muscle induced by short-term isometric resistance training. J Appl Physiol. 2007;103:402–11.CrossRefPubMedGoogle Scholar
  25. 25.
    Thomee R, Kaplan Y, Kvist Y, et al. Muscle strength and hop performance criteria prior to return to sports after ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. 2011;19:1798–805.CrossRefPubMedGoogle Scholar
  26. 26.
    Wellsandt E, Failia MS, Synder-Mackler L. Limb symmetry indexes can overestimate knee function after anterior cruciate ligament injury. J Orthop Sports Ther. 2017;47(5):334–8.CrossRefGoogle Scholar
  27. 27.
    Adams D, Logerstedt DS, Hunter-Giordano A, Axe MJ, Synder-Mackler L. Current concepts for anterior cruciate ligament reconstruction: a criterion-based rehabilitation progression. J Orthop Sports Phys Ther. 2012;42(7):601–14.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Andersen JL, Aagaard P. Effects of strength training on muscle fiber types and size; consequences for athletes training for high-intensity sport. Scand J Med Sci Sports. 2010;20(2):32–8.CrossRefPubMedGoogle Scholar
  29. 29.
    Wallace BJ, Kernozek TW, White JM, et al. Quantification of vertical ground reaction forces of popular bilateral plyometric exercises. J Strength Cond Res. 2010;24(1):207–12.CrossRefPubMedGoogle Scholar
  30. 30.
    Aagaard P, Simonsen EB, Andersen JL, Magnusson P, Dyhre-Poulsen P. Increased rate of force development and neural drive of human skeletal muscle following resistance training. J Appl Physiol. 2002;93:1318–26.CrossRefPubMedGoogle Scholar
  31. 31.
    Tillin NA, Pain MTG, Folland JP. Short-term training for explosive strength causes neural and mechanical adaptations. Exp Physiol. 2012;97:630–41.CrossRefPubMedGoogle Scholar
  32. 32.
    Mangine GT, Hoffman JR, Wang R, et al. Resistance training intensity and volume affect changes in rate of force development in resistance-trained men. Eur J Appl Physiol. 2016;116:2367–74.CrossRefPubMedGoogle Scholar
  33. 33.
    Van Cutsem M, Duchateau J, Hainaut K. Changes in single motor unit behaviour contribute to the increase in contraction speed after dynamic training in humans. J Physiol. 1998;513(Part 1):295–305.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Tillin NA, Folland JP. Maximal and explosive strength training elicit distinct neuromuscular adaptations, specific to the training stimulus. Eur J Appl Physiol. 2014;114(12):365–74.CrossRefPubMedGoogle Scholar
  35. 35.
    Herrington L, Myer G, Horsley I. Task-based rehabilitation protocol for elite athletes following anterior cruciate ligament reconstruction: a clinical commentary. Phys Ther Sport. 2013;14(4):188–98.CrossRefPubMedGoogle Scholar
  36. 36.
    Herrington L, Ghulam H, Comfort P. Quadriceps strength and functional performance after anterior cruciate ligament reconstruction in professional soccer players at time of return to sport. J Strength Cond Res. 2018. (Epub ahead of print).CrossRefPubMedGoogle Scholar
  37. 37.
    Welling W, Benjaminse A, Seil R, et al. Low rates of patients meeting return to sport criteria 9 months after anterior cruciate ligament reconstruction: a prospective longitudinal study. Knee Surg Sports Traumatol Arthrosc. 2018. (Epub ahead of print).CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Houglum PA. Therapeutic exercise for musculoskeletal injuries. Champaign: Human Kinetics; 2010.Google Scholar
  39. 39.
    Buckthorpe MW, Hannah R, Pain MTG, Folland JP. Reliability of neuromuscular measurements during explosive isometric contractions, with special reference to electromyography normalization techniques. Muscle Nerve. 2012;46(4):566–76.CrossRefPubMedGoogle Scholar
  40. 40.
    Nuzzo JL, McBride JM, Cormier P, McCaulley GO. Relationship between countermovement jump performance and multijoint isometric and dynamic tests of strength. J Strength Cond Res. 2008;22(3):699–707.CrossRefPubMedGoogle Scholar
  41. 41.
    Tillin NA, Pain MTG, Folland JP. Explosive force production during isometric squats correlates with athletic performance in rugby union players. J Sports Sci. 2013;31:66–76.CrossRefPubMedGoogle Scholar
  42. 42.
    Hannah R, Folland JP, Smith SL, Minshull C. Explosive hamstrings-to-quadriceps force ratio of males versus females. Eur J Appl Physiol. 2015;15(4):837–47.CrossRefGoogle Scholar
  43. 43.
    Struzik A, Juras G, Pietraszewski B, Rokita A. Effect of drop jump technique on the reactive speed index. J Hum Kinet. 2016;52:157–64.CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Balsalobre-Fernandez C, Glaister M, Lockey RA. The validity and reliability of an iPhone app for measuring vertical jump performance. J Sport Sci. 2015;33(15):1574–9.CrossRefGoogle Scholar
  45. 45.
    Decker MJ, Torry MR, Noonan TJ, Riviere A, Sterett WI. Landing adaptations after ACL reconstruction. Med Sci Sports Exerc. 2002;34(9):1408–13.CrossRefPubMedGoogle Scholar
  46. 46.
    de Fontenay BP, Argaud S, Blache Y, Monteil K. Motion alterations after anterior cruciate ligament reconstruction: comparison of the injured and uninjured lower limbs during a single-legged jump. J Athl Train. 2014;49(3):311–6.CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Goerger BM, Marshall SW, Beutler AI. Anterior cruciate ligament injury alters preinjury lower extremity biomechanics in the injured and uninjured leg: the JUMP-ACL study. Br J Sports Med. 2015;49:188–95.CrossRefPubMedGoogle Scholar
  48. 48.
    Lee SP, Chow JW, Tillman MD. Persons with reconstructed ACL exhibit altered knee mechanics during high speed maneuvers. J Sports Med. 2014;35(6):528–33.Google Scholar
  49. 49.
    Paterno MV, Ford KR, Myer GD, Heyl R, Hewett TE. Limb asymmetries in landing and jumping 2 years following anterior cruciate ligament reconstruction. Clin J Sports Med. 2007;17(4):258–62.CrossRefGoogle Scholar
  50. 50.
    Sterns KM, Pollard CD. Abnormal frontal plane knee mechanics during sidestep cutting in female soccer athletes after anterior cruciate ligament reconstruction and return to sport. Am J Sports Med. 2013;41(4):918–23.CrossRefGoogle Scholar
  51. 51.
    Paterno MV, Schmitt LC, Ford KR, et al. Biomechanical measures during landing and postural stability predict second anterior cruciate ligament after anterior cruciate ligament reconstruction and return to sport. Am J Sports Med. 2010;38(10):1968–78.CrossRefPubMedPubMedCentralGoogle Scholar
  52. 52.
    Paterno MV, Kiefer AW, Bonnette S, et al. Prospectively identified deficits in sagittal plane hip-ankle coordination in female athletes who sustain a second anterior cruciate ligament injury after anterior cruciate ligament reconstruction and return to sport. Clin Biomech. 2015;30(10):1094–104.CrossRefGoogle Scholar
  53. 53.
    Bien DP, Dubuque TJ. Considerations for late stage ACL rehabilitation and return to sport to limit re-injury risk and maximize athletic performance. Int J Sports Phys Ther. 2015;10(2):256–71.PubMedPubMedCentralGoogle Scholar
  54. 54.
    Grooms DR, Page SJ, Nichols-Larsen DS, Chaudhari AM, White SE, Onate JA. Neuroplasticity associated with anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther. 2017;47(3):180–9.CrossRefPubMedGoogle Scholar
  55. 55.
    Swanik CB. Brains and sprains: the brain’s role in noncontact anterior cruciate ligament injuries. J Athl Train. 2015;50(10):1100–2.CrossRefPubMedGoogle Scholar
  56. 56.
    Padua DA, DiStefano LJ, Marshall SW, Beutler AI, de la Motte SJ, DiStefano MJ. Retention of movement pattern changes after a lower extremity injury prevention program is affected by program duration. Am J Sports Med. 2012;40(2):300–6.CrossRefPubMedGoogle Scholar
  57. 57.
    Palmieri-Smith RM, Lepley LK. Quadriceps strength asymmetry following ACL reconstruction alters knee joint biomechanics and functional performance at time of return to activity. Am J Sports Med. 2015;43(7):1662–9.CrossRefPubMedPubMedCentralGoogle Scholar
  58. 58.
    Mills M, Frank B, Goto S, et al. Effect of restricted hip flexor muscle length on hip extensor muscle activity and lower extremity biomechanics in college-aged female soccer players. Int J Sports Phys Ther. 2015;10(7):946–54.PubMedPubMedCentralGoogle Scholar
  59. 59.
    Zebis MK, Andersen LL, Bencke J, Kjaer M, Aagaard P. Identification of athletes at future risk of anterior cruciate ligament ruptures by neuromuscular screening. Am J Sports Med. 2009;37(10):1967–73.CrossRefPubMedGoogle Scholar
  60. 60.
    Pollard CD, Sigward SM, Powers CM. ACL injury prevention training results in modification of hip and knee mechanics during a drop-landing task. Orthop J Sports Med. 2017;5(9):2325967117726267. (published online 2017 Sep 8).CrossRefPubMedPubMedCentralGoogle Scholar
  61. 61.
    Taylor JB, Waxman JP, Richter SJ, Shultz SJ. Evaluation of the effectiveness of anterior cruciate ligament injury prevention programme training components: a systematic review and meta-analysis. Br J Sports Med. 2015;49:79–87.CrossRefPubMedGoogle Scholar
  62. 62.
    Bobbert MF, Van Soest AJ. Effects of muscle strengthening on vertical jump height: a simulation study. Med Sci Sports Exerc. 1994;26(8):1012–20.CrossRefPubMedGoogle Scholar
  63. 63.
    Doyon J, Benali H. Reorganisation and plasticity in the adult brain during learning of motor skills. Curr Opin Neurobiol. 2005;15(2):161–7.CrossRefPubMedGoogle Scholar
  64. 64.
    Gokeler A, Benjaminse A, Hewett TE, et al. Feedback techniques to target functional deficits following anterior cruciate ligament reconstruction: implications for motor control and reduction of second injury risk. Sports Med. 2013;43(11):1065–75.CrossRefPubMedPubMedCentralGoogle Scholar
  65. 65.
    Gokeler A, Benjaminse A, Welling W, et al. The effects of attentional focus on jump performance and knee joint kinematics in patients after ACL reconstruction. Phys Ther Sport. 2015;16:114–20.CrossRefPubMedGoogle Scholar
  66. 66.
    Besier TF, Lloyd DG, Ackland TR, et al. Anticipatory effects on knee joint loading during running and cutting maneuvers. Med Sci Sports Exerc. 2001;33(7):1176–81.CrossRefPubMedGoogle Scholar
  67. 67.
    Vanrenterghem J, Venables E, Pataky T, et al. The effect of running speed on knee mechanical loading in females during side cutting. J Biomech. 2012;45(14):2444–9.CrossRefPubMedGoogle Scholar
  68. 68.
    Waldén M, Krosshaug T, Bjørneboe J, et al. Three distinct mechanisms predominate in non-contact anterior cruciate ligament injuries in male professional football players: a systematic video analysis of 39 cases. Br J Sports Med. 2015;49:1452–60.CrossRefPubMedPubMedCentralGoogle Scholar
  69. 69.
    Grooms D, Appelbaum G, Onate J. Neuroplasticity following anterior cruciate ligament injury: a framework for visual-motor training approaches in rehabilitation. J Orthop Sports Phys Ther. 2015;10(1):1–33.Google Scholar
  70. 70.
    Swanik CB, Covassin T, Stearne DJ, et al. The relationship between neurocognitive function and noncontact anterior cruciate ligament injuries. Am J Sports Med. 2007;35(6):943–8.CrossRefPubMedGoogle Scholar
  71. 71.
    Dhillon MS, Kamal B, Sharad P. Differences among mechanoreceptors in healthy anterior cruciate ligaments and their clinical importance. Muscles Ligaments Tendons J. 2012;2(1):38–43.PubMedPubMedCentralGoogle Scholar
  72. 72.
    Almonroeder TG, Garcia E, Kurt M. The effects of anticipation on the mechanics of the knee during single-leg cutting tasks: a systematic review. Int J Sports Phys Ther. 2015;10(7):918–28.PubMedPubMedCentralGoogle Scholar
  73. 73.
    Brown SR, Brughelli M, Hume PA. Knee mechanics during planned and unplanned sidestepping: a systematic review and meta-analysis. Sports Med. 2014;44(11):1573–88.CrossRefPubMedGoogle Scholar
  74. 74.
    Negahban H, Ahmadi P, Salehi R, et al. Attentional demands of postural control during single leg stance in patients with anterior cruciate ligament reconstruction. Neurosci Lett. 2013;556:118–23.CrossRefPubMedGoogle Scholar
  75. 75.
    Negahban H, Hadian MR, Salavati M, et al. The effects of dual tasking on postural control in people with unilateral anterior cruciate ligament injury. Gait Posture. 2009;30(4):477–81.CrossRefPubMedGoogle Scholar
  76. 76.
    Okuda K, Abe N, Katayama Y, et al. Effect of vision on postural sway in anterior cruciate ligament injured knees. J Orthop Sci. 2005;10(3):277–83.CrossRefPubMedGoogle Scholar
  77. 77.
    Barber-Westin SD, Noyes FR. Effect of fatigue protocols on lower limb neuromuscular function and implications for anterior cruciate ligament injury prevention training: a systematic review. Am J Sports Med. 2017;45(14):3388–96.CrossRefPubMedGoogle Scholar
  78. 78.
    Benjaminse A, Webster KE, Kimp A, Meijer M, Gokeler A. Revised approach to the role of fatigue in anterior cruciate ligament injury prevention: a systematic review with meta-analyses. Sports Med. 2019. Scholar
  79. 79.
    De Ste Croix MB, Priestly AM, Lloyd RS, Oliver JL. ACL injury risk in elite female soccer: Changes in neuromuscular control of the knee following soccer specific fatigue. Scand J Med Sci Sports. 2015;25(5):e531–8.CrossRefPubMedGoogle Scholar
  80. 80.
    Frank B, Gilsdorf CM, Goerger BM, Prentice WE, Padua DA. Neuromuscular fatigue alters postural control and sagittal plane hip biomechanics in active females with anterior cruciate ligament reconstruction. Sports Health. 2014;6(4):301–8.CrossRefPubMedPubMedCentralGoogle Scholar
  81. 81.
    Gokeler A, Eppinga P, Dijkstra PU, et al. Effect of fatigue on landing performance assessed with the landing error score system (less) in patients after acl reconstruction. A pilot study. Int J Sports Phys Ther. 2014;9(3):302–11.PubMedPubMedCentralGoogle Scholar
  82. 82.
    Santamaria LJ, Webster KE. The effect of fatigue on lower-limb biomechanics during single-limb landings: a systematic review. J Orthop Sports Phys Ther. 2010;40:464–73.CrossRefPubMedGoogle Scholar
  83. 83.
    Webster KE, Santamaria LJ, McClelland JA, Fellar JA. Effect of fatigue on landing biomechanics after anterior cruciate ligament reconstruction surgery. Med Sci Sports Exerc. 2012;44(5):910–6.CrossRefPubMedGoogle Scholar
  84. 84.
    Chappell JD, Herman DC, Knight BS, Kirkendall DT, Garrett WE, Yu B. Effect of fatigue on knee kinetics and kinematics in stop-jump tasks. Am J Sports Med. 2005;33:1022–9.CrossRefPubMedGoogle Scholar
  85. 85.
    Borotikar BS, Newcomer R, Koppes R, McLean SG. Combined effects of fatigue and decision making on female lower limb landing postures: central and peripheral contributions to ACL injury risk. Clin Biomech. 2008;23:81–92.CrossRefGoogle Scholar
  86. 86.
    Mohr M, Krustrup P, Bangsbo J. Match performance of high-standard soccer players with special reference to development of fatigue. J Sports Sci. 2003;21(7):519–28.CrossRefPubMedGoogle Scholar
  87. 87.
    McLean SG, Fellin RE, Suedekum N, Calabrese G, Passerallo A, Joy S. Impact of fatigue on gender-based high-risk landing strategies. Med Sci Sports Exerc. 2007;39:502–14.CrossRefPubMedGoogle Scholar
  88. 88.
    Sanna G, O’Connor KM. Fatigue-related changes in stance leg mechanics during sidestep cutting manoeuvres. Clin Biomech. 2008;23:946–54.CrossRefGoogle Scholar
  89. 89.
    Buckthorpe M, Pain MT, Folland JP. Central fatigue contributes to the greater reductions in explosive than maximal strength with high-intensity fatigue. Exp Physiol. 2014;99(7):964–73.CrossRefPubMedGoogle Scholar
  90. 90.
    Russell M, Benton D, Kingsley M. The effects of fatigue on soccer skills performed during a soccer match simulation. Int J Sports Physiol Perform. 2011;6(2):221–33.CrossRefPubMedGoogle Scholar
  91. 91.
    Hawkins RD, Hulse MA, Wilkinson C, Hodson A, Gibson M. The association football medical research programme: an audit of injuries in professional football. Br J Sports Med. 2001;35:43–7.CrossRefPubMedPubMedCentralGoogle Scholar
  92. 92.
    Nagle K, Johnson B, Brou L, Landman T, Sochanska A, Comstock RD. Timing of lower extremity injuries in competition and practice in high school sports. Sports Health. 2017;9(3):238–46.CrossRefPubMedPubMedCentralGoogle Scholar
  93. 93.
    Greig M. The influence of soccer-specific fatigue on peak isokinetic torque production of the knee flexors and extensors. Am J Sports Med. 2008;36:1403–9.CrossRefPubMedGoogle Scholar
  94. 94.
    Rahnama N, Reilly T, Lees A, Graham-Smith P. Muscle fatigue induced by exercise simulating the work rate of competitive soccer. J Sports Sci. 2003;21:933–42.CrossRefPubMedGoogle Scholar
  95. 95.
    Rahnama N, Lees A, Reilly T. Electromyography of selected lower-limb muscles fatigued by exercise at the intensity of soccer match-play. J Electromyogr Kinesiol. 2006;16:257–63.CrossRefPubMedGoogle Scholar
  96. 96.
    Van Melick N, van Rijn L, Nijhuis-van der Sanden MWG, Hoogeboom TJ, van Cingel REH. Fatigue affects quality of movement more in ACL-reconstructed soccer players than in healthy soccer players. Knee Surg Traumatol Arthrosc. 2018. (Epub ahead of print).CrossRefGoogle Scholar
  97. 97.
    Small K, McNaughton L, Greig M, Lovell R. The effects of multidirectional soccer-specific fatigue on markers of hamstring injury risk. J Sci Med Sport. 2010;13(1):120–5.CrossRefPubMedGoogle Scholar
  98. 98.
    Thorlund JB, Aagaard P, Madsen K. Rapid muscle force capacity changes after soccer match play. Int J Sports Med. 2009;30(4):273–8.CrossRefPubMedGoogle Scholar
  99. 99.
    Small K, McNaughton L, Greig M, Lovell R. Effect of timing of eccentric hamstring strengthening exercises during soccer training: implications for muscle fatigability. J Strength Cond Res. 2009;23:1077–83.CrossRefPubMedGoogle Scholar
  100. 100.
    Dupont G, Nedelec M, McCall A, et al. Effect of 2 soccer matches in a week on physical performance and injury rate. Am J Sports Med. 2010;38(9):1752–8.CrossRefPubMedGoogle Scholar
  101. 101.
    Blanch P, Gabbett TJ. Has the athlete trained enough to return to play safely? The acute: chronic workload ratio permits clinicians to quantify a player’s risk of subsequent injury. Br J Sports Med. 2016;50:471–5.CrossRefPubMedGoogle Scholar
  102. 102.
    Bowen L, Gross AS, Gimpel M, Li FX. Accumulated workloads and the acute:chronic workload ratio relate to injury risk in elite youth football players. Br J Sports Med. 2017;51:452–9.CrossRefPubMedGoogle Scholar
  103. 103.
    Duhig S, Shield AJ, Opar D, et al. Effect of high-speed running on hamstring strain injury risk. Br J Sports Med. 2016;50:1536–40.CrossRefPubMedGoogle Scholar
  104. 104.
    Gabbett TJ. The training—injury prevention paradox: should athletes be training smarter and harder? Br J Sports Med. 2016;50:273–80.CrossRefPubMedPubMedCentralGoogle Scholar
  105. 105.
    Hulin BT, Gabbett T, Caputi P, Lawson DW, Sampson JA. Low chronic workload and the acute:chronic workload ratio are more predictive of injury than between-match recovery time: a two-season prospective cohort study in elite rugby league players. Br J Sports Med. 2016;50(16):1008–12.CrossRefPubMedGoogle Scholar
  106. 106.
    Gabbett TJ, Ullah S, Finch CF. Identifying risk factors for contact injury in professional rugby league players—applicability of the frailty model for recurrent injury. J Sci Med Sport. 2012;15:496–504.CrossRefPubMedGoogle Scholar
  107. 107.
    Malone S, Hughes B, Doran DA, Collins K, Gabbett TJ. Can the workload-injury relationship be moderated by improved strength, speed and repeated-sprint qualities? J Sci Med Sport. 2019;22(1):29–34.CrossRefPubMedGoogle Scholar
  108. 108.
    Malone S, Roe M, Doran DA, Gabbett TJ, Collins K. Protection against spikes in workload with aerobic fitness and playing experience: the role of the acute:chronic workload ratio on injury risk in gaelic football. Int J Sports Physiol Perform. 2017;12:393–401.CrossRefPubMedGoogle Scholar
  109. 109.
    Bizzini M, Hancock D, Impellizzeri F. Suggestions from the field for return to sports participation following anterior cruciate ligament reconstruction: soccer. J Orthop Sports Phys Ther. 2012;42(4):304–12.CrossRefPubMedGoogle Scholar
  110. 110.
    English B. Phases of rehabilitation. Foot Ankle Clin. 2013;18(2):357–67.CrossRefPubMedGoogle Scholar
  111. 111.
    Langford JL, Webster KE, Feller JA. A prospective longitudinal study to assess psychological changes following anterior cruciate ligament reconstruction surgery. Br J Sports Med. 2009;43:377–8.CrossRefPubMedGoogle Scholar
  112. 112.
    Ardern CL, Webster KE, Taylor NF, Fellar JA. Return to sport following anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis of the state of play. Br J Sports Med. 2011;45(7):596–606.CrossRefPubMedGoogle Scholar
  113. 113.
    te Wierike SC, van der Sluis A, van den Akker-Scheek I, Elferink-Gemser MT, Visscher C. Psychological factors influencing the recovery of athletes with anterior cruciate ligament injury: a systematic review. Scand J Med Sci Sports. 2013;23(5):527–40.Google Scholar
  114. 114.
    Della Villa S, Boldrini L, Ricci M, et al. Clinical outcomes and return-to-sports participation of 50 soccer players after anterior cruciate ligament reconstruction through a sport-specific rehabilitation protocol. Sports Health. 2012;4:17–24.CrossRefPubMedPubMedCentralGoogle Scholar
  115. 115.
    Kyritsis P, Bahr R, Landreau P, Miladi R, Witvrouw E. Likelihood of ACL graft rupture: not meeting six clinical discharge criteria before return to sport is associated with a four times greater risk of rupture. Br J Sports Med. 2016;50:946–51.CrossRefPubMedGoogle Scholar
  116. 116.
    Soligard T, Schwellnus M, Alonso J-M, et al. How much is too much? (Part 1) International Olympic Committee consensus statement on load in sport and risk of injury. Br J Sports Med. 2016;50:1030–41.CrossRefPubMedGoogle Scholar
  117. 117.
    Windt J, Zumbo BD, Sporer B, MacDonald K, Gabbett TJ. Why do workload spikes cause injuries, and which athletes are at higher risk? Mediators and moderators in workload–injury investigations. Br J Sports Med. 2017;51:993–4.CrossRefPubMedGoogle Scholar
  118. 118.
    Bradley PS, Carling C, Gomez Diaz A, et al. Match performance and physical capacity of players in the top three competitive standards of English professional soccer. Hum Mov Sci. 2013;32(4):808–21.CrossRefPubMedGoogle Scholar
  119. 119.
    Reilly T, Bangsbo J, Franks A. Anthropometric and physiological predispositions for elite soccer. J Sports Sci. 2000;18(9):669–83.CrossRefPubMedGoogle Scholar
  120. 120.
    Tønnessen E, Hem E, Leirstein S, Haugen T, Seiler S. Maximal aerobic power characteristics of male professional soccer players, 1989–2012. Int J Sports Physiol Perform. 2013;8(3):323–9.CrossRefPubMedGoogle Scholar
  121. 121.
    Mohr M, Krustrup P, Bangsbo J. Match performance of high-standard soccer players with special reference to development of fatigue. J Sport Sci. 2003;21:439–49.CrossRefGoogle Scholar
  122. 122.
    Bangsbo J, Mohr M, Krustrup P. Physical and metabolic demands of training and match-play in the elite football player. J Sports Sci. 2006;24:665–74.CrossRefPubMedGoogle Scholar
  123. 123.
    Mascio M, Bradley PS. Evaluation of the most intense high-intensity running period in English FA premier league soccer matches. J Strength Cond Res. 2013;27(4):909–15.CrossRefPubMedGoogle Scholar
  124. 124.
    Stølen T, Chamari K, Castagna C, Wisloff U. Physiology of soccer: an update. Sports Med. 2005;35(6):501–36.CrossRefPubMedGoogle Scholar
  125. 125.
    Bradley PS, Sheldon W, Wooster B, et al. High-intensity running in English FA Premier League soccer matches. J Sports Sci. 2009;27:159–68.CrossRefPubMedGoogle Scholar
  126. 126.
    Osgnach C, Poser S, Bernardini R, Rinaldo R, di Prampero PE. Energy cost and metabolic power in elite soccer: a new match analysis approach. Med Sci Sports Exerc. 2010;42(1):170–8.CrossRefPubMedGoogle Scholar
  127. 127.
    Varley MC, Aughey RJ. Acceleration profiles in elite Australian soccer. Int J Sports Med. 2013;34(1):34–9.PubMedGoogle Scholar
  128. 128.
    Krustrup P, Mohr M, Steensberg A, et al. Muscle and blood metabolites during a soccer game: implications for sprint performance. Med Sci Sports Exerc. 2006;38:1165–74.CrossRefPubMedGoogle Scholar
  129. 129.
    Faude O, Koch T, Meyer T. Straight sprinting is the most frequent action in goal situations in professional soccer. J Sports Sci. 2012;30:625–31.CrossRefPubMedGoogle Scholar
  130. 130.
    Bangsbo J. The physiology of soccer—with special reference to intense intermittent exercise. Acta Physiol Scand. 1994;151(suppl. 619):1–155.Google Scholar
  131. 131.
    Almeida AM, Santos Silva PR, Pedrinelli A, Hernandez AJ. Aerobic fitness in professional soccer players after anterior cruciate ligament reconstruction. PLoS One. 2018;13(3):e0194432. (eCollection 2018).CrossRefPubMedPubMedCentralGoogle Scholar
  132. 132.
    Buckthorpe M, Frizziero A, Roi GS. Update on functional recovery process for the injured athlete: return to sport continuum redefined. Br J Sports Med. 2018. (published online first: 29 September 2018).CrossRefPubMedPubMedCentralGoogle Scholar
  133. 133.
    Dupuy O, Douzi W, Theurot D, Bosquet L, Duqué B. An evidence-based approach for choosing post-exercise recovery techniques to reduce markers of muscle damage, soreness, fatigue, and inflammation: a systematic review with meta-analysis. Front Physiol. 2018;9:403. (eCollection 2018).CrossRefPubMedPubMedCentralGoogle Scholar
  134. 134.
    Reilly T, Ekblom B. The use of recovery methods post-exercise. J Sports Sci. 2005;23(6):619–27.CrossRefPubMedGoogle Scholar
  135. 135.
    Losciale JM, Zdeb RM, Ledbetter L, Reiman MP, Sell TC. The association between passing return-to-sport criteria and second anterior cruciate ligament injury risk: a systematic review with meta-analysis. J Orthop Sports Phys Ther. 2019;49(2):43–54. (Epub 2018 Nov 30).CrossRefPubMedGoogle Scholar
  136. 136.
    Nawasreh Z, Logerstedt D, Cummer K, et al. Do patients failing return-to-activity criteria at 6 months after anterior cruciate ligament reconstruction continue demonstrating deficits at 2 years? Am J Sports Med. 2017;45:1037–48. Scholar
  137. 137.
    Sousa PL, Krych AJ, Cates RA, et al. Return to sport: does excellent 6-month strength and function following ACL reconstruction predict midterm outcomes? Knee Surg Sports Traumatol Arthrosc. 2017;25:1356–63. Scholar
  138. 138.
    Davis GJ, McCarthy E, Provencher M, Manske RC. ACL return to sport guidelines and criteria. Curr Rev Musculoskeletal Med. 2017;10:307–14.CrossRefGoogle Scholar
  139. 139.
    Noyes FR, Barber SD, Mangine RE. Abnormal lower limb symmetry determined by function hop tests after anterior cruciate ligament rupture. Am J Sports Med. 1991;19(5):513–8.CrossRefPubMedGoogle Scholar
  140. 140.
    Shier I. Strategic Assessment of Risk and Risk Tolerance (StARRT) framework for return-to-play decision-making. Br J Sports Med. 2015;49:1311–5.CrossRefGoogle Scholar
  141. 141.
    Bittencourt NFN, Meeuwisse WH, Mendonca LD, et al. Complex systems approach for sports injuries: moving from risk factor identification to injury pattern recognition-narrative review and new concept. Br J Sports Med. 2016;50:1308–14.CrossRefGoogle Scholar
  142. 142.
    Gokeler A, Welling W, Zaffagnini S, Seil R, Padua D. Development of a test battery to enhance safe return to sports after anterior ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2017;25(1):192–9.CrossRefPubMedGoogle Scholar
  143. 143.
    O’Malley E, Richter C, King E, et al. Countermovement jump and isokinetic dynamometry as measures of rehabilitation status after anterior cruciate ligament reconstruction. J Athl Train. 2018;53(7):687–95.CrossRefPubMedPubMedCentralGoogle Scholar
  144. 144.
    Noyes FR, Barber SD, Mangine RE. Abnormal lower limb symmetry determined by function hop tests after anterior cruciate ligament rupture. Am J Sports Med. 1991;19:513–8.CrossRefPubMedGoogle Scholar
  145. 145.
    Padua DA, Marshall SW, Boling MC, et al. The Landing Error Scoring System (LESS) is a valid and reliable clinical assessment tool of jump-landing biomechanics: The JUMP-ACL study. Am J Sports Med. 2009;37:1996–2002.CrossRefPubMedGoogle Scholar
  146. 146.
    Bangsbo J, Iaia FM, Krustrup P. The Yo-Yo intermittent recovery test: a useful tool for evaluation of physical performance in intermittent sports. Sports Med. 2008;38(1):37–51.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Isokinetic Medical GroupFIFA Medical Centre of Excellence, Education and Research DepartmentBolognaItaly
  2. 2.Isokinetic Medical GroupFIFA Medical Centre of ExcellenceLondonUK

Personalised recommendations