Muscle strength and hop performance criteria prior to return to sports after ACL reconstruction
- 5.4k Downloads
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.
Level of evidence
KeywordsReturn to sport Strength Hop performance Patient’s opinion Knee function
- 1.Ageberg E, Pettersson A, Friden T (2007) 15-year follow-up of neuromuscular function in patients with unilateral nonreconstructed anterior cruciate ligament injury initially treated with rehabilitation and activity modification: a longitudinal prospective study. Am J Sports Med 35(12):2109–2117PubMedCrossRefGoogle Scholar
- 2.Ageberg E, Thomee R, Neeter C, Silbernagel KG, Roos EM (2008) Muscle strength and functional performance in patients with anterior cruciate ligament injury treated with training and surgical reconstruction or training only: a two to five-year followup. Arthritis Rheum 59(12):1773–1779PubMedCrossRefGoogle Scholar
- 3.Alentorn-Geli E, Myer GD, Silvers HJ, Samitier G, Romero D, Lazaro-Haro C, Cugat R (2009) Prevention of non-contact anterior cruciate ligament injuries in soccer players. Part 2: a review of prevention programs aimed to modify risk factors and to reduce injury rates. Knee Surg Sports Traumatol Arthrosc 17(8):859–879PubMedCrossRefGoogle Scholar
- 6.Andrade MS, Cohen M, Picarro IC, Silva AC (2002) Knee performance after anterior cruciate ligament reconstruction. Isokinetics Exerc Sci 10:81–86Google Scholar
- 8.Ardern CL, Webster KE, Taylor NF, Feller JA (2010) Return to the preinjury 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. doi: 10.1177/0363546510384798
- 9.Ardern CL, Webster KE, Taylor NF, Feller JA (2011) Return to sport following anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis of the state of play. Br J Sports Med. doi: 10.1136/bjsm.2010.076364
- 13.Beynnon BD, Johnson RJ, Fleming BC (2002) The science of anterior cruciate ligament rehabilitation. Clin Orthop Relat Res (402):9–20Google Scholar
- 14.Beynnon BD, Uh BS, Johnson RJ, Abate JA, Nichols CE, Fleming BC, Poole AR, Roos H (2005) Rehabilitation after anterior cruciate ligament reconstruction: a prospective, randomized, double-blind comparison of programs administered over 2 different time intervals. Am J Sports Med 33(3):347–359PubMedCrossRefGoogle Scholar
- 24.Felson DT, Lawrence RC, Dieppe PA, Hirsch R, Helmick CG, Jordan JM, Kington RS, Lane NE, Nevitt MC, Zhang Y, Sowers M, McAlindon T, Spector TD, Poole AR, Yanovski SZ, Ateshian G, Sharma L, Buckwalter JA, Brandt KD, Fries JF (2000) Osteoarthritis: new insights. Part 1: the disease and its risk factors. Ann Intern Med 133(8):635–646PubMedGoogle Scholar
- 26.Gerber JP, Marcus RL, Dibble LE, Greis PE, Burks RT, LaStayo PC (2009) Effects of early progressive eccentric exercise on muscle size and function after anterior cruciate ligament reconstruction: a 1-year follow-up study of a randomized clinical trial. Phys Ther 89(1):51–59PubMedCrossRefGoogle Scholar
- 46.Lautamies R, Harilainen A, Kettunen J, Sandelin J, Kujala UM (2008) Isokinetic quadriceps and hamstring muscle strength and knee function 5 years after anterior cruciate ligament reconstruction: comparison between bone-patellar tendon-bone and hamstring tendon autografts. Knee Surg Sports Traumatol Arthrosc 16(11):1009–1016PubMedCrossRefGoogle Scholar
- 53.Mikkelsen C, Werner S, Eriksson E (2000) Closed kinetic chain alone compared to combined open and closed kinetic chain exercises for quadriceps strengthening after anterior cruciate ligament reconstruction with respect to return to sports: a prospective matched follow-up study. Knee Surg Sports Traumatol Arthrosc 8(6):337–342PubMedCrossRefGoogle Scholar
- 65.Oiestad BE, Holm I, Aune AK, Gunderson R, Myklebust G, Engebretsen L, Fosdahl MA, Risberg MA (2010) Knee function and prevalence of knee osteoarthritis after anterior cruciate ligament reconstruction: a prospective study with 10–15 years of follow-up. Am J Sports Med 38(11):2201–2210PubMedCrossRefGoogle Scholar
- 66.Oiestad BE, Holm I, Engebretsen L, Risberg MA (2010) The association between radiographic knee osteoarthritis and knee symptoms, function and quality of life 10–15 years after anterior cruciate ligament reconstruction. Br J Sports MedGoogle Scholar
- 72.Palmieri-Smith RM, Thomas AC, Wojtys EM (2008) Maximizing quadriceps strength after ACL reconstruction. Clin Sports Med 27(3): 405–424, vii–ixGoogle Scholar
- 91.Thomee R, Neeter C, Gustavsson A, Thomee P, Augustsson J, Eriksson B, Karlsson J (2011) Variability in leg muscle power and hop performance after anterior cruciate ligament reconstruction: A two-year prospective study. SubmittedGoogle Scholar
- 102.Wright RW, Dunn WR, Amendola A, Andrish JT, Bergfeld J, Kaeding CC, Marx RG, McCarty EC, Parker RD, Wolcott M, Wolf BR, Spindler KP (2007) Risk of tearing the intact anterior cruciate ligament in the contralateral knee and rupturing the anterior cruciate ligament graft during the first 2 years after anterior cruciate ligament reconstruction: a prospective MOON cohort study. Am J Sports Med 35(7):1131–1134PubMedCrossRefGoogle Scholar