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Return to sport after anterior cruciate ligament injury: Panther Symposium ACL Injury Return to Sport Consensus Group

Abstract

Purpose

A precise and consistent definition of return to sport (RTS) after anterior cruciate ligament (ACL) injury is lacking, and there is controversy surrounding the process of returning patients to sports and their previous activity level. The aim of the Panther Symposium ACL Injury RTS Consensus Group was to provide a clear definition of RTS and description of the RTS continuum, as well as to provide clinical guidance on RTS testing and decision-making.

Methods

An international, multidisciplinary group of ACL experts convened as part of a consensus meeting. Consensus statements were developed using a modified Delphi method. Literature review was performed to report the supporting evidence.

Results

Key points include that RTS is characterized by achievement of the pre-injury level of sport and involves a criteria-based progression from return to participation to return to sport, and ultimately return to performance. Purely time-based RTS decision-making should be abandoned. Progression occurs along a RTS continuum with decision-making by a multidisciplinary group that incorporates objective physical examination data and validated and peer-reviewed RTS tests, which should involve functional assessment as well as psychological readiness. Consideration should be given to biological healing, contextual factors and concomitant injuries.

Conclusion

The resultant consensus statements and scientific rationale aim to inform the reader of the complex process of RTS after ACL injury that occurs along a dynamic continuum. Research is needed to determine the ideal RTS test battery, the best implementation of psychological readiness testing and methods for the biologic assessment of healing and recovery.

Level of evidence

IV.

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Acknowledgements

Panther Symposium ACL Injury Return to Sport Consensus Group: Mario Bizzini PhD, MSc, PT; Shiyi Chen MD, PhD; Moises Cohen MD PhD; Stefano Della Villa MD; Lars Engebretsen MD, PhD; Hua Feng MD; Mario Ferretti MD, PhD; Freddie H. Fu MD; Andreas B. Imhoff MD; Christopher C. Kaeding MD; Jon Karlsson MD, PhD; Ryosuke Kuroda MD, PhD; Andrew D. Lynch, PT, PhD; Jacques Menetrey MD, PhD; Volker Musahl MD; Ronald A. Navarro MD; Stephen J. Rabuck MD; Rainer Siebold MD, PhD; Lynn Snyder-Mackler PT, ATC, ScD, SCS, FAPTA; Tim Spalding FRCS Orth; Carola van Eck, MD, PhD; Dharmesh Vyas MD, PhD; Kate Webster PhD; Kevin Wilk PT, DPT, FAPTA

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There was no funding for this study.

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Each named author has substantially contributed to conducting the underlying research and drafting this manuscript. Each of the authors in the Panther Symposium ACL Injury Return to Sport Consensus Group has contributed according to the Group Authorship guidelines. All authors have approved the final manuscript.

Corresponding author

Correspondence to Sean J. Meredith.

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Conflict of interest

CF—Karl Storz: IP royalties, paid consultant; Medacta: IP royalties, paid consultant, paid presenter or speaker; Zimmer: research support; SLS—Arthrex, Inc: paid consultant; Smith & Nephew: paid consultant; CONMED: knee design team, paid consultant; Flexion Therapeutics: paid consultant; JRF Ortho: paid consultant; Olympus: paid consultant; Vericel: paid consultant; Zimmer: Research support; BPL—Wolters Kluwer Health—Lippincott Williams & Wilkins: publishing royalties, financial or material support; SJM, TR, TLC, TD, BBR, ES, EHS, TEH—none declared.

Ethical approval

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

Informed consent

Informed consent were not applicable.

Panther group authorship disclosures

Bizzini—none, Chen—none, Cohen—none, Della Villa—none, Engebretsen—Smith & Nephew grants, editor of JBJS and BJSM, Feng—none, Ferretti—none, Fu—none, Imhoff—none, Kaeding—none, Karlsson—Editor-in-Chief KSSTA, Kuroda—grants and personal fees from Smith & Nephew, grants and personal fees from Zimmer Biomet, grants from Stryker Japan KK, grants and personal fees from Johnson & Johnson KK, personal fees from Medacta International, personal fees from Arthrex, Inc, personal fees from Japan Tissue Engineering Co., Ltd,, personal fees from Hirosaki Life Science Innovation, Inc, personal fees from Arthrex Japan G.K, Lynch—none, Menetrey—none, Musahl—educational grants from Smith & Nephew and educational grants from Arthrex, Navarro—none, Rabuck—none, Siebold—Medacta International personal fees, Snyder-Mackler—none, Spalding—none, van Eck—none, Vyas—none, Webster—none, Wilk—none.

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Meredith, S.J., Rauer, T., Chmielewski, T.L. et al. Return to sport after anterior cruciate ligament injury: Panther Symposium ACL Injury Return to Sport Consensus Group. Knee Surg Sports Traumatol Arthrosc 28, 2403–2414 (2020). https://doi.org/10.1007/s00167-020-06009-1

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Keywords

  • Return to sport
  • Anterior cruciate ligament
  • Consensus statement
  • Rehabilitation