Skip to main content

Optimization of the Return-to-Sport Paradigm After Anterior Cruciate Ligament Reconstruction: A Critical Step Back to Move Forward

Abstract

Athletes who have sustained an anterior cruciate ligament (ACL) injury often opt for an ACL reconstruction (ACLR) with the goal and expectation to resume sports. Unfortunately, the proportion of athletes successfully returning to sport is relatively low, while the rate of second ACL injury has been reported to exceed 20% after clearance to return to sport, especially within younger athletic populations. Despite the development of return-to-sport guidelines over recent years, there are still more questions than answers on the most optimal return-to-sport criteria after ACLR. The primary purpose of this review was to provide a critical appraisal of the current return-to-sport criteria and decision-making processes after ACLR. Traditional return-to-sport criteria mainly focus on time after injury and impairments of the injured knee joint. The return-to-sport decision making is only made at the hypothetical ‘end’ of the rehabilitation. We propose an optimized criterion-based multifactorial return-to-sport approach based on shared decision making within a broad biopsychosocial framework. A wide spectrum of sensorimotor and biomechanical outcomes should be assessed comprehensively, while the interactions of an individual athlete with the tasks being performed and the environment in which the tasks are executed are taken into account. A layered approach within a smooth continuum with repeated athletic evaluations throughout rehabilitation followed by a gradual periodized reintegration into sport with adequate follow-up may help to guide an individual athlete toward a successful return to sport.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2

References

  1. 1.

    Marx RG, Jones EC, Angel M, et al. 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.

    PubMed  Article  Google Scholar 

  2. 2.

    Wiggins AJ, Grandhi RK, Schneider DK, et al. 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.

    PubMed  PubMed Central  Article  Google Scholar 

  3. 3.

    Culvenor AG, Cook JL, Collins NJ, et al. Is patellofemoral joint osteoarthritis an under-recognised outcome of anterior cruciate ligament reconstruction? A narrative literature review. Br J Sports Med. 2013;47(2):66–70.

    PubMed  Article  Google Scholar 

  4. 4.

    Oiestad BE, Holm I, Engebretsen L, et al. 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 Med. 2011;45(7):583–8.

    CAS  PubMed  Article  Google Scholar 

  5. 5.

    Risberg MA, Oiestad BE, Gunderson R, et al. Changes in knee osteoarthritis, symptoms, and function after anterior cruciate ligament reconstruction: a 20-year prospective follow-up study. Am J Sports Med. 2016;44(5):1215–24.

    PubMed  Article  Google Scholar 

  6. 6.

    Zaffagnini S, Grassi A, Serra M, et al. Return to sport after ACL reconstruction: how, when and why? A narrative review of current evidence. Joints. 2015;3(1):25–30.

    PubMed  PubMed Central  Google Scholar 

  7. 7.

    Ardern CL. Anterior cruciate ligament reconstruction – not exactly a one-way ticket back to the preinjury level: a review of contextual factors affecting return to sport after surgery. Sports Health. 2015;7(3):224–30.

    PubMed  PubMed Central  Article  Google Scholar 

  8. 8.

    Ardern CL, Taylor NF, Feller JA, et al. Fifty-five per cent return to competitive sport following anterior cruciate ligament reconstruction surgery: an updated systematic review and meta-analysis including aspects of physical functioning and contextual factors. Br J Sports Med. 2014;48(21):1543–52.

    PubMed  Article  Google Scholar 

  9. 9.

    Walden M, Hagglund M, Magnusson H, et al. ACL injuries in men’s professional football: a 15-year prospective study on time trends and return-to-play rates reveals only 65% of players still play at the top level 3 years after ACL rupture. Br J Sports Med. 2016;50(12):744–50.

    PubMed  Article  Google Scholar 

  10. 10.

    Kester BS, Behery OA, Minhas SV, et al. Athletic performance and career longevity following anterior cruciate ligament reconstruction in the national basketball association. Knee Surg Sports Traumatol Arthrosc. 2016. doi:10.1007/s00167-016-4060-y (Epub 12 Mar 2016).

  11. 11.

    Thomee R, Kaplan Y, Kvist J, et al. Muscle strength and hop performance criteria prior to return to sports after ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. 2011;19(11):1798–805.

    PubMed  Article  Google Scholar 

  12. 12.

    Samitier G, Marcano AI, Alentorn-Geli E, et al. Failure of anterior cruciate ligament reconstruction. Arch Bone Jt Surg. 2015;3(4):220–40.

    PubMed  PubMed Central  Google Scholar 

  13. 13.

    Feller J, Webster KE. Return to sport following anterior cruciate ligament reconstruction. Int Orthop. 2013;37(2):285–90.

    PubMed  Article  Google Scholar 

  14. 14.

    Shrier I. Strategic assessment of risk and risk tolerance (StARRT) framework for return-to-play decision-making. Br J Sports Med. 2015;49(20):1311–5.

    PubMed  Article  Google Scholar 

  15. 15.

    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(14):853–64.

    PubMed  Article  Google Scholar 

  16. 16.

    Lynch AD, Logerstedt DS, Grindem H, et al. Consensus criteria for defining ‘successful outcome’ after ACL injury and reconstruction: a Delaware-Oslo ACL cohort investigation. Br J Sports Med. 2015;49(5):335–42.

    PubMed  Article  Google Scholar 

  17. 17.

    Ardern CL, Bizzini M, Bahr R. It is time for consensus on return to play after injury: five key questions. Br J Sports Med. 2016;50(9):506–8.

    PubMed  Article  Google Scholar 

  18. 18.

    Barber-Westin SD, Noyes FR. Factors used to determine return to unrestricted sports activities after anterior cruciate ligament reconstruction. Arthroscopy. 2011;27(12):1697–705.

    PubMed  Article  Google Scholar 

  19. 19.

    Grindem H, Snyder-Mackler L, Moksnes H, et al. Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study. Br J Sports Med. 2016;50(13):804–8.

    PubMed  PubMed Central  Article  Google Scholar 

  20. 20.

    Kyritsis P, Bahr R, Landreau P, et al. 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(15):946–51.

    PubMed  Article  Google Scholar 

  21. 21.

    Czuppon S, Racette BA, Klein SE, et al. Variables associated with return to sport following anterior cruciate ligament reconstruction: a systematic review. Br J Sports Med. 2014;48(5):356–64.

    PubMed  Article  Google Scholar 

  22. 22.

    Gokeler A, Welling W, Zaffagnini S, et al. Development of a test battery to enhance safe return to sports after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2016. doi:10.1007/s00167-016-4246-3 (Epub 16 Jul 2016).

  23. 23.

    Bittencourt NF, 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. doi:10.1136/bjsports-2015-095850 (Epub 21 Jul 2016).

  24. 24.

    Karlsson J, Becker R. Return to sports after ACL reconstruction: individual considerations. Knee Surg Sports Traumatol Arthrosc. 2015;23(5):1271–2.

    PubMed  Article  Google Scholar 

  25. 25.

    Schlumberger M, Schuster P, Schulz M, et al. Traumatic graft rupture after primary and revision anterior cruciate ligament reconstruction: retrospective analysis of incidence and risk factors in 2915 cases. Knee Surg Sports Traumatol Arthrosc. 2015. doi:10.1007/s00167-015-3699-0 (Epub 26 Sep 2015).

  26. 26.

    Paterno MV, Rauh MJ, Schmitt LC, et al. Incidence of second ACL injuries 2 years after primary ACL reconstruction and return to sport. Am J Sports Med. 2014;42(7):1567–73.

    PubMed  PubMed Central  Article  Google Scholar 

  27. 27.

    Laboute E, Savalli L, Puig P, et al. Analysis of return to competition and repeat rupture for 298 anterior cruciate ligament reconstructions with patellar or hamstring tendon autograft in sportspeople. Ann Phys Rehabil Med. 2010;53(10):598–614.

    CAS  PubMed  Article  Google Scholar 

  28. 28.

    Nagelli CV, Hewett TE. Should return to sport be delayed until 2 years after anterior cruciate ligament reconstruction? Biological and functional considerations. Sports Med. 2016. doi:10.1007/s40279-016-0584-z (Epub 11 Jul 2016).

  29. 29.

    Myer GD, Martin L Jr, Ford KR, et al. No association of time from surgery with functional deficits in athletes after anterior cruciate ligament reconstruction: evidence for objective return-to-sport criteria. Am J Sports Med. 2012;40(10):2256–63.

    PubMed  PubMed Central  Article  Google Scholar 

  30. 30.

    Capin JJ, Khandha A, Zarzycki R, et al. Gait mechanics and second ACL rupture: implications for delaying return-to-sport. J Orthop Res. 2016. doi:10.1002/jor.23476 (Epub 9 Nov 2016).

  31. 31.

    Chan DK, Lonsdale C, Ho PY, et al. Patient motivation and adherence to postsurgery rehabilitation exercise recommendations: the influence of physiotherapists’ autonomy-supportive behaviors. Arch Phys Med Rehabil. 2009;90(12):1977–82.

    PubMed  Article  Google Scholar 

  32. 32.

    Thomee R, Neeter C, Gustavsson A, et al. Variability in leg muscle power and hop performance after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2012;20(6):1143–51.

    PubMed  Article  Google Scholar 

  33. 33.

    Logerstedt D, Arundale A, Lynch A, et al. A conceptual framework for a sports knee injury performance profile (SKIPP) and return to activity criteria (RTAC). Braz J Phys Ther. 2015;19(5):340–59.

    PubMed  PubMed Central  Article  Google Scholar 

  34. 34.

    Anderson AF, Irrgang JJ, Kocher MS, et al. The International Knee Documentation Committee Subjective Knee Evaluation Form: normative data. Am J Sports Med. 2006;34(1):128–35.

    PubMed  Article  Google Scholar 

  35. 35.

    Collins NJ, Misra D, Felson DT, et al. Measures of knee function: International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Knee Injury and Osteoarthritis Outcome Score (KOOS), Knee Injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS-PS), Knee Outcome Survey Activities of Daily Living Scale (KOS-ADL), Lysholm Knee Scoring Scale, Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Activity Rating Scale (ARS), and Tegner Activity Score (TAS). Arthritis Care Res (Hoboken). 2011;63(Suppl 11):S208–28.

    PubMed  PubMed Central  Article  Google Scholar 

  36. 36.

    van Meer BL, Meuffels DE, Vissers MM, et al. Knee injury and Osteoarthritis Outcome Score or International Knee Documentation Committee Subjective Knee Form: which questionnaire is most useful to monitor patients with an anterior cruciate ligament rupture in the short term? Arthroscopy. 2013;29(4):701–15.

    PubMed  Article  Google Scholar 

  37. 37.

    Logerstedt D, Di Stasi S, Grindem H, et al. Self-reported knee function can identify athletes who fail return-to-activity criteria up to 1 year after anterior cruciate ligament reconstruction: a Delaware-Oslo ACL cohort study. J Orthop Sports Phys Ther. 2014;44(12):914–23.

    PubMed  PubMed Central  Article  Google Scholar 

  38. 38.

    Parsons JT, Snyder AR. Health-related quality of life as a primary clinical outcome in sport rehabilitation. J Sport Rehabil. 2011;20(1):17–36.

    PubMed  Article  Google Scholar 

  39. 39.

    Undheim MB, Cosgrave C, King E, et al. 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. 2015;49(20):1305–10.

    PubMed  Article  Google Scholar 

  40. 40.

    Petersen W, Taheri P, Forkel P, et al. Return to play following ACL reconstruction: a systematic review about strength deficits. Arch Orthop Trauma Surg. 2014;134(10):1417–28.

    PubMed  Article  Google Scholar 

  41. 41.

    Khayambashi K, Ghoddosi N, Straub RK, et al. Hip muscle strength predicts noncontact anterior cruciate ligament injury in male and female athletes: a prospective study. Am J Sports Med. 2016;44(2):355–61.

    PubMed  Article  Google Scholar 

  42. 42.

    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.

    CAS  PubMed  Article  Google Scholar 

  43. 43.

    Reid A, Birmingham TB, Stratford PW, et al. Hop testing provides a reliable and valid outcome measure during rehabilitation after anterior cruciate ligament reconstruction. Phys Ther. 2007;87(3):337–49.

    PubMed  Article  Google Scholar 

  44. 44.

    Hegedus EJ, McDonough S, Bleakley C, et al. Clinician-friendly lower extremity physical performance measures in athletes: a systematic review of measurement properties and correlation with injury, part 1. The tests for knee function including the hop tests. Br J Sports Med. 2015;49(10):642–8.

    PubMed  Article  Google Scholar 

  45. 45.

    Itoh H, Kurosaka M, Yoshiya S, et al. Evaluation of functional deficits determined by four different hop tests in patients with anterior cruciate ligament deficiency. Knee Surg Sports Traumatol Arthrosc. 1998;6(4):241–5.

    CAS  PubMed  Article  Google Scholar 

  46. 46.

    Gustavsson A, Neeter C, Thomee P, et al. A test battery for evaluating hop performance in patients with an ACL injury and patients who have undergone ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. 2006;14(8):778–88.

    PubMed  Article  Google Scholar 

  47. 47.

    Abrams GD, Harris JD, Gupta AK, et al. Functional performance testing after anterior cruciate ligament reconstruction: a systematic review. Orthop J Sports Med. 2014;2(1):2325967113518305.

    PubMed  PubMed Central  Article  Google Scholar 

  48. 48.

    Xergia SA, Pappas E, Georgoulis AD. Association of the single-limb hop test with isokinetic, kinematic, and kinetic asymmetries in patients after anterior cruciate ligament reconstruction. Sports Health. 2015;7(3):217–23.

    PubMed  PubMed Central  Article  Google Scholar 

  49. 49.

    Kvist J. Rehabilitation following anterior cruciate ligament injury: current recommendations for sports participation. Sports Med. 2004;34(4):269–80.

    PubMed  Article  Google Scholar 

  50. 50.

    van Grinsven S, van Cingel RE, Holla CJ, et al. Evidence-based rehabilitation following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2010;18(8):1128–44.

    PubMed  Article  Google Scholar 

  51. 51.

    Barber-Westin SD, Noyes FR. Objective criteria for return to athletics after anterior cruciate ligament reconstruction and subsequent reinjury rates: a systematic review. Phys Sports Med. 2011;39(3):100–10.

    Article  Google Scholar 

  52. 52.

    Dingenen B, Janssens L, Claes S, et al. Postural stability deficits during the transition from double-leg stance to single-leg stance in anterior cruciate ligament reconstructed subjects. Hum Mov Sci. 2015;41:46–58.

    PubMed  Article  Google Scholar 

  53. 53.

    Dingenen B, Janssens L, Claes S, et al. Lower extremity muscle activation onset times during the transition from double-leg stance to single-leg stance in anterior cruciate ligament reconstructed subjects. Clin Biomech (Bristol, Avon). 2016;35:116–23.

    Article  Google Scholar 

  54. 54.

    Culvenor AG, Alexander BC, Clark RA, et al. Dynamic single-leg postural control is impaired bilaterally following anterior cruciate ligament reconstruction: implications for reinjury risk. J Orthop Sports Phys Ther. 2016;46(5):357–64.

    PubMed  Article  Google Scholar 

  55. 55.

    Clagg S, Paterno MV, Hewett TE, et al. Performance on the modified star excursion balance test at the time of return to sport following anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther. 2015;45(6):444–52.

    PubMed  Article  Google Scholar 

  56. 56.

    Hall MP, Paik RS, Ware AJ, et al. Neuromuscular evaluation with single-leg squat test at 6 months after anterior cruciate ligament reconstruction. Orthop J Sports Med. 2015;3(3):2325967115575900.

    PubMed  PubMed Central  Article  Google Scholar 

  57. 57.

    Chung KS, Ha JK, Yeom CH, et al. Are muscle strength and function of the uninjured lower limb weakened after anterior cruciate ligament injury? Two-year follow-up after reconstruction. Am J Sports Med. 2015;43(12):3013–21.

    PubMed  Article  Google Scholar 

  58. 58.

    Paterno MV, Schmitt LC, Ford KR, et al. Biomechanical measures during landing and postural stability predict second anterior cruciate ligament injury after anterior cruciate ligament reconstruction and return to sport. Am J Sports Med. 2010;38(10):1968–78.

    PubMed  PubMed Central  Article  Google Scholar 

  59. 59.

    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 (Bristol, Avon). 2015;30(10):1094–101.

    Article  Google Scholar 

  60. 60.

    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.

    PubMed  Article  Google Scholar 

  61. 61.

    Engelen-van Melick N, van Cingel RE, Tijssen MP, et al. Assessment of functional performance after anterior cruciate ligament reconstruction: a systematic review of measurement procedures. Knee Surg Sports Traumatol Arthrosc. 2013;21(4):869–79.

    PubMed  Article  Google Scholar 

  62. 62.

    Wilk KE, Macrina LC, Cain EL, et al. Recent advances in the rehabilitation of anterior cruciate ligament injuries. J Orthop Sports Phys Ther. 2012;42(3):153–71.

    PubMed  Article  Google Scholar 

  63. 63.

    Powers CM. The influence of abnormal hip mechanics on knee injury: a biomechanical perspective. J Orthop Sports Phys Ther. 2010;40(2):42–51.

    PubMed  Article  Google Scholar 

  64. 64.

    Mendiguchia J, Ford KR, Quatman CE, et al. Sex differences in proximal control of the knee joint. Sports Med. 2011;41(7):541–57.

    PubMed  PubMed Central  Article  Google Scholar 

  65. 65.

    Pataky TC, Robinson MA, Vanrenterghem J. Vector field statistical analysis of kinematic and force trajectories. J Biomech. 2013;46(14):2394–401.

    PubMed  Article  Google Scholar 

  66. 66.

    Dingenen B, Malfait B, Vanrenterghem J, et al. The reliability and validity of the measurement of lateral trunk motion in two-dimensional video analysis during unipodal functional screening tests in elite female athletes. Phys Ther Sport. 2014;15(2):117–23.

    PubMed  Article  Google Scholar 

  67. 67.

    Dingenen B, Malfait B, Vanrenterghem J, et al. Can two-dimensional measured peak sagittal plane excursions during drop vertical jumps help identify three-dimensional measured joint moments? Knee. 2015;22(2):73–9.

    PubMed  Article  Google Scholar 

  68. 68.

    Dingenen B, Malfait B, Nijs S, et al. Can two-dimensional video analysis during single-leg drop vertical jumps help identify non-contact knee injury risk? A one-year prospective study. Clin Biomech (Bristol, Avon). 2015;30(8):781–7.

    Article  Google Scholar 

  69. 69.

    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(10):1996–2002.

    PubMed  Article  Google Scholar 

  70. 70.

    Fox AS, Bonacci J, McLean SG, et al. What is normal? Female lower limb kinematic profiles during athletic tasks used to examine anterior cruciate ligament injury risk: a systematic review. Sports Med. 2014;44(6):815–32.

    PubMed  Article  Google Scholar 

  71. 71.

    Chua EN, Yeung MY, Fu SC, et al. Motion task selection for kinematic evaluation after anterior cruciate ligament reconstruction: a systematic review. Arthroscopy. 2016;32(7):1453–65.

    PubMed  Article  Google Scholar 

  72. 72.

    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.

    PubMed  Article  Google Scholar 

  73. 73.

    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.

    PubMed  PubMed Central  Google Scholar 

  74. 74.

    Gray R. Differences in attentional focus associated with recovery from sports injury: does injury induce an internal focus? J Sport Exerc Psychol. 2015;37(6):607–16. doi:10.1123/jsep.2015-0156.

    PubMed  Article  Google Scholar 

  75. 75.

    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. doi:10.1007/s00776-005-0893-9.

    PubMed  Article  Google Scholar 

  76. 76.

    Dingenen B, Janssens L, Luyckx T, et al. Postural stability during the transition from double-leg stance to single-leg stance in anterior cruciate ligament injured subjects. Clin Biomech (Bristol, Avon). 2015;30(3):283–9.

    Article  Google Scholar 

  77. 77.

    Dingenen B, Janssens L, Luyckx T, et al. Lower extremity muscle activation onset times during the transition from double-leg stance to single-leg stance in anterior cruciate ligament injured subjects. Hum Mov Sci. 2015;44:234–45.

    PubMed  Article  Google Scholar 

  78. 78.

    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.

    PubMed  Article  Google Scholar 

  79. 79.

    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.

    CAS  PubMed  Article  Google Scholar 

  80. 80.

    Kapreli E, Athanasopoulos S. The anterior cruciate ligament deficiency as a model of brain plasticity. Med Hypotheses. 2006;67(3):645–50.

    PubMed  Article  Google Scholar 

  81. 81.

    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;45(5):381–93.

    PubMed  Article  Google Scholar 

  82. 82.

    Swanik CB. Brains and sprains: the brain’s role in noncontact anterior cruciate ligament injuries. J Athl Train. 2015;50(10):1100–2.

    PubMed  Article  Google Scholar 

  83. 83.

    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.

    PubMed  Article  Google Scholar 

  84. 84.

    Benjaminse A, Gokeler A, Dowling AV, et al. Optimization of the anterior cruciate ligament injury prevention paradigm: novel feedback techniques to enhance motor learning and reduce injury risk. J Orthop Sports Phys Ther. 2015;45(3):170–82.

    PubMed  Article  Google Scholar 

  85. 85.

    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):1065–74.

    PubMed  PubMed Central  Article  Google Scholar 

  86. 86.

    Augustsson J, Thomee R, Karlsson J. Ability of a new hop test to determine functional deficits after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2004;12(5):350–6.

    PubMed  Article  Google Scholar 

  87. 87.

    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(8):464–73.

    PubMed  Article  Google Scholar 

  88. 88.

    Webster KE, Santamaria LJ, McClelland JA, et al. Effect of fatigue on landing biomechanics after anterior cruciate ligament reconstruction surgery. Med Sci Sports Exerc. 2012;44(5):910–6.

    PubMed  Article  Google Scholar 

  89. 89.

    Gokeler A, Eppinga P, Dijkstra PU, et al. Effect of fatigue on landing performance assessed with the landing error scoring system (LESS) in patients after ACL reconstruction. A pilot study. Int J Sports Phys Ther. 2014;9(3):302–11.

    CAS  PubMed  PubMed Central  Google Scholar 

  90. 90.

    Frank BS, Gilsdorf CM, Goerger BM, et al. 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.

    PubMed  PubMed Central  Article  Google Scholar 

  91. 91.

    Borotikar BS, Newcomer R, Koppes R, et al. Combined effects of fatigue and decision making on female lower limb landing postures: central and peripheral contributions to ACL injury risk. Clin Biomech (Bristol, Avon). 2008;23(1):81–92.

    Article  Google Scholar 

  92. 92.

    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.

    PubMed  PubMed Central  Google Scholar 

  93. 93.

    Ardern CL, Webster KE, Taylor NF, et al. 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.

    PubMed  Article  Google Scholar 

  94. 94.

    Everhart JS, Best TM, Flanigan DC. Psychological predictors of anterior cruciate ligament reconstruction outcomes: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2015;23(3):752–62.

    PubMed  Article  Google Scholar 

  95. 95.

    Sonesson S, Kvist J, Ardern C, et al. Psychological factors are important to return to pre-injury sport activity after anterior cruciate ligament reconstruction: expect and motivate to satisfy. Knee Surg Sports Traumatol Arthrosc. 2016. doi:10.1007/s00167-016-4294-8 (Epub 25 Aug 2016).

  96. 96.

    Thomee P, Wahrborg P, Borjesson M, et al. A new instrument for measuring self-efficacy in patients with an anterior cruciate ligament injury. Scand J Med Sci Sports. 2006;16(3):181–7.

    CAS  PubMed  Article  Google Scholar 

  97. 97.

    Hamrin Senorski E, Samuelsson K, Thomee C, et al. Return to knee-strenuous sport after anterior cruciate ligament reconstruction: a report from a rehabilitation outcome registry of patient characteristics. Knee Surg Sports Traumatol Arthrosc. 2016. doi:10.1007/s00167-016-4280-1 (Epub 26 Aug 2016).

  98. 98.

    Webster KE, Feller JA, Lambros C. Development and preliminary validation of a scale to measure the psychological impact of returning to sport following anterior cruciate ligament reconstruction surgery. Phys Ther Sport. 2008;9(1):9–15.

    PubMed  Article  Google Scholar 

  99. 99.

    Ardern CL, Taylor NF, Feller JA, et al. Psychological responses matter in returning to preinjury level of sport after anterior cruciate ligament reconstruction surgery. Am J Sports Med. 2013;41(7):1549–58.

    PubMed  Article  Google Scholar 

  100. 100.

    Ardern C, Kvist J. What is the evidence to support a psychological component to rehabilitation programs after anterior cruciate ligament reconstruction? Curr Orthop Pract. 2016;27(3):263–8.

    Article  Google Scholar 

  101. 101.

    te Wierike SC, van der Sluis A, van den Akker-Scheek I, et al. Psychosocial 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 

  102. 102.

    Nyland J. Update on rehabilitation following ACL reconstruction. Open Access J Sports Med. 2010;1:151.

    PubMed  PubMed Central  Article  Google Scholar 

  103. 103.

    Wilk KE, Arrigo CA. Rehabilitation principles of the anterior cruciate ligament reconstructed knee: twelve steps for successful progression and return to play. Clin Sports Med. 2017;36(1):189–232.

    PubMed  Article  Google Scholar 

  104. 104.

    Ellman MB, Sherman SL, Forsythe B, et al. Return to play following anterior cruciate ligament reconstruction. J Am Acad Orthop Surg. 2015;23(5):283–96.

    PubMed  Article  Google Scholar 

  105. 105.

    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.

    PubMed  Article  Google Scholar 

  106. 106.

    Myer GD, Paterno MV, Ford KR, et al. Rehabilitation after anterior cruciate ligament reconstruction: criteria-based progression through the return-to-sport phase. J Orthop Sports Phys Ther. 2006;36(6):385–402.

    PubMed  Article  Google Scholar 

  107. 107.

    Nyland J, Mattocks A, Kibbe S, et al. Anterior cruciate ligament reconstruction, rehabilitation, and return to play: 2015 update. Open Access J Sports Med. 2016;7:21–32.

    PubMed  PubMed Central  Article  Google Scholar 

  108. 108.

    Hewett TE, Di Stasi SL, Myer GD. Current concepts for injury prevention in athletes after anterior cruciate ligament reconstruction. Am J Sports Med. 2013;41(1):216–24.

    PubMed  Article  Google Scholar 

  109. 109.

    Di Stasi S, Myer GD, Hewett TE. Neuromuscular training to target deficits associated with second anterior cruciate ligament injury. J Orthop Sports Phys Ther. 2013;43(11):777–92, A1–11.

  110. 110.

    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(8):471–5.

    PubMed  Article  Google Scholar 

  111. 111.

    Windt J, Gabbett TJ. How do training and competition workloads relate to injury? The workload-injury aetiology model. Br J Sports Med. 2016. doi:10.1136/bjsports-2016-096040 (Epub 14 Jul 2016).

  112. 112.

    Shrier I, Safai P, Charland L. Return to play following injury: whose decision should it be? Br J Sports Med. 2014;48(5):394–401.

    PubMed  Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Bart Dingenen.

Ethics declarations

Funding

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

Conflict of interest

Bart Dingenen and Alli Gokeler declare that they have no conflicts of interest relevant to the content of this review.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

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 47, 1487–1500 (2017). https://doi.org/10.1007/s40279-017-0674-6

Download citation

Keywords

  • Anterior Cruciate Ligament
  • Anterior Cruciate Ligament Reconstruction
  • Anterior Cruciate Ligament Injury
  • Movement Quality
  • Limb Symmetry Index