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The Physician’s Comprehensive Examination for Return to Sport

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Return to Sport after ACL Reconstruction and Other Knee Operations

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Abstract

The decision of when to release an athlete to unrestricted sports activities after major knee surgery is based on many factors, including successful completion of advanced rehabilitation, psychological readiness, completion of advanced neuromuscular training programs appropriate for the desired sport, and a comprehensive examination by the physician. This chapter details the essential components of the physician’s examination, including the assessment of knee motion, gait, patellofemoral indices, meniscus retears, ligament function, and use of appropriate imaging studies. Guidelines for the use of knee arthrometer testing (KT-2000) and muscle strength assessment are provided. Facilitation of communication with the entire medical team involved in the patient’s care may be accomplished using the International Knee Documentation Committee’s objective knee evaluation form. Our comprehensive evaluation and criteria for return to unrestricted sports activities are summarized.

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References

  1. Noyes FR, Grood ES. Scientific basis for examination and classification of knee ligament injuries. In: Noyes’ knee disorders: surgery, rehabilitation, clinical outcomes. 2nd ed. Philadelphia: Elsevier; 2017. p. 37–82. https://doi.org/10.1016/b978-0-323-32903-3.00003-2.

    Chapter  Google Scholar 

  2. Noyes FR, Barber-Westin SD. Scientific basis for examination and classification of knee ligament injuries. In: Noyes FR, Barber-Westin SD, editors. Noyes’ knee disorders: surgery, rehabilitation, clinical outcomes. 2nd ed. Philadelphia: Elsevier; 2017. p. 137–82.

    Chapter  Google Scholar 

  3. Noyes FR, Grood ES. Classification of ligament injuries: why an anterolateral laxity or anteromedial laxity is not a diagnostic entity. Instr Course Lect. 1987;36:185–200.

    CAS  PubMed  Google Scholar 

  4. Matheson GO, Shultz R, Bido J, Mitten MJ, Meeuwisse WH, Shrier I. Return-to-play decisions: are they the team physician’s responsibility? Clin J Sport Med. 2011;21(1):25–30. https://doi.org/10.1097/JSM.0b013e3182095f92.

    Article  PubMed  Google Scholar 

  5. Noyes FR, Barber-Westin SD. Tibial and femoral osteotomy for Varus and Valgus knee syndromes: diagnosis, osteotomy techniques, and clinical outcomes. In: Noyes FR, Barber-Westin SD, editors. Noyes’ knee disorders: surgery, rehabilitation, clinical outcomes. 2nd ed. Philadelphia, PA: Elsevier; 2017. p. 773–847. https://doi.org/10.1016/b978-0-323-32903-3.00026-3.

    Chapter  Google Scholar 

  6. Noyes FR, Barber-Westin SD. Unicompartmental knee replacement for varus or valgus malalignment. In: Noyes FR, Barber-Westin SD, editors. Noyes’ knee disorders: surgery, rehabilitation, clinical outcomes. 2nd ed. Philadelphia: Elsevier; 2017. p. 882–910.

    Chapter  Google Scholar 

  7. Noyes FR, Barber-Westin SD. Posterior cruciate ligament injuries: diagnosis, operative techniques, and clinical outcomes. In: Noyes FR, Barber-Westin SD, editors. Noyes’ knee disorders: surgery, rehabilitation, clinical outcomes. 2nd ed. Philadelphia, PA: Elsevier; 2017. p. 447–526. https://doi.org/10.1016/b978-0-323-32903-3.00016-0.

    Chapter  Google Scholar 

  8. Noyes FR, Barber-Westin SD. Posterolateral ligament injuries: diagnosis, operative techniques, and clinical outcomes. In: Noyes FR, Barber-Westin SD, editors. Noyes’ knee disorders: surgery, rehabilitation, clinical outcomes. 2nd ed. Philadelphia, PA: Elsevier; 2017. p. 527–77. https://doi.org/10.1016/b978-0-323-32903-3.00017-2.

    Chapter  Google Scholar 

  9. Noyes FR, Barber-Westin SD. Operative options for extensor mechanism malalignment and patellar dislocation. In: Noyes FR, Barber-Westin SD, editors. Noyes’ knee disorders: surgery, rehabilitation, clinical outcomes. 2nd ed. Philadelphia: Elsevier; 2017. p. 970–1013.

    Chapter  Google Scholar 

  10. Noyes FR, Albright J. Reconstruction of the medial patellofemoral ligament with autologous quadriceps tendon. Arthr. 2006;22:904e1–7.

    Google Scholar 

  11. McMurray TP. The semilunar cartilages. Br J Surg. 1942;29:407.

    Article  Google Scholar 

  12. Mohan BR, Gosal HS. Reliability of clinical diagnosis in meniscal tears. Int Orthop. 2007;31(1):57–60. https://doi.org/10.1007/s00264-006-0131-x.

    Article  CAS  PubMed  Google Scholar 

  13. Noyes FR, Barber-Westin SD. Meniscus tears: diagnosis, repair techniques, and clinical outcomes. In: Noyes FR, Barber-Westin SD, editors. Noyes’ knee disorders: surgery, rehabilitation, clinical outcomes. 2nd ed. Philadelphia, PA: Elsevier; 2017. p. 677–718. https://doi.org/10.1016/b978-0-323-32903-3.00023-8.

    Chapter  Google Scholar 

  14. Noyes FR, Barber-Westin SD. Medial and posteromedial ligament injuries: diagnosis, operative techniques, and clinical outcomes. In: Noyes FR, Barber-Westin SD, editors. Noyes' knee disorders: surgery, rehabilitation, clinical outcomes. 2nd ed. Philadelphia, PA: Elsevier; 2017. p. 608–35. https://doi.org/10.1016/b978-0-323-32903-3.00019-6.

    Chapter  Google Scholar 

  15. Noyes FR, Barber-Westin SD. Anterior cruciate ligament primary reconstruction: diagnosis, operative techniques, and clinical outcomes. In: Noyes FR, Barber-Westin SD, editors. Noyes’ knee disorders: surgery, rehabilitation, clinical outcomes. 2nd ed. Philadelphia: Elsevier; 2017. p. 137–220.

    Chapter  Google Scholar 

  16. Noyes FR, Matthews DS, Mooar PA, Grood ES. The symptomatic anterior cruciate-deficient knee. Part II: the results of rehabilitation, activity modification, and counseling on functional disability. J Bone Joint Surg Am. 1983;65(2):163–74.

    Article  CAS  PubMed  Google Scholar 

  17. Noyes FR, Mooar PA, Matthews DS, Butler DL. The symptomatic anterior cruciate-deficient knee. Part I: the long-term functional disability in athletically active individuals. J Bone Joint Surg Am. 1983;65(2):154–62.

    Article  CAS  PubMed  Google Scholar 

  18. Chin YC, Wijaya R, Chong le R, Chang HC, Lee YH. Bone bruise patterns in knee injuries: where are they found? Eur J Orthop Surg Traumatol. 2014;24(8):1481–7. https://doi.org/10.1007/s00590-013-1319-6.

    Article  PubMed  Google Scholar 

  19. Papalia R, Torre G, Vasta S, Zampogna B, Pedersen DR, Denaro V, Amendola A. Bone bruises in anterior cruciate ligament injured knee and long-term outcomes. A review of the evidence. Open Access J Sports Med. 2015;6:37–48. https://doi.org/10.2147/OAJSM.S75345.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Potter HG, Jain SK, Ma Y, Black BR, Fung S, Lyman S. Cartilage injury after acute, isolated anterior cruciate ligament tear: immediate and longitudinal effect with clinical/MRI follow-up. Am J Sports Med. 2012;40(2):276–85. https://doi.org/10.1177/0363546511423380.

    Article  PubMed  Google Scholar 

  21. Hoser C, Fink C, Brown C, Reichkendler M, Hackl W, Bartlett J. Long-term results of arthroscopic partial lateral meniscectomy in knees without associated damage. J Bone Joint Surg. 2001;83(4):513–6.

    Article  CAS  Google Scholar 

  22. Magnussen RA, Mansour AA, Carey JL, Spindler KP. Meniscus status at anterior cruciate ligament reconstruction associated with radiographic signs of osteoarthritis at 5- to 10-year follow-up: a systematic review. J Knee Surg. 2009;22(4):347–57.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Noyes FR, Barber-Westin SD. Long-term survivorship and function of meniscus transplantation. Am J Sports Med. 2016;44(9):2330–8. https://doi.org/10.1177/0363546516646375.

    Article  PubMed  Google Scholar 

  24. Getgood A, LaPrade RF, Verdonk P, Gersoff W, Cole B, Spalding T, Group I. International meniscus reconstruction experts forum (IMREF) 2015 consensus statement on the practice of meniscal allograft transplantation. Am J Sports Med. 2016; https://doi.org/10.1177/0363546516660064.

    Article  PubMed  Google Scholar 

  25. Noyes FR, Barber-Westin SD. Diagnosis and treatment of complex regional pain syndrome. In: Noyes FR, Barber-Westin SD, editors. Noyes’ knee disorders: surgery, rehabilitation, clinical outcomes. 2nd ed. Philadelphia, PA: Elsevier; 2017. p. 1122–60. https://doi.org/10.1016/b978-0-323-32903-3.00040-8.

    Chapter  Google Scholar 

  26. Turner-Stokes L, Goebel A. Complex regional pain syndrome in adults: concise guidance. Clin Med. 2011;11(6):596–600.

    Article  Google Scholar 

  27. Ogilvie-Harris DJ, Roscoe M. Reflex sympathetic dystrophy of the knee. J Bone Joint Surg. 1987;69(5):804–6.

    Article  CAS  Google Scholar 

  28. Poehling GG, Pollock FE Jr, Koman LA. Reflex sympathetic dystrophy of the knee after sensory nerve injury. Arthroscopy. 1988;4(1):31–5.

    Article  CAS  PubMed  Google Scholar 

  29. Poplawski ZJ, Wiley AM, Murray JF. Post-traumatic dystrophy of the extremities. J Bone Joint Surg Am. 1983;65(5):642–55.

    Article  CAS  PubMed  Google Scholar 

  30. Jupiter JB, Seiler JG 3rd, Zienowicz R. Sympathetic maintained pain (causalgia) associated with a demonstrable peripheral-nerve lesion. Operative treatment. J Bone Joint Surg Am. 1994;76(9):1376–84.

    Article  CAS  PubMed  Google Scholar 

  31. Schwartzman RJ, Erwin KL, Alexander GM. The natural history of complex regional pain syndrome. Clin J Pain. 2009;25(4):273–80. https://doi.org/10.1097/AJP.0b013e31818ecea5.

    Article  PubMed  Google Scholar 

  32. Vaneker M, Wilder-Smith OH, Schrombges P, Oerlemans HM. Impairments as measured by ISS do not greatly change between one and eight years after CRPS 1 diagnosis. Eur J Pain. 2006;10(7):639–44. https://doi.org/10.1016/j.ejpain.2005.10.003.

    Article  PubMed  Google Scholar 

  33. de Mos M, Huygen FJ, van der Hoeven-Borgman M, Dieleman JP, Ch Stricker BH, Sturkenboom MC. Outcome of the complex regional pain syndrome. Clin J Pain. 2009;25(7):590–7. https://doi.org/10.1097/AJP.0b013e3181a11623.

    Article  PubMed  Google Scholar 

  34. Harden RN, Bruehl S, Stanton-Hicks M, Wilson PR. Proposed new diagnostic criteria for complex regional pain syndrome. Pain Med. 2007;8(4):326–31. https://doi.org/10.1111/j.1526-4637.2006.00169.x.

    Article  PubMed  Google Scholar 

  35. Harden RN, Bruehl S, Perez RS, Birklein F, Marinus J, Maihofner C, Lubenow T, Buvanendran A, Mackey S, Graciosa J, Mogilevski M, Ramsden C, Chont M, Vatine JJ. Validation of proposed diagnostic criteria (the “Budapest criteria”) for complex regional pain syndrome. Pain. 2010;150(2):268–74. https://doi.org/10.1016/j.pain.2010.04.030.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Maihofner C, Seifert F, Markovic K. Complex regional pain syndromes: new pathophysiological concepts and therapies. Eur J Neurol. 2010;17(5):649–60. https://doi.org/10.1111/j.1468-1331.2010.02947.x.

    Article  CAS  PubMed  Google Scholar 

  37. Oaklander AL, Fields HL. Is reflex sympathetic dystrophy/complex regional pain syndrome type I a small-fiber neuropathy? Ann Neurol. 2009;65(6):629–38. https://doi.org/10.1002/ana.21692.

    Article  PubMed  Google Scholar 

  38. Goebel A. Complex regional pain syndrome in adults. Rheumatology (Oxford). 2011;50(10):1739–50. https://doi.org/10.1093/rheumatology/ker202.

    Article  Google Scholar 

  39. de Mos M, Sturkenboom MC, Huygen FJ. Current understandings on complex regional pain syndrome. Pain Pract. 2009;9(2):86–99. https://doi.org/10.1111/j.1533-2500.2009.00262.x.

    Article  PubMed  Google Scholar 

  40. van Eijs F, Stanton-Hicks M, Van Zundert J, Faber CG, Lubenow TR, Mekhail N, van Kleef M, Huygen F. Evidence-based interventional pain medicine according to clinical diagnoses. 16. Complex regional pain syndrome. Pain Pract. 2011;11(1):70–87. https://doi.org/10.1111/j.1533-2500.2010.00388.x.

    Article  PubMed  Google Scholar 

  41. Beerthuizen A, van 't Spijker A, Huygen FJ, Klein J, de Wit R. Is there an association between psychological factors and the complex regional pain syndrome type 1 (CRPS1) in adults? A systematic review. Pain. 2009;145(1–2):52–9. https://doi.org/10.1016/j.pain.2009.05.003.

    Article  PubMed  Google Scholar 

  42. Schwenkreis P, Maier C, Tegenthoff M. Functional imaging of central nervous system involvement in complex regional pain syndrome. AJNR Am J Neuroradiol. 2009;30(7):1279–84. https://doi.org/10.3174/ajnr.A1630.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Dowd GS, Hussein R, Khanduja V, Ordman AJ. Complex regional pain syndrome with special emphasis on the knee. J Bone Joint Surg. 2007;89(3):285–90. https://doi.org/10.1302/0301-620X.89B3.18360.

    Article  CAS  Google Scholar 

  44. Noyes FR, Barber-Westin SD. Prevention and treatment of knee Arthrofibrosis. In: Noyes FR, Barber-Westin SD, editors. Noyes’ knee disorders: surgery, rehabilitation, clinical outcomes. 2nd ed. Philadelphia, PA: Elsevier; 2017. p. 1059–102. https://doi.org/10.1016/b978-0-323-32903-3.00038-x.

    Chapter  Google Scholar 

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Author information

Authors and Affiliations

  1. Cincinnati Sports Medicine and Orthopaedic Center, The Noyes Knee Institute, Cincinnati, OH, USA

    Frank R. Noyes

  2. Noyes Knee Institute, Cincinnati, OH, USA

    Sue Barber-Westin

Authors
  1. Frank R. Noyes
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  2. Sue Barber-Westin
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Corresponding author

Correspondence to Sue Barber-Westin .

Editor information

Editors and Affiliations

  1. Professor of Orthopaedic Surgery, Emeritus, University of Cincinnati, College of Medicine, Noyes Knee Institute, Cincinnati, OH, USA

    Frank R. Noyes

  2. Noyes Knee Institute, Cincinnati, OH, USA

    Sue Barber-Westin

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Noyes, F.R., Barber-Westin, S. (2019). The Physician’s Comprehensive Examination for Return to Sport. In: Noyes, F., Barber-Westin, S. (eds) Return to Sport after ACL Reconstruction and Other Knee Operations. Springer, Cham. https://doi.org/10.1007/978-3-030-22361-8_19

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  • DOI: https://doi.org/10.1007/978-3-030-22361-8_19

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-22360-1

  • Online ISBN: 978-3-030-22361-8

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