Functional assessments for decisionmaking regardi

Authors: E Herbst C Hoser C Hildebrandt C Raschner C Hepperger H Pointner C Fink

Publish Date: 2015/02/28

Volume: 23, Issue: 5, Pages: 1283-1291

PDF Link

Abstract

Sixtynine patients with unilateral ACL reconstruction were included in this pilot study All the patients performed a standardized test battery consisting of one and twolegged stability tests counter movement jumps speedy jumps plyometric jumps and a quick feed test The first test was administered on average 1707 ± 751 days postoperatively and the retest was administered on average 2391 ± 797 days postoperatively The values of the subtests were compared with the normative data of healthy gender and agematched controls to determine the functional capacities of patients following ACL reconstructionAfter the first and second test 159 and 174  of the patients met the criteria for a “return to noncompetitive sports” One patient fulfilled the criteria for a “return to competitive sports” after the second test battery The most limiting factor was a poor LSI value of 90  if the dominant leg was involved and 80  if the nondominant leg was involvedThis test battery demonstrates that in terms of neuromuscular abilities most patients compared to healthy controls are most likely not ready for a safe return to sports even 8 months postoperatively This should be considered in the future to determine when it is safe to return to sports and should avoid a premature return to competitive sportsDuring the last decade anterior cruciate ligament ACL research has focused predominantly on anatomy and anatomic ACL reconstruction Although the surgical procedure has been investigated thoroughly there are unresolved problems One major problem is the high ACL rerupture rate Webster et al 31 recently reported an overall ACL rerupture rate of 45  In young and active subjects rerupture rates of up to 20  have been reported One factor that might contribute to such high ACL rerupture rates is a premature return to sports activities According to Webster et al 31 50  of ACL graft ruptures occur during the first year after primary ACL reconstruction There is general agreement that professional and highlevel recreational athletes must undergo ACL reconstruction to return to the preinjury level 21 Currently at least 6 months are recommended before patients are allowed to return to contact or pivoting sports although there is little firm evidence regarding the safe return to play 15 many athletes are pressured to make their comeback as soon as possible following surgeryThere are several relevant factors for a safe return to sports however some factors are more practicable than others One important factor concerns the strength and maturation of the ACL graft The graft undertakes a remodelling process during which the mechanical properties are affected Most of the knowledge regarding the remodelling process is based on animal studies 8 18 27 and the results from animal models are not directly applicable to humans From human biopsy studies it is known that the remodelling process is similar in animal models and humans however the timeline is variable and unpredictable 14 33 Currently clinical and/or functional predictors are relied upon to determine a safe return to sports One important predictor to determine the safe return to sports after ACL reconstruction is the patient’s functional capacity Even professional athletes with access to intensive rehabilitation and training programs have functional neuromuscular and postural deficits following surgery possibly leading to a higher ACL rerupture risk Several test protocols have been designed to provide objective measures which should facilitate deciding when a return to contact or highrisk pivoting sports is relatively safe Test protocols typically consist of laxity measurements and subjective scores as well as various jumping and strength tests 4 5 11 23 25 Most of these protocols require expensive equipment or are extremely timeconsuming or excessively complex for implementation in daily clinical practice 22 Nevertheless probably more than 90  of the patients return to sports without any objective functional evaluation after ACL surgery This might be a reason of such high ACL graft rupture rates Therefore a novel standardized test battery that is simple to use and does not require excessive equipment or a large amount of time or space was developed 34In this pilot study the test protocol was used for the first time to evaluate the functional abilities of a group of patients following ACL reconstruction The test battery covers different neuromuscular and coordinative skills and allows comparison to normative data of healthy subjects It can be used in a routine fashion to objectively determine the earliest time point when patients are ready to safely return to sports following ACL reconstruction

Keywords: