Functional Performance Testing After Anterior Cruciate Ligament Reconstruction: A Systematic Review.

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Abstract

When to allow an athlete to return to unrestricted sporting activity after anterior cruciate ligament (ACL) reconstruction remains controversial.

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Biomechanical measures during landing and postural stability predict second anterior cruciate ligament injury after anterior cruciate ligament reconstruction and return to sport.

Mark Paterno, Laura Schmitt, Kevin R. Ford … (2010)

Athletes who return to sport participation after anterior cruciate ligament reconstruction (ACLR) have a higher risk of a second anterior cruciate ligament injury (either reinjury or contralateral injury) compared with non-anterior cruciate ligament-injured athletes. Prospective measures of neuromuscular control and postural stability after ACLR will predict relative increased risk for a second anterior cruciate ligament injury. Cohort study (prognosis); Level of evidence, 2. Fifty-six athletes underwent a prospective biomechanical screening after ACLR using 3-dimensional motion analysis during a drop vertical jump maneuver and postural stability assessment before return to pivoting and cutting sports. After the initial test session, each subject was followed for 12 months for occurrence of a second anterior cruciate ligament injury. Lower extremity joint kinematics, kinetics, and postural stability were assessed and analyzed. Analysis of variance and logistic regression were used to identify predictors of a second anterior cruciate ligament injury. Thirteen athletes suffered a subsequent second anterior cruciate ligament injury. Transverse plane hip kinetics and frontal plane knee kinematics during landing, sagittal plane knee moments at landing, and deficits in postural stability predicted a second injury in this population (C statistic = 0.94) with excellent sensitivity (0.92) and specificity (0.88). Specific predictive parameters included an increase in total frontal plane (valgus) movement, greater asymmetry in internal knee extensor moment at initial contact, and a deficit in single-leg postural stability of the involved limb, as measured by the Biodex stability system. Hip rotation moment independently predicted second anterior cruciate ligament injury (C = 0.81) with high sensitivity (0.77) and specificity (0.81). Altered neuromuscular control of the hip and knee during a dynamic landing task and postural stability deficits after ACLR are predictors of a second anterior cruciate ligament injury after an athlete is released to return to sport.

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A meta-analysis of the incidence of anterior cruciate ligament tears as a function of gender, sport, and a knee injury-reduction regimen.

Chadwick C. Prodromos, Yung Han, Julie Rogowski … (2007)

The literature has shown that anterior cruciate ligament (ACL) tear rates vary by gender, by sport, and in response to injury-reduction training programs. However, there is no consensus as to the magnitudes of these tear rates or their variations as a function of these variables. For example, the female-male ACL tear ratio has been reported to be as high as 9:1. Our purpose was to apply meta-analysis to the entire applicable literature to generate accurate estimates of the true incidences of ACL tear as a function of gender, sport, and injury-reduction training. A PubMed literature search was done to identify all studies dealing with ACL tear incidence. Bibliographic cross-referencing was done to identify additional articles. Meta-analytic principles were applied to generate ACL incidences as a function of gender, sport, and prior injury-reduction training. Female-male ACL tear incidences ratios were as follows: basketball, 3.5; soccer, 2.67; lacrosse, 1.18; and Alpine skiing, 1.0. The collegiate soccer tear rate was 0.32 for female subjects and 0.12 for male subjects. For basketball, the rates were 0.29 and 0.08, respectively. The rate for recreational Alpine skiers was 0.63, and that for experts was 0.03, with no gender variance. The two volleyball studies had no ACL tears. Training reduced the ACL tear incidence in soccer by 0.24 but did not reduce it at all in basketball. Female subjects had a roughly 3 times greater incidence of ACL tears in soccer and basketball versus male subjects. Injury-reduction programs were effective for soccer but not basketball. Recreational Alpine skiers had the highest incidences of ACL tear, whereas expert Alpine skiers had the lowest incidences. Volleyball may in fact be a low-risk sport rather than a high-risk sport. Alpine skiers and lacrosse players had no gender difference for ACL tear rate. Year-round female athletes who play soccer and basketball have an ACL tear rate of approximately 5%. Level IV, therapeutic case series.

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Hop testing provides a reliable and valid outcome measure during rehabilitation after anterior cruciate ligament reconstruction.

Andrea Reid, Trevor Birmingham, Paul Stratford … (2007)

Although various hop tests have been proposed as performance-based outcome measures following anterior cruciate ligament (ACL) reconstruction, limited reports of their measurement properties exist. The purpose of this study was to investigate the reliability and longitudinal validity of data obtained from hop tests during rehabilitation after ACL reconstruction. Forty-two patients, 15 to 45 years of age, who had undergone ACL reconstruction participated in the study. The study design was prospective and observational with repeated measures. The subjects performed a series of 4 hop tests on 3 separate occasions within the 16th week following surgery and on a fourth occasion 6 weeks later. The tests were a single hop for distance, a 6-m timed hop, a triple hop for distance, and crossover hops for distance. Performance on the ACL-reconstructed limb was expressed as a percentage of the performance on the nonoperative limb, termed the "limb symmetry index." Subjects also completed the Lower Extremity Functional Scale and a global rating of change questionnaire. Intraclass correlation coefficients for limb symmetry index values ranged from .82 to .93. Standard errors of measurement were 3.04% to 5.59%. Minimal detectable changes, at the 90% confidence level, were 7.05% to 12.96%. Changes in hop test scores on the operative limb were statistically greater than changes on the nonoperative limb. Pearson correlations (r) between change in hop performances and self-reported measures ranged from .26 to .58. The results show that the described series of hop tests provide a reliable and valid performance-based outcome measure for patients undergoing rehabilitation following ACL reconstruction. These findings support the use and facilitate the interpretation of hop tests for research and clinical practice.

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Author and article information

Journal

Journal ID (iso-abbrev): Orthop J Sports Med

Title: Orthopaedic journal of sports medicine

Publisher: SAGE Publications

ISSN: 2325-9671

ISSN (Print): 2325-9671

Publication date (Electronic): Jan 2014

Volume: 2

Issue: 1

Affiliations

[1 ] Department of Orthopedic Surgery, Stanford University, Stanford, California, USA. ; Veterans Administration Hospital-Palo Alto, Palo Alto, California, USA.

[2 ] Houston Methodist Orthopedics and Sports Medicine, Houston, Texas, USA.

[3 ] Florida Orthopedic Institute, Tampa, Florida, USA.

[4 ] Orthopedic Institute, Holy Cross Hospital, Fort Lauderdale, Florida, USA.

[5 ] Department of Orthopedic Surgery, Rush University, Chicago, Illinois, USA.