Time line for noncopers to pass return-to-sports criteria after anterior cruciate ligament reconstruction

Abstract

Study design: Randomized clinical trial.

Objectives: Determine effective interventions for improving readiness to return to sports postoperatively in patients with complete, unilateral, anterior cruciate ligament (ACL) rupture who do not compensate well after the injury (noncopers). Specifically, we compared the effects of 2 preoperative interventions on quadriceps strength and functional outcomes.

Background: The percentage of athletes who return to sports after ACL reconstruction varies considerably, possibly due to differential responses after acute ACL rupture and different management. Prognostic data for noncopers following ACL reconstruction is absent in the literature.

Methods: Forty noncopers were randomly assigned to receive either progressive quadriceps strength-training exercises (STR group) or perturbation training in conjunction with strength-training exercises (PERT group) for 10 preoperative rehabilitation sessions. Postoperative rehabilitation was similar between groups. Data on quadriceps strength indices [(involved limb/uninvolved limb force) x 100], 4 hop score indices, and 2 self-report questionnaires were collected preoperatively and 3, 6, and 12 months postoperatively. Mann-Whitney U tests were used to compare functional differences between the groups. Chi-square tests were used to compare frequencies of passing functional criteria and reasons for differences in performance between groups postoperatively.

Results: Functional outcomes were not different between groups, except a greater number of patients in the PERT group achieved global rating scores (current knee function expressed as a percentage of overall knee function prior to injury) necessary to pass return-to-sports criteria 6 and 12 months after surgery. Mean scores for each functional outcome met return-to-sports criteria 6 and 12 months postoperatively. Frequency counts of individual data, however, indicated that 5% of noncopers passed RTS criteria at 3, 48% at 6, and 78% at 12 months after surgery.

Conclusion: Functional outcomes suggest that a subgroup of noncopers require additional supervised rehabilitation to pass stringent criteria to return to sports.

Level of evidence: Therapy, level 2b.Note: If watching the first video, we recommend downloading and referring to the accompanying PowerPoint slides for any text that is not readable.

FIGURE 1

Cohort flow chart. Abbreviations: ACL, anterior cruciate ligament; PT, physical therapy. *Retear indicates patients who reruptured their graft after recruitment into the study.

FIGURE 2

All leg press 1-repetition maximum testing and exercise were performed through an arc of motion of 0° to 100°.

FIGURE 3

All knee extension 1-repetition-maximum testing and exercise were performed through an arc of motion of 0° to 100°.

FIGURE 4

Platforms used for the perturbation training. Rocker board (A), roller board with caster wheels under each corner (B), and a stable platform aside the roller board to keep the patient’s feet at equal height (C). The order of the use of the platforms was randomized prior to each session. During the first session, patients began on both limbs and progressed to single-limb activities for the first 2 platforms (A and B) (ONLINE VIDEOS).