CRITERION-BASED REHABILITATION PROGRAM WITH RETURN TO SPORT TESTING FOLLOWING ACL RECONSTRUCTION: A CASE SERIES

Abstract

Background: Less than 50% of those sustaining an anterior cruciate ligament (ACL) injury return to their preinjury level of sports participation or participate in competitive sport at two to seven years post ACL reconstruction (ACLR). After ACLR, it has been reported that frequency of subsequent ACL tears has reached as high as 31%.

Purpose: The purpose of this case series was to evaluate return to sport and reinjury rates following the use of a criterion-based rehabilitation protocol with a final return to sport test that utilizes minimal equipment following ACL reconstruction.

Study design: Case series.

Methods: Following ACL reconstruction, participants were included if they had a goal of returning to their pre-injury sport or level of activity, were between 16 and 50 years of age at the time of evaluation, had at least 25 physical therapy visits covered by insurance, and planned to complete physical therapy until clearance for return to sport.

Results: Forty-three participants met the inclusion criteria and enrolled in the study. Twenty-one participants completed the full course of rehabilitation including passing their return to sport test and nineteen participants completed the two-year follow-up. Data obtained at two years indicated that 84% were able to return to their preinjury level of sports competition. A smaller percentage (16%) were able to return to a reduced level of sport and only one participant reported a second ACL injury.

Conclusion: Participants that completed the full course of rehabilitation and passed return to sport testing had a larger percentage that were able to return to preinjury participation levels than currently reported in the literature. This case series did not exclude participants based on graft type, single vs double bundle procedure, ACL revision surgeries, nor concomitant procedures or injuries.

Level of evidence: Level 4.

Keywords: anterior cruciate ligament; criterion-based rehabilitation; movement system; return to sport testing.

Figure 1.

In the step and hold exercise, the individual A) steps from the uninjured limb, B) onto the injured limb, at least the distance of the individual's normal stride length. The individual is cued to imagine they are stepping over a puddle of water and to land with a heel-toe gait pattern without excessive stiffening, knee flexion, loss of balance, or valgus collapse.

Figure 2.

Participants are instructed to hop on one leg as far as they can in a medial and a lateral direction. A) Right leg medial hop start position. B) Right leg medial hop end position. C) Left leg lateral hop start position. D) Left leg lateral hop end position.

Figure 3.

For rotational hops, participants stood in the center of the “Y” used for the SEBT and were instructed to hop straight up in the air and spin/rotate in a medially and laterally rotating direction and control the landing. A) Left leg rotational hop starting position. B) Left leg medial rotating hop end position. C) Left leg lateral rotating hop end position. D) Measurement of the amount of rotation for each hop. The stationary arm of the goniometer is aligned parallel to the tape and the moving arm bisects the foot.

Figure 4.

For the single and triple broad jump, participants are instructed to A) start the jump with two feet, and then B) land on the single leg being tested. For the triple jump, the last jump will be landed on the single leg being tested.

Figure 5.

Participants will sprint 10 yards, then backpedal to the starting line; side-shuffle 10 yards and back; carioca 10 yards and back; and finally sprint 10 yards to the finish line. To pass this test, participants must run and change direction at full speed without any compensation patterns.

Figure 6.

Participants will start facing the tester straddling cone 1. When indicated, they will turn and sprint 5 yards and touch cone 2; then sprint 10 yards and touch cone 3; and finally, sprint 5 yards past cone 1. They will then repeat this test in reverse order (cone 1 to 3 to 2 to 1). To pass this test, participants must run and change direction at full speed without any compensation patterns.