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Review
. 2021 May;6(3):138-146.
doi: 10.1136/jisakos-2020-000495. Epub 2021 Mar 15.

Return to sport after anterior cruciate ligament injury: Panther Symposium ACL Injury Return to Sport Consensus Group

Sean J Meredith #  1   2 , Thomas Rauer #  3 , Terese L Chmielewski  4 , Christian Fink  5 , Theresa Diermeier  6 , Benjamin B Rothrauff  2 , Eleonor Svantesson  7   8 , Eric Hamrin Senorski  8   9 , Timothy E Hewett  10 , Seth L Sherman  11 , Bryson P Lesniak  2 , Panther Symposium  2
Affiliations
Free article
Review

Return to sport after anterior cruciate ligament injury: Panther Symposium ACL Injury Return to Sport Consensus Group

Sean J Meredith et al. J ISAKOS. 2021 May.
Free article

Abstract

Objectives: A precise and consistent definition of return to sport (RTS) after anterior cruciate ligament (ACL) injury is lacking, and there is controversy surrounding the process of returning patients to sports and their previous activity level. The aim of the Panther Symposium ACL Injury RTS Consensus Group was to provide a clear definition of RTS after ACL injury and description of the RTS continuum, as well as provide clinical guidance on RTS testing and decision-making.

Methods: An international, multidisciplinary group of ACL experts convened as part of a consensus meeting. Consensus statements were developed using a modified Delphi method. Literature review was performed to report the supporting evidence.

Results: Key points include that RTS is characterised by achievement of the preinjury level of sport and involves a criteria-based progression from return to participation to RTS, and ultimately return to performance. Purely time-based RTS decision-making should be abandoned. Progression occurs along an RTS continuum with decision-making by a multidisciplinary group that incorporates objective physical examination data and validated and peer-reviewed RTS tests, which should involve functional assessment as well as psychological readiness. Consideration should be given to biological healing, contextual factors and concomitant injuries.

Conclusion: The resultant consensus statements and scientific rationale aim to inform the reader of the complex process of RTS after ACL injury that occurs along a dynamic continuum. Research is needed to determine the ideal RTS test battery, the best implementation of psychological readiness testing and methods for the biological assessment of healing and recovery.

Keywords: ACL/PCL; knee; orthopaedic sports medicine; rehabilition/physical therapy.

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Conflict of interest statement

Competing interests: CF–Karl Storz: IP royalties, paid consultant; Medacta: IP royalties, paid consultant, paid presenter or speaker; Zimmer: Research support. SLS–Arthrex: paid consultant; Smith & Nephew: paid consultant; CONMED: knee design team, paid consultant; Flexion Therapeutics: paid consultant; JRF Ortho: paid consultant; Olympus: paid consultant; Vericel: paid consultant; Zimmer: research support. BPL–Wolters Kluwer Health - Lippincott Williams & Wilkins: publishing royalties, financial or material support. Panther group authorship: Lars Engebretsen–Smith & Nephew grants, editor of JBJS and BJSM. Christopher C Kaeding–grant support from DJO, educational support from CDC medical, consulting fees from Zimmer Biomet, non-consulting fees from Arthrex. Jon Karlsson–Editor-in-Chief KSSTA. Ryosuke Kuroda–grants and personal fees from Smith & Nephew, grants and personal fees from Zimmer Biomet, grants from Stryker Japan KK, grants and personal fees from Johnson & Johnson KK, personal fees from Medacta International, personal fees from Arthrex, personal fees from Japan Tissue Engineering, personal fees from Hirosaki Life Science Innovation, personal fees from Arthrex Japan G.K.Volker Musahl–educational grants from Smith &Nephew and educational grants from Arthrex. Stephen J Rabuck–educational support from Mid-Atlantic Surgical, Siebold - Medacta International personal fees. Carola van Eck–eduational support from Arthrex, Mid-Atlantic Surgical and Smith & Nephew and grant support from DJO and Zimmer Biomet. Dharmesh Vyas–educational support from Mid-Atlantic Surgical, hospitality payments from Arthrex.