The Need To Change Return to Play Testing in Athletes Following ACL Injury: A Theoretical Model

Abstract

The incidence of knee injuries in sport, particularly involving the ACL, appears to be increasing yearly, especially in younger age athletes. Even more concerning is the frequency of ACL reinjury also appears to be increasing year after year. Improving the objective criteria and testing methods used to determine return to play (RTP) readiness following ACL surgery is one aspect of the rehabilitation process that can significantly help in reducing reinjury rates. Currently, the majority of clinicians are still using post operative time frames as their number one criterion for clearance to RTP. This flawed method demonstrates an inadequate reflection of the true unpredictable, dynamic environment athletes are returning to participate in. In our clinical experience, objective testing to allow for clearance to sport participation following an ACL injury should incorporate neurocognitive and reactive testing due to the nature of the injury typically occurs because of failed control of unanticipated reactive movements. The purpose of this manuscript is to share a neurocognitive testing sequence we currently employ consisting of 8 tests in 3 categories: Blazepod tests, reactive shuttle run tests, and reactive hop tests. The use of a more dynamic reactive testing battery may decrease the reinjury rates when an athlete is cleared for participation by measuring readiness in chaotic circumstances that are more truly reflective of the sporting environment the athlete is working to return to and in the process give them a greater sense of confidence.

Keywords: ACL injury; neurocognitive training; reactive testing; return to play.

Figure 1.. Lateral slide test with light targets (Blazepods Inc.)

Each target light is 60 inches apart.

Figure 2.. Four corner target light test (Blazepods Inc.)

Each light target is 21 feet apart.

Figure 3.. Standing Right versus Left Reactive target light test.

Targets are placed 3 feet apart and the participant is instructed to tap the right foot to the red target & the left foot to the blue target.

Figure 4.. Reactive 10-yard T Shuttle Run Test.

This test involves a 10-yard run then a side shuffle to one direction for 5 yards & then in opposite direction for 5 yards and then turn and run back to start line.

Figure 5.. Reactive 10 Yard L Run Test.

This test is performed with a 10 yard straight run then a turn to instructed direction for 5 yards and then a turn back to start position.

Figure 6.. Reactive Single Leg Hop for Distance Test.

The participant stands on one foot and hops outward – as the participant hops, they are instructed which foot to land on.

Figure 7.. Reactive Single Limb Cross Over Hop for Distance Test.

The participant stands on one foot and hops outward – as the participant hops, they are instructed which foot to land on and they must cross over the center tape. They will then complete the sequence by completing two more cross over hops on the same limb.

Figure 8.. Reactive Single Limb Alternate Cross Over Hop for Distance Test.

The participant stands on one foot and hops outward – as the participant hops, they are instructed which foot to land on and they must cross over the center tape. The athlete will then complete the sequence by performing two more cross over hops successively on alternating limbs.