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Functional performance 6 months after ACL reconstruction can predict return to participation in the same preinjury activity level 12 and 24 months after surgery
  1. Zakariya Nawasreh1,2,
  2. David Logerstedt3,4,
  3. Kathleen Cummer1,
  4. Michael Axe5,6,
  5. May Arna Risberg7,
  6. Lynn Snyder-Mackler1,4,5
  1. 1Department of Biomechanics and Movement Science program, College of Health Sciences, University of Delaware, Newark, Delaware, USA
  2. 2Division of Physical Therapy, Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology (JUST), Irbid, Jordan
  3. 3Department of Physical Therapy, University of the Sciences, Philadelphia, Pennsylvania, USA
  4. 4Delaware Rehabilitation Institute, University of Delaware, Newark, Delaware, USA
  5. 5Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, USA
  6. 6Department of Orthopedics, First State Orthopedics, Newark, Delaware, USA
  7. 7Division of Orthopedic Surgery, Department of Sports Medicine, Norwegian Research Center for Active Rehabilitation, Norwegian School of Sport Sciences, Oslo University Hospital, Oslo, Norway
  1. Correspondence to Dr Zakariya Nawasreh, Division of Physical Therapy, Department of Rehabilitation Sciences, Biomechanics and Movement Science program, College of Health Sciences, Irbid 22110, Jordan; zhnawasreh84{at}gmail.com

Abstract

Background Assessing athletes’ readiness is a key component for successful outcomes after ACL reconstruction (ACLR).

Objectives To investigate whether return-to-activity criteria, individually or in combination, at 6 months after ACLR can predict return to participation in the same preinjury activity level at 12 and 24 months after ACLR.

Methods Ninety-five level I/II participants completed return-to-activity criteria testing (isometric quadriceps index, single-legged hop tests, Knee Outcome Survey-Activities of Daily Living Scale (KOS-ADLS) and Global Rating Score (GRS)) at 6 months after ACLR. The PASS group was defined as scoring >90% on all criteria and the FAIL group as scoring <90% on any criteria. At 12 and 24 months after ACLR, participants were asked if they had returned to participate in the same preinjury activity level or not. All return-to-activity criteria, except quadriceps index, were entered into the logistic regression model.

Results 81% and 84.4% of the PASS group returned to participation in the same preinjury activity level, while only 44.2% and 46.4% of the FAIL group returned at 12 and 24 months, respectively, after ACLR. The 6-meter timed hop, single hop and triple hop limb symmetry indexes; GRS; and KOS-ADLS individually predicted the outcome of interest at 12 months after ACLR (range: R2: 0.12–0.22, p<0.024). In combination, they explained 27% of the variance (p=0.035). All hop tests, individually, predicted the outcome of interest at 24 months after ACLR (range: R2: 0.26–0.37; p<0.007); in combination they explained 45% of the variance (p<0.001).

Conclusion Return to participation in the same preinjury activity level at 12 and 24 months after ACLR was higher in those who passed the criteria compared with those who failed. Individual and combined return-to-activity criteria predicted the outcomes of interest, with the hop tests as consistent predictors at 12 and 24 months after ACLR.

  • functional movement screen
  • knee ACL
  • sporting injuries
  • sports medicine
  • sports physiotherapy
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Footnotes

  • Handling editor Karim M Khan

  • Contributors ZN, DL and LSM conceived the idea of this study. MA performed most of the surgeries. KC, DL and ZN collected the data from participants. ZN analysed the data.

  • Funding This ongoing prospective cohort study was funded by the National Institutes of Health (NIH R37HD37985, P30 GM103333) and Promotion of Doctoral Studies (PODS 1) Scholarship.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval University of Delaware Institutional Human Subjects Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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