No association of time from surgery with functional deficits in athletes after anterior cruciate ligament reconstruction: Evidence for objective return-to-sport criteria

Gregory D. Myer, Larry Martin, Kevin R. Ford, Mark V. Paterno, Laura C. Schmitt, Robert S. Heidt, Angelo Colosimo, Timothy Hewett

Research output: Contribution to journalArticle

81 Citations (Scopus)

Abstract

Background: Release for full activity and return to sport after anterior cruciate ligament reconstruction (ACLR) is often dictated by time from surgery and subjective opinion by the medical team. Temporal guidelines for return to sport may not accurately identify impaired strength and neuromuscular control, which are associated with increased risk for second injury (contralateral and/or ipsilateral limb) after ACLR in athletes. Hypotheses: Athletes undergoing ACLR and returning to sport would demonstrate functional deficits that would not be associated with time from surgery. Study Design: Controlled laboratory study. Methods: Thirty-three male (n = 10) and female (n = 23) athletes with unilateral ACLR, who were cleared by a physician to return to their sport after surgery and rehabilitation, performed the single-legged vertical hop test for 10 seconds on a portable force plate. Matched teammates of each patient were recruited to serve as sex-, sport-, and age-matched controls (CTRL; n = 67). Maximum vertical ground-reaction force (VGRF) was measured during each single-limb landing. Single-limb symmetry index (LSI) was calculated as the ratio of the involved divided by uninvolved limb, expressed as a percentage. Results: The single-limb vertical jump height LSI was reduced in the ACLR group, 89% (95% confidence interval [CI], 83%-95%), compared with the matched CTRL group, 101% (95% CI, 96%-105%; P<.01). The LSI for VGRF normalized to potential energy achieved during flight of the hop was increased in ACLR at 112% (95% CI, 106%-117%) relative to the CTRL group at 102% (95% CI, 98%-106%; P<.01). Linear regression analysis indicated that time from surgery was not associated with limb symmetry deficits in the ACLR group (P > .05; R2 = .002-.01). Conclusion: Deficits in unilateral force development (vertical jump height) and absorption (normalized VGRF) persist in an athlete's single-limb performance after ACLR and full return to sports. These symmetry deficits appear to be independent of time after reconstruction. Clinical Relevance: On the basis of these results, clinicians should consider assessment of single-limb power performance in the decision-making process for return-to-sport release. Persistent side-to-side asymmetries may increase the risk of contralateral and/or ipsilateral injury.

Original languageEnglish (US)
Pages (from-to)2256-2263
Number of pages8
JournalAmerican Journal of Sports Medicine
Volume40
Issue number10
DOIs
StatePublished - Oct 2012
Externally publishedYes

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Anterior Cruciate Ligament Reconstruction
Athletes
Extremities
Sports
Confidence Intervals
Humulus
Return to Sport
Wounds and Injuries
Decision Making
Research Design
Rehabilitation
Guidelines
Physicians

Keywords

  • ACL reinjury
  • anterior cruciate ligament injury risk factors
  • clinical assessment tools
  • knee injury prevention
  • knee rehabilitation
  • lower extremity biomechanics
  • sports reentry
  • targeted neuromuscular training

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Physical Therapy, Sports Therapy and Rehabilitation
  • Medicine(all)

Cite this

No association of time from surgery with functional deficits in athletes after anterior cruciate ligament reconstruction : Evidence for objective return-to-sport criteria. / Myer, Gregory D.; Martin, Larry; Ford, Kevin R.; Paterno, Mark V.; Schmitt, Laura C.; Heidt, Robert S.; Colosimo, Angelo; Hewett, Timothy.

In: American Journal of Sports Medicine, Vol. 40, No. 10, 10.2012, p. 2256-2263.

Research output: Contribution to journalArticle

Myer, Gregory D. ; Martin, Larry ; Ford, Kevin R. ; Paterno, Mark V. ; Schmitt, Laura C. ; Heidt, Robert S. ; Colosimo, Angelo ; Hewett, Timothy. / No association of time from surgery with functional deficits in athletes after anterior cruciate ligament reconstruction : Evidence for objective return-to-sport criteria. In: American Journal of Sports Medicine. 2012 ; Vol. 40, No. 10. pp. 2256-2263.
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abstract = "Background: Release for full activity and return to sport after anterior cruciate ligament reconstruction (ACLR) is often dictated by time from surgery and subjective opinion by the medical team. Temporal guidelines for return to sport may not accurately identify impaired strength and neuromuscular control, which are associated with increased risk for second injury (contralateral and/or ipsilateral limb) after ACLR in athletes. Hypotheses: Athletes undergoing ACLR and returning to sport would demonstrate functional deficits that would not be associated with time from surgery. Study Design: Controlled laboratory study. Methods: Thirty-three male (n = 10) and female (n = 23) athletes with unilateral ACLR, who were cleared by a physician to return to their sport after surgery and rehabilitation, performed the single-legged vertical hop test for 10 seconds on a portable force plate. Matched teammates of each patient were recruited to serve as sex-, sport-, and age-matched controls (CTRL; n = 67). Maximum vertical ground-reaction force (VGRF) was measured during each single-limb landing. Single-limb symmetry index (LSI) was calculated as the ratio of the involved divided by uninvolved limb, expressed as a percentage. Results: The single-limb vertical jump height LSI was reduced in the ACLR group, 89{\%} (95{\%} confidence interval [CI], 83{\%}-95{\%}), compared with the matched CTRL group, 101{\%} (95{\%} CI, 96{\%}-105{\%}; P<.01). The LSI for VGRF normalized to potential energy achieved during flight of the hop was increased in ACLR at 112{\%} (95{\%} CI, 106{\%}-117{\%}) relative to the CTRL group at 102{\%} (95{\%} CI, 98{\%}-106{\%}; P<.01). Linear regression analysis indicated that time from surgery was not associated with limb symmetry deficits in the ACLR group (P > .05; R2 = .002-.01). Conclusion: Deficits in unilateral force development (vertical jump height) and absorption (normalized VGRF) persist in an athlete's single-limb performance after ACLR and full return to sports. These symmetry deficits appear to be independent of time after reconstruction. Clinical Relevance: On the basis of these results, clinicians should consider assessment of single-limb power performance in the decision-making process for return-to-sport release. Persistent side-to-side asymmetries may increase the risk of contralateral and/or ipsilateral injury.",
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T1 - No association of time from surgery with functional deficits in athletes after anterior cruciate ligament reconstruction

T2 - Evidence for objective return-to-sport criteria

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AU - Martin, Larry

AU - Ford, Kevin R.

AU - Paterno, Mark V.

AU - Schmitt, Laura C.

AU - Heidt, Robert S.

AU - Colosimo, Angelo

AU - Hewett, Timothy

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N2 - Background: Release for full activity and return to sport after anterior cruciate ligament reconstruction (ACLR) is often dictated by time from surgery and subjective opinion by the medical team. Temporal guidelines for return to sport may not accurately identify impaired strength and neuromuscular control, which are associated with increased risk for second injury (contralateral and/or ipsilateral limb) after ACLR in athletes. Hypotheses: Athletes undergoing ACLR and returning to sport would demonstrate functional deficits that would not be associated with time from surgery. Study Design: Controlled laboratory study. Methods: Thirty-three male (n = 10) and female (n = 23) athletes with unilateral ACLR, who were cleared by a physician to return to their sport after surgery and rehabilitation, performed the single-legged vertical hop test for 10 seconds on a portable force plate. Matched teammates of each patient were recruited to serve as sex-, sport-, and age-matched controls (CTRL; n = 67). Maximum vertical ground-reaction force (VGRF) was measured during each single-limb landing. Single-limb symmetry index (LSI) was calculated as the ratio of the involved divided by uninvolved limb, expressed as a percentage. Results: The single-limb vertical jump height LSI was reduced in the ACLR group, 89% (95% confidence interval [CI], 83%-95%), compared with the matched CTRL group, 101% (95% CI, 96%-105%; P<.01). The LSI for VGRF normalized to potential energy achieved during flight of the hop was increased in ACLR at 112% (95% CI, 106%-117%) relative to the CTRL group at 102% (95% CI, 98%-106%; P<.01). Linear regression analysis indicated that time from surgery was not associated with limb symmetry deficits in the ACLR group (P > .05; R2 = .002-.01). Conclusion: Deficits in unilateral force development (vertical jump height) and absorption (normalized VGRF) persist in an athlete's single-limb performance after ACLR and full return to sports. These symmetry deficits appear to be independent of time after reconstruction. Clinical Relevance: On the basis of these results, clinicians should consider assessment of single-limb power performance in the decision-making process for return-to-sport release. Persistent side-to-side asymmetries may increase the risk of contralateral and/or ipsilateral injury.

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KW - lower extremity biomechanics

KW - sports reentry

KW - targeted neuromuscular training

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