Validity of return-to-sport tests after ACL reconstruction
After ACL reconstruction, only 23% of patients passed return-to-sport (RTS) test batteries. This is the conclusion of a systematic review that analysed how many athletes pass return-to-sport testing and whether passing the tests results in lower rates of subsequent knee injury.
Most studies included in the review found no decrease in subsequent knee or anterior cruciate ligament (ACL) injuries after passing RTS testing. Successful RTS testing did, however, reduce the risk of subsequent graft rupture. Surprisingly, athletes who passed RTS testing had a higher risk of contralateral ACL injury.
The topic of RTS criteria after ACL reconstruction has gathered much interest in the field of sports medicine, with multiple batteries being created. Three basic components have been suggested to be included these batteries: strength tests, hop tests, and measures of quality of movement. However, no review has assessed the validity of most tests.
Eighteen studies were included in the current qualitative analysis. Risk of bias was assessed using both the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies and the Quality Assessment Tool for Case-Series Studies.
The authors showed that the validity of currently available RTS test batteries is doubtful in reducing the risk of both graft rupture and contralateral ACL injury.
In fact, there was even an increased risk of contralateral ACL injury after passing RTS testing. These findings suggest that care should be taken when discussing RTS testing results with patients and that better efforts are required to improve the validity of these tests.
Expert opinion by José Pedro Correia
This systematic reviews shows us that there is still a long way to go in selecting the appropriate criteria to ensure a safe return to sport after ACL reconstruction.
As things stand, test batteries provide more guidance than certainty in sending athletes back to sports. In fact, there was even a substantial increased risk of contralateral ACL injury after passing the test batteries. This finding also alerts us to the importance of comparing outcomes of the injured leg not to the contralateral limb but to normative values, as the contralateral limb is also affected after the injury.
> From: Webster et al., Sports Med (2019) (Epub ahead of print). All rights reserved to Springer Nature Switzerland AG. Click here for the online summary.