A multi-center group of researchers has created a multifactorial clinical algorithm to successfully evaluate when it is time for an athlete to return to sport following anterior cruciate ligament (ACL) reconstruction.
New Algorithm Sets Time for Return to Sport
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The participating research teams were from: New England Baptist Hospital in Boston, Atrium Health Musculoskeletal Institute in Charlotte, North Carolina, Thomas Jefferson University in Philadelphia, Brown University School of Medicine in Providence, Rhode Island and Katherine Ives of New England Shoulder and Elbow Care in Boston.
The study, “Critical Criteria Recommendations: Return to Sport After ACL reconstruction requires evaluation of time after surgery of 8 months, >2 functional tests, psychological readiness, and quadriceps/hamstring strength,” was published online in the journal Arthroscopy on October 7, 2022.
In the review of previously published studies, the researchers examined the factors commonly used to determine readiness for return to sport after ACL reconstruction and determined which ones were most important when it came to avoiding a retear.
Only those studies with more than a year of outcomes which included the rate of return and re-tear were included. Forty-seven studies with 1,432 patients passed the criteria. The majority of patients were male.
The researchers did a meta-analysis of re-tear rate and calculated it to be 2.8%. Subgroups including a strict time until return to sport, strength testing and two or more dynamic tests decreased return to sport and re-tear heterogeneity from the larger group.
Time to return to sport, strength testing, dynamic functional testing, and knee stability were the most important criteria, the researchers found.
Overall, the criteria the researchers found to be the most critical for a successful return to sport after ACL reconstruction were time since surgery of eight months, use of more than two functional tests, psychological readiness testing, quadriceps/hamstring strength testing, and the modification of patients factors for age and gender.
Study authors include Sarav Shah, M.D., Matthew Chilton, B.S., Chibuzo Anene, B.S., Albert Mousad, B.S., Stephen Le Breton, B.S., Rob Petit, M.D., and Arun Ramappa, M.D., all from the New England Baptist Hospital in Boston, Massachusetts. Robby Turk, M.D., M.B.A, Atrium Health Musculoskeletal Institute in Charlotte, North Carolina, Terence L. Thomas, B.S., Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, Lambert Li, B.S., Brown University School of Medicine, Providence, Rhode Island. Katherine Ives of New England Shoulder and Elbow Care also contributed to the study.
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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