Sean J Meredith1,2, Thomas Rauer3,4, Terese L Chmielewski5, Christian Fink6,7, Theresa Diermeier8, Benjamin B Rothrauff3, Eleonor Svantesson9,10, Eric Hamrin Senorski10,11, Timothy E Hewett12, Seth L Sherman13, Bryson P Lesniak3. 1. Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA. seanjmeredith@gmail.com. 2. UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, 3200 S Water St, Pittsburgh, 15203, PA, USA. seanjmeredith@gmail.com. 3. UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, 3200 S Water St, Pittsburgh, 15203, PA, USA. 4. Department of Trauma Surgery, University Hospital Zurich, Zurich, Switzerland. 5. TRIA Orthopaedic Center, Bloomington, MN, USA. 6. Gelenkpunkt-Sports and Joint Surgery Innsbruck, Innsbruck, Austria. 7. Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI), UMIT, Hall in Tirol, Austria. 8. Department of Sportorthopedics, Klinikum rechts der Isar Technische Universitat Munchen, Munchen, Germany. 9. Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. 10. Gothenburg Sport Trauma Research Center, Gothenburg, Sweden. 11. Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. 12. Hewett Consulting, Minneapolis & Rochester, MN, USA. 13. Department of Orthopaedic Surgery, Stanford Medicine, Stanford, CA, USA.
Abstract
PURPOSE: A precise and consistent definition of return to sport (RTS) after anterior cruciate ligament (ACL) injury is lacking, and there is controversy surrounding the process of returning patients to sports and their previous activity level. The aim of the Panther Symposium ACL Injury RTS Consensus Group was to provide a clear definition of RTS and description of the RTS continuum, as well as to provide clinical guidance on RTS testing and decision-making. METHODS: An international, multidisciplinary group of ACL experts convened as part of a consensus meeting. Consensus statements were developed using a modified Delphi method. Literature review was performed to report the supporting evidence. RESULTS: Key points include that RTS is characterized by achievement of the pre-injury level of sport and involves a criteria-based progression from return to participation to return to sport, and ultimately return to performance. Purely time-based RTS decision-making should be abandoned. Progression occurs along a RTS continuum with decision-making by a multidisciplinary group that incorporates objective physical examination data and validated and peer-reviewed RTS tests, which should involve functional assessment as well as psychological readiness. Consideration should be given to biological healing, contextual factors and concomitant injuries. CONCLUSION: The resultant consensus statements and scientific rationale aim to inform the reader of the complex process of RTS after ACL injury that occurs along a dynamic continuum. Research is needed to determine the ideal RTS test battery, the best implementation of psychological readiness testing and methods for the biologic assessment of healing and recovery. LEVEL OF EVIDENCE: IV.
PURPOSE: A precise and consistent definition of return to sport (RTS) after anterior cruciate ligament (ACL) injury is lacking, and there is controversy surrounding the process of returning patients to sports and their previous activity level. The aim of the Panther Symposium ACL Injury RTS Consensus Group was to provide a clear definition of RTS and description of the RTS continuum, as well as to provide clinical guidance on RTS testing and decision-making. METHODS: An international, multidisciplinary group of ACL experts convened as part of a consensus meeting. Consensus statements were developed using a modified Delphi method. Literature review was performed to report the supporting evidence. RESULTS: Key points include that RTS is characterized by achievement of the pre-injury level of sport and involves a criteria-based progression from return to participation to return to sport, and ultimately return to performance. Purely time-based RTS decision-making should be abandoned. Progression occurs along a RTS continuum with decision-making by a multidisciplinary group that incorporates objective physical examination data and validated and peer-reviewed RTS tests, which should involve functional assessment as well as psychological readiness. Consideration should be given to biological healing, contextual factors and concomitant injuries. CONCLUSION: The resultant consensus statements and scientific rationale aim to inform the reader of the complex process of RTS after ACL injury that occurs along a dynamic continuum. Research is needed to determine the ideal RTS test battery, the best implementation of psychological readiness testing and methods for the biologic assessment of healing and recovery. LEVEL OF EVIDENCE: IV.
Entities:
Keywords:
Anterior cruciate ligament; Consensus statement; Rehabilitation; Return to sport
Authors: Bart Muller; Mohammad A Yabroudi; Andrew Lynch; Adam J Popchak; Chung-Liang Lai; C Niek van Dijk; Freddie H Fu; James J Irrgang Journal: Knee Surg Sports Traumatol Arthrosc Date: 2021-04-22 Impact factor: 4.342
Authors: Eleonor Svantesson; Eric Hamrin Senorski; Kate E Webster; Jón Karlsson; Theresa Diermeier; Benjamin B Rothrauff; Sean J Meredith; Thomas Rauer; James J Irrgang; Kurt P Spindler; C Benjamin Ma; Volker Musahl Journal: Knee Surg Sports Traumatol Arthrosc Date: 2020-08-06 Impact factor: 4.342