In early 2019 Cristiani et al published an article showing < 20% of patients met rehabilitation goals of having > 90% limb symmetry in strength (isokinetic quads and hamstrings at 90deg/sec) and single hop for distance tests at 6 months post-op.
This study had a very large sample size (4093 patients), comprising 45.7% females, with a mean age of 28 years (+/-10 years). 86.5% of participants completed the full test battery at 6 months post-op.
Ardern et al’s (2016) consensus statement on Return to Sport (RTS) following ACL reconstruction notes that the goal of the athlete (along with other stakeholders eg, coach, club, medical team) is a successful ‘safe and timely’ return to sport.
This highlights the importance of balancing three key components
-Minimising time away from play
-Minimising reinjury risk
-Maximising sporting performance upon return to play
Wellsandt et al (2017) Limb Symmetry Indexes Can Overestimate Knee Function After Anterior Cruciate Ligament Injury
Comparison between single leg hop and quad strength – in two different ways.
Who - Non professional cutting athletes, 14-55 yrs old(Excluded other significant injuries).
Limb Symmetry Index (LSI) = comparison between Left and Right during an assessment.
Estimated pre-injury capacity (EPIC) = measuring uninvolved limb pre-operatively then comparing to the involved side at 6 months post-op.
Summary
For every 10% loss of HS/Quads ratio = 10.6 x likelihood of graft rupture
This ratio is increased if quadriceps strength is not fully regained to pre operative level
Meeting the 6 criteria - 116 athletes Discharged (73%) – (12/116 had a graft rupture) = 10%
