Systematic Review Return to Sport, Arthr 2011

Abstract
Objective: To review anterior cruciate ligament (ACL) clinical studies to assess the objective functional criteria used to determine when patients can return to athletics postoperatively, and to determine the rates of reinjury to either knee when these criteria are applied.

Purpose: Anterior cruciate ligament (ACL) reconstruction is commonly performed in athletes, with the goal of return to sports activities. Unfortunately, this operation may fail, and the rates of either reinjuring an ACL-reconstructed knee or sustaining an ACL rupture to the contralateral knee range from 3% to 49%. One problem that exists is a lack of information and consensus regarding the appropriate criteria for releasing patients to unrestricted sports activities postoperatively. The purpose of this study was to determine the published criteria used to allow athletes to return to unrestricted sports activities after ACL reconstruction.

Methods: A systematic search was performed to identify the factors investigators used to determine when return to athletics was allowed after primary ACL reconstruction. Inclusion criteria were English language, publication within the last 10 years, clinical trial, all adult patients, primary ACL reconstruction, original research investigation, and minimum 12 months’ follow-up.

Results: Of 716 studies identified, 264 met the inclusion criteria. Of these, 105 (40%) failed to provide any criteria for return to sports after ACL reconstruction. In 84 studies (32%) the amount of time postoperatively was the only criterion provided. In 40 studies (15%) the amount of time along with subjective criteria were given. Only 35 studies (13%) noted objective criteria required for return to athletics. These criteria included muscle strength or thigh circumference (28 studies), general knee examination (15 studies), single-leg hop tests (10 studies), Lachman rating (1 study), and validated questionnaires (1 study).

Conclusions: The results of this systematic review show noteworthy problems and a lack of objective assessment before release to unrestricted sports activities. General recommendations are made for quantification of muscle strength, stability, neuromuscular control, and function in patients who desire to return to athletics after ACL reconstruction, with acknowledgment of the need for continued research in this area.

ACL Train Spts Health 11

Context: Many anterior cruciate ligament (ACL) injury prevention training programs have been published, but few have assessed the effects of training on both ACL injury rates and athletic performance tests.

Objective: To determine if ACL injury prevention programs have a positive influence on both injury rates and athletic performance tests in female athletes.

Data sources: In August 2011, a search was conducted (1995–August 2011) of the PubMed, Science Direct, and CINAHL databases.

Study selection: Selected studies determined the effect of ACL intervention training programs on ACL incidence rates (determined by athlete-exposures) and athletic performance tests, such as isokinetic strength, vertical jump height, speed, agility, and dynamic balance. Because no single article contained both criteria, investigations were cross-referenced to obtain data on both factors from the same training programs.

Data extraction: The authors reviewed the selected studies for cohort population numbers, age, sports, duration of study, program components, duration of training, number of athlete-exposures, ACL injury incidence rates, and results of athletic performance tests.

Results: Initially, 57 studies were identified that described 42 ACL injury prevention training programs. Of these, 17 studies that investigated 5 programs met the inclusion criteria. Two programs significantly reduced ACL injury rates and improved athletic performance tests: Sportsmetrics and the Prevent Injury and Enhance Performance program (PEP). Sportsmetrics produced significant increases in lower extremity and abdominal strength, vertical jump height, estimated maximal aerobic power, speed, and agility. Prevent Injury and Enhance Performance significantly improved isokinetic knee flexion strength but did not improve vertical jump height, speed, or agility. The other 3 programs (Myklebust, the “11,” and Knee Ligament Injury Prevention) did not improve both ACL injury rates and athletic performance tests.

Conclusions: Only the Sportsmetrics and PEP ACL intervention training programs had a positive influence on injury reduction and athletic performance tests.

Obj Criteria Return to Athletics, PhysSM 2011

Abstract

Objective: To review anterior cruciate ligament (ACL) clinical studies to assess the objective functional criteria used to determine when patients can return to athletics postoperatively, and to determine the rates of reinjury to either knee when these criteria are applied.  Methods:  A literature search was conducted using the Medline database.  The inclusionary criteria were the English language, publication between April 2001 and April 2011, original clinical trials, all levels of evidence, primary ACL reconstruction, skeletal maturity, minimum 2 years of follow-up, and >1 objective test used to allow release to sports activities.  The exclusionary criteria were revision ACL reconstructions or dislocated knees; studies that specifically excluded patients with ACL graft failure or reinjuries; major concomitant procedures such as high tibial osteotomy, meniscus allograft, other knee ligament reconstructions; and case reports, abstracts, review articles, and technical notes.  Results:  Three objective criteria were used to allow release to sports activities.  The most common were lower extremity muscle strength, followed by lower limb symmetry and knee examination parameters of range of knee motion and effusion.  Twelve studies listed 1 criterion for release to sports, 8 studies listed 2 criteria, and 1 study recommended 3 criteria.  Failure rates of the ACL reconstructions raged from 0% to 3% in 7 studies, from 4% to 6% in 6 studies, from 7% to 10% in 4 studies, and from 14% to 24 % in 4 studies.  There were no injuries in the contralateral ACL in 14 studies (67%); in the other 7 studies, contralateral injury was reported in 2% to 15% of patients.  Conclusions:  Few objective functional criteria are used to determine when patients return to unrestricted sports activities. Clinically feasible recommendations are made for measurement of muscle strength, lower limb symmetry, lower limb neuromuscular control, and ligament function in patients who desire to return to athletics after ACL reconstruction.  Future studies are required to determine whether the demonstration of normal lower limb function before return to sports is effective in reducing reinjury rates.

ABSTRACT-Plyometric training programs have been implemented in anterior cruciate ligament injury prevention programs. Plyometric exercises are designed to aid in the improvement of muscle strength and neuromuscular control. Our purpose was to examine the effects of plyometric training on lower leg strength in women. Thirty (age = 20.3 6 1.9 years) recreationally active women were divided into control and experimental groups. The experimental group performed a plyometric training program for 6 weeks, 3 dwk21. All subjects attended 4 testing sessions: before the start of the training program and after weeks 2, 4, and 6. Concentric quadriceps and hamstring strength (dominant leg) was assessed using an isokinetic dynamometer at speeds of 60 and 120s21. Peak torque, average peak torque, and average power (AvgPower) were measured. The results revealed a significant (p , 0.05) interaction between time and group for flexion PkTq and AvgPower at 120s21. Post hoc analysis further revealed that PkTq at 120s21 was greater in the plyometric group than in the control group at testing session 4 and that AvgPower was greater in the plyometric group than in the control group in testing sessions 2–4. Our results indicate that the plyometric training program increased hamstring strength while maintaining quadriceps strength, thereby improving the Q:H strength ratio.

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