gms | German Medical Science

Objectives: The definition of standardized criteria to determine the correct timing of return to sport (RTS) after ACL reconstruction (ACLR) is gaining an increasing importance. This study aims to assess the advantage of the integrated evaluation with functional, clinical and psychological tests, to define the correct RTS timing, in athletes undergoing ACLR.

Methods: Non-professional athletes with acute ACL injury were recruited. Inclusion criteria: age comprised between 18 and 35; hamstrings autograft; all-inside technique. Anthropometric data and the presence of associated meniscal injuries were recorded at baseline.

All the patients underwent a clinical and radiographic evaluation at 1-, 3-, 5- and 8-months follow-up. The following clinical scales were used: Tegner Activity Level Score (TALS); Tegner Lysholm Knee Scoring Scale (TLKSS); Modified Cincinnati rating System Questionnaire (mCRSQ).

At 8-months follow-up, all the patients performed a functional and psychological evaluation. The functional evaluation included the femoral biceps and quadriceps electromyographical activity evaluation during the sit-to-stand fatigue test and the Back-In-Action (BIA) battery tests (Zimmer Biomet, Warsaw, USA), validated on health subjects (Hildebrandt et al,2015) and on patients undergoing ACLR (Herbst et al, 2015).

The psychological status of the athletes was assessed using the Tampa Scale of Kinesiophobia (TSK) the score ACL Return to Sport after Injury (ACL-RSI). Based on the results of the BIA tests, the patients were divided into two groups: patients who passed the RTS criteria (Group-A) and patients who failed RTS criteria (group-B). Statistical analysis was performed with SPSS v25.0 (SPSS Inc., Chicago, IL, USA). The Shapiro-Wilk Test was conducted; multivariate analysis of variance (MANOVA) with post-hoc tests and Pearson correlation test were performed. The tests were two-tailed with a confidence level of 5%.

Results and conclusion: 52 patients (male=44; female=8; mean age= 24.8) were recruited; 35 patients (67.3%) were able to RTS, according to BAI tests (Group-A), whereas the remaining 17 patients failed the RTS criteria (Group-B). Concomitant meniscal tears were observed in 12 patients (23%), who showed a significant worse performance in proprioceptive tests. However, no correlation was observed between concomitant meniscus tears and RT criteria failing. Surprisingly, the clinical scores showed no differences between Group-A and Group-B, at 8-months follow-up. The psychological tests, on the other hand, showed a significant better scores in Group-A, compared with Group-B (TSK, p=0.0021; ACL-RSI, p=0.0053). No significant correlations were observed between functional tests and psychological tests.

This study shows that the integrated evaluation with functional, clinical and psychological tests is useful to decide the correct timing of return to sport in athletes undergoing ACLR.

Further studies with a longer follow-up, nonetheless, are needed to correlate these data to the re-injury rate.