2023 ISAKOS Biennial Congress Paper
Reduction in re-rupture rates following implementation of return to sport testing after ACL reconstruction; 313 patients with a median follow-up of 50 months
Dominic Patrick O’Dowd, MBChB, BSc(SEM), MSc(SEM), FRCS(Tr&Orth), Sheffield UNITED KINGDOM
Jeremy Stanley, BHB, MBChB, FRACS, Auckland NEW ZEALAND
Michael Rosenfeldt, MBChB, FRACS, Auckland NEW ZEALAND
Stewart J. Walsh, FRACS, Mount Eden, Auckland, Region NEW ZEALAND
Bruce C. Twaddle, MD, FRACS, Prof., Auckland, Auckland NEW ZEALAND
Paul Monk, DPhil (Oxon), FRCS, Auckland, Westmere NEW ZEALAND
Unisports Sports Medicine and Surgery Centre, Auckland, NEW ZEALAND
FDA Status Not Applicable
Summary
Passing a RTS-test battery following ACLR reduces ACL re-rupture by 36.21% and contralateral ACL injury by 19.15% at mid-term follow-up.
Abstract
Objectives To assess mid-term effectiveness of a return to sport (RTS) test battery in relation to preventing ACL re-rupture following reconstruction. Secondary purposes to assess timing of passing a RTS-test battery post-surgery, age in relation to RTS outcomes and contralateral ACL injuries.
Methods
Patients undergoing ACLR between August 2014 - December 2018 performed a RTS-test battery following rehabilitation. The RTS-test battery consisted of the ACL-RSI, single leg hop, triple hop, and triple cross-over hop, box drop vertical jump down, single leg 4 rep max incline leg press and a T-test. Pass criteria was = 90% LSI in addition to symmetrical, controlled takeoff and landing patterns.
Results
352 patients underwent RTS-testing following ACLR with 313 (89%) contactable at a median of 50 months (SD11.41, range28-76) post-surgery. The re-rupture rate was 6.60% after passing the RTS-test battery and 10.34% following failure (p=0.24). Contralateral ACL injury rate during the study follow-up period was 6.07%. Median age of patients passing their first RTS-test battery was significantly older than those who failed (p=0.0003). Re-ruptures in those who passed the RTS-test battery first time all occurred late (>34 months) compared to those who failed first time which all occurred early (<33 months) (P=0.044). Median age of re-rupture was significantly younger compared to those who didn’t sustain a re-rupture (p=0.025).
Conclusion
Passing a RTS-test battery following ACLR reduces ACL re-rupture by 36.21% and contralateral ACL injury by 19.15% at mid-term follow-up. Younger patients are more likely to fail a RTS-test battery and are at higher risk of contralateral ACL rupture.