Summary

Supplementing primary ACL reconstruction and standard physical therapy with a return to sports bridge program prior to release to unrestricted sports performance was effective at improving patient outcomes and decreasing ipsilateral knee re-injury and contralateral knee injury rates

Abstract

Purpose

To present the results of a return to sports bridge program designed to reduce knee injuries following ACL reconstruction and physical therapy.

Methods

Two hundred and twelve (male = 111, female = 101) patients participated in an 8-week duration whole body neuromuscular control, progressive resistance strength and agility training program. Post-program testing included functional movement form, dynamic knee stability, lower extremity power, agility, and sports skill assessments. Participants completed the Knee Outcome Survey–Sports Activity Scale (KOS-SAS) before and after program initiation. Subjects re-estimated their pre-participation scores following program completion.

Results

Global KOS-SAS scores at program entry were 75.8 ± 14. Post-program global rating and calculated KOS-SAS scores were 91.0 ± 9.8 and 90.9 ± 9.7, respectively (p < 0.0001). Pre-participation KOS-SAS score re-estimates at program completion were 54.8 ± 23 (global) and 58.2 ± 20 (calculated). The approximately 30% lower pre-program global KOS-SAS score re-estimate (46.7 ± 32 vs. 75.8 ± 14), and 20% calculated KOS-SAS score re-estimate (56.2 ± 27 vs. 75.0 ± 15)(p = 0.04) observed at program completion suggests that subjects had inaccurately high sports readiness perceptions at program entry. Perceived overall sports activity knee function ratings improved from 2.9 ± 0.6 (abnormal) at program entry to 1.2 ± 0.5 (normal) at completion (p < 0.001). Most subjects returned back to sports at or above their pre-injury performance skill/performance level (84%, 179/212). By 7.7 ± 4.0 years (range = 2–15 years) post-surgery, 14 subjects had sustained an ipsilateral knee re-injury or contralateral knee injury (6.6%). The 2.8% non-contact contralateral and 1.9% non-contact ipsilateral knee injury rates observed were significantly lower than those cited in previous reports.

Conclusion

Supplementing primary ACL reconstruction and standard physical therapy with a return to sports bridge program prior to release to unrestricted sports performance was effective at improving patient outcomes and decreasing ipsilateral knee re-injury and contralateral knee injury rates.