ISAKOS: 2023 Congress in Boston, MA USA

2023 ISAKOS Biennial Congress Paper

 

Return to Sports Bridge Program Improves Outcomes, Decreases Ipsilateral Knee Re-injury and Contralateral Knee Injury Rates Post-ACL Reconstruction: 2022 Update

John Nyland, EdD, DPT, Louisville, Kentucky UNITED STATES
Jennifer Brey, MD, Louisville, Kentucky UNITED STATES
Samuel Carter, MD, Louisville, KY UNITED STATES
Ryan Jeffrey Krupp, MD, Prospect, KY UNITED STATES
Brandon Pyle, MS, ATC, Louisville, KY UNITED STATES
David N. M. Caborn, MD, Crestwood, KY UNITED STATES

Norton Orthopedic Institute, Spalding University, Louisville, Kentucky, UNITED STATES

FDA Status Not Applicable

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.