Summary

The purpose of this study was to evaluate if athletes are ready to return to play six months following ACL reconstruction using a Quality of Movement Assessment (QMA).

Abstract

Background

Anterior cruciate ligament (ACL) injuries are one of the most common ligamentous injuries among young, active people. ACL injury prevention programs evaluate the quality of movement (QM) to identify and correct high-risk movement patterns. However, return to play (RTP) decisions post-ACL reconstruction (ACLR) in the general population are often based on non-sport-related quantitative measures such as isokinetic tests and/or time from surgery, with six months post-ACLR being a common expectation for RTP. Athletes represent a unique cohort that is exposed to environments that put these individuals at higher risk for knee ligament injuries, but also exhibit intrinsic and extrinsic characteristics that drive them to return to play.

Purpose

The purpose of this study was to evaluate whether athletes are ready to RTP 6 months following ACLR using a Quality of Movement Assessment (QMA).

Methods

A QMA including ten dynamic tasks (squat; single leg [SL] stance; 8” forward step down; SL bridge; SL squat; jump-in-place; side-to-side jump, broad jump, hop to opposite, SL hop) progressing from double- to single-limb vertical and horizontal movements was administered to 136 athletes at five to seven months post-ACLR. Tasks were viewed from the frontal and sagittal planes by a physical therapist and performance specialist. Movements were evaluated live for risk factors associated with ACL injury (strategy, depth, control, symmetry, and alignment). The proportion of patients exhibiting risky movement patterns for each task was calculated. Fisher’s Exact test was used to determine if there were differences in movement patterns between groups such as males versus females and injured versus contralateral side.

Results

The proportion of patients demonstrating risky movement patterns for a task ranged from 48% to 100%. All 136 patients exhibited risky movement patterns for at least one task and 58% of patients displayed risky movement patterns in five or more of the ten tasks. Rates of risky movement patterns were not different between males and females for all tasks (P>0.05 for all tasks). No difference was found between 9/10 tasks between the injured and contralateral side (P>0.05). Forward step down had a higher proportion of risky movement pattern on injured side compared to contralateral (95% vs. 72%, p<0.001).

Conclusion

Six months has been cited as a probable time for RTP post-ACLR; thus this is the expectation of the athlete. Our data showed that athletes demonstrated multiple QM patterns associated with initial ACL injury, as well as second injury, at five to seven months post-operatively. Altered movement patterns evident in tasks as simple as a SL stance remained with the athlete through tasks of increasing difficulty. Integrated QMA screening into rehabilitation with a focus on movement retraining to address mechanical risk factors prior to RTP or RTD may reduce the risk of revision ACLR. We recommend that therapists integrate QM screening into rehabilitation with a focus on movement retraining to address mechanical risk factors prior to RTP.