Checklist for return after ACL Injury
Returning to sports after an ACL injury can be a daunting task. You want to make sure that you're ready to get back on the field or court, but you also want to prevent any further injury. A study published in the American Journal of Sports Medicine provided some helpful guidance on how to determine when it's safe to return to sports after ACL reconstruction (ACLR).
The study's authors developed a checklist of criteria for returning to sports after ACLR, including a combination of four tests of joint kinetics, strength, coordination, and control, traditional physical examination findings, and a patient questionnaire. The study found that patients who successfully passed the checklist before returning to play experienced a lower injury rate, particularly a significant reduction in same-side ACL injury, compared to patients who failed the checklist or returned to play using traditional clinical judgment.
The checklist the authors came up with includes the following 7 items:
No or minimal effusion, Full ROM, no instability
Thigh circumference <1.5 cm difference
IKDC greater than or equal to 90%
FMS score greater than or equal to 14
LSI greater than or equal to 90% for all 4 hop tests
Pro agility greater than or equal to 90% in both directions
Movement Assessment greater than or equal to 80%
12-inch box jump assessing; hip stability, shock absorption, hip strategy, pelvic stability, and trunk stability
By using the checklist, athletes and trainers can be more confidently prepared to return to sports and decrease their risk of further injury. It's important to note some limitations to the study. For example, not all studies reviewed provided detailed criteria for return to play, and the checklist was not designed to assess an athlete's psychological readiness to return to play. (The brain is just as important as the body when it comes to rehab)
I found it interesting that the study didn’t include measuring quad strength, which plays a huge role in the function of the knee. They didn’t want to include any measures that weren’t easily replicable for someone without access to equipment like a leg press or dynamometer to measure leg strength. I’d add a simple single leg squat type of test to the mix to address quad strength assessment.
All in all, there are so many factors that go into ACL rehab and getting ready to get back in the game. If you're an athlete looking to return to sports after an ACL injury, find a Doctor of Physical Therapy to help you evaluate and decide when it's safe to return to play.
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https://journals.sagepub.com/doi/full/10.1177/23259671221090412
1.
Hadley CJ, Rao S, Tjoumakaris FP, et al. Safer Return to Play After Anterior Cruciate Ligament Reconstruction: Evaluation of a Return-to-Play Checklist. Orthopaedic Journal of Sports Medicine. 2022;10(4). doi:10.1177/23259671221090412
