Time line for noncopers to pass return-to-sports criteria after anterior cruciate ligament reconstruction.
METHODS
Randomized clinical trial.


OBJECTIVE
Determine effective interventions for improving readiness to return to sports postoperatively in patients with complete, unilateral, anterior cruciate ligament (ACL) rupture who do not compensate well after the injury (noncopers). Specifically, we compared the effects of 2 preoperative interventions on quadriceps strength and functional outcomes.


BACKGROUND
The percentage of athletes who return to sports after ACL reconstruction varies considerably, possibly due to differential responses after acute ACL rupture and different management. Prognostic data for noncopers following ACL reconstruction is absent in the literature.


METHODS
Forty noncopers were randomly assigned to receive either progressive quadriceps strength-training exercises (STR group) or perturbation training in conjunction with strength-training exercises (PERT group) for 10 preoperative rehabilitation sessions. Postoperative rehabilitation was similar between groups. Data on quadriceps strength indices [(involved limb/uninvolved limb force) x 100], 4 hop score indices, and 2 self-report questionnaires were collected preoperatively and 3, 6, and 12 months postoperatively. Mann-Whitney U tests were used to compare functional differences between the groups. Chi-square tests were used to compare frequencies of passing functional criteria and reasons for differences in performance between groups postoperatively.


RESULTS
Functional outcomes were not different between groups, except a greater number of patients in the PERT group achieved global rating scores (current knee function expressed as a percentage of overall knee function prior to injury) necessary to pass return-to-sports criteria 6 and 12 months after surgery. Mean scores for each functional outcome met return-to-sports criteria 6 and 12 months postoperatively. Frequency counts of individual data, however, indicated that 5% of noncopers passed RTS criteria at 3, 48% at 6, and 78% at 12 months after surgery.


CONCLUSIONS
Functional outcomes suggest that a subgroup of noncopers require additional supervised rehabilitation to pass stringent criteria to return to sports.


METHODS
Therapy, level 2b.Note: If watching the first video, we recommend downloading and referring to the accompanying PowerPoint slides for any text that is not readable.
Hartigan
Erin H
EH
Physical Therapy Department, University of Delaware, Newark, DE, USA. ehartigan@une.edu
Axe
Michael J
MJ
Snyder-Mackler
Lynn
L
D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D001265:Athletic Injuries / Q000534:rehabilitation* / Q000601:surgery; D005081:Exercise Therapy / Q000379:methods; D005260:Female; D006801:Humans; D007718:Knee Injuries / Q000534:rehabilitation* / Q000601:surgery; D008297:Male; D053580:Muscle Strength / Q000502:physiology; D011182:Postoperative Care; D011300:Preoperative Care; D052097:Quadriceps Muscle / Q000502:physiology; D020127:Recovery of Function / Q000502:physiology*; D055070:Resistance Training; D012421:Rupture / Q000601:surgery; D013177:Sports; D013997:Time Factors