Global knee function rating more strongly influences adolescent athletes that sustain a sports-related surgical ACL re-injury or contralateral ACL injury.

PURPOSE: This study evaluated differences between adolescent athletes who sustained a surgical anterior cruciate ligament (ACL) re-injury, or contralateral ACL injury following return to sports bridge programme participation (Group 1) compared to those that did not (Group 2). METHODS: At 19.9 ± 7 years of age, 198 athletes participated in this study. Groups were compared for time postsurgery, preprogramme and postprogramme Knee Outcome Survey Sports Activity Scale (KOS-SAS) and global rating of knee function (GRKF) during sports activities, postprogramme lower extremity physical function test performance and perceived sports performance compared to preinjury level. RESULTS: By 6.0 ± 3.2 years postsurgery, 11 (5.6%) sustained another ACL injury. Group 1 was younger (17.3 ± 1.7 years vs. 20.1 ± 6.8 years, p < 0.001). Postprogramme re-evaluation revealed that Group 1 had a greater GRKF compared to their programme initiation GRKF than Group 2 (32.6 ± 38 vs. 20.0 ± 23, p = 0.04). Group 1 also had a greater mean preprogramme to postprogramme GRKF change than Group 2 (51.3 ± 31 vs. 35.5 ± 21, p = 0.02) (effect size = 0.73). More Group 1 subjects also had a GRKF difference that exceeded the overall mean than Group 2 (p = 0.04). Group 1 had moderately strong relationships between preprogramme and postprogramme GRKF score change and the postprogramme GRKF score (r = 0.65, p = 0.04) and between preprogramme and postprogramme KOS-SAS score change and postprogramme GRKF score (r = 0.60, p = 0.04). CONCLUSION: Global rating scores had a stronger influence among adolescent athletes that sustained either surgical ACL re-injury or contralateral ACL injury. Since group physical function and neuromuscular control factors were similar, clinicians need to increase their awareness and understanding of other factors that may influence surgical ACL re-injury or contralateral ACL injury risk. LEVEL OF EVIDENCE: Level III, retrospective cohort study.

A clinical practice review of therapeutic movement-based anterior cruciate ligament reconstruction return to sports bridge program: the biological, biomechanical and behavioral rationale.

This clinical practice review describes the biological, biomechanical and behavioral rationale behind a return to sport bridge program used predominantly with non-elite, youth and adolescent high school and college athletes following anterior cruciate ligament (ACL) reconstruction. Post-physiotherapy, this program has produced outcomes that meet or exceed previous reports. With consideration for athletic identity and the Specific Adaptations to Imposed Demands (SAID) principle, the early program focus was on restoring non-impaired bilateral lower extremity joint mobility and bi-articular musculotendinous extensibility. Building on this foundation, movement training education, fundamental bilateral lower extremity strength and power, and motor learning was emphasized with use of external focus cues and ecological dynamics-social cognition considerations. Plyometric and agility tasks were integrated to enhance fast twitch muscle fiber recruitment, anaerobic metabolic energy system function, and fatigue resistance. The ultimate goal was to achieve the lower extremity neuromuscular control and activation responsiveness needed for bilateral dynamic knee joint stability. The rationale and conceptual basis of selected movement tasks and general philosophy of care concepts are described and discussed in detail. Based on the previously reported efficacy of this movement-based therapeutic exercise program we recommend that supplemental programs such as this become standard practice following release from post-surgical physiotherapy and before return to sports decision-making.