Is Hop Testing Enough? ACL Late-Phase Return to Sport

Return to sport readiness following ACL Reconstruction has been researched extensively, yet re-injury rates continue to be high. Nearly 30% of athletes post ACLR experience re-injury (21% on contralateral limb, 9% on ipsilateral limb). Currently, only 81% of individuals with ACLR return to any level of their sport and only 55% return to pre-injury competition level. Current return to sport (RTS) testing consists of quad strength limb symmetry index >90%, hop testing >90%, KOS ADL/Sport >90%, ACL RSI >80%, MARX <9%, and time >9 months post-op. Even when meeting this criterion, there is a 20-30% chance of re-injury in young athletes. So, what are we missing during rehabilitation?

            Traditional ACL rehab consists of isolated quadricep strength, neuromuscular control, movement coordination, and controlled sport specific drills. While these variables are crucial in early to middle phases of rehab, they are not enough to meet the demands of competitive sports performance. Neurocognitive rehabilitation is a crucial piece of the puzzle that is often over looked. Athletes that sustained a non-contact ACL injury demonstrate slower reaction time, processing speed, and decreased performance on verbal and visual memory testing.

            Late phase rehabilitation (5-9 months) should be focused on returning athletes to sport specific drills and eventually progress to return to practice participation. During this phase, interventions should consist of variables including speed, resistance, dual tasking, perturbations, cognitive tasks, and altered vision. Physical therapists can utilize verbal cues, visual input, sport specific equipment, force plates, Blaze Pods, and many other tools to implement these interventions. Progressions of these activities include increasing complexity of the task, just like any other intervention.

            Athletes must be comfortable, confident, and competent in all aspects of their respective sport to return to performance in game situations. Traditional rehabilitation has proven to fall short with high re-injury rates. Diving into the variables listed above will expose athletes to what they will see on the court or field and, in turn, likely decrease risk of re-injury. Buckthorpe M. Optimising the Late-Stage Rehabilitation and Return-to-Sport Training and Testing Process After ACL Reconstruction. Sports Med. 2019;49(7):1043-1058. doi:10.1007/s40279-019-01102-z