Return-to-play criteria after anterior cruciate ligament reconstruction: actual medicine practice in professional soccer teams

Return-to-play (RTP) decisions are a crucial component in sports medicine (1). After an Anterior Cruciate Ligament (ACL) reconstruction, one problem that exists is a lack of information and consensus regarding the appropriate criteria for releasing patients to unrestricted sports activity postoperatively (2). The purpose of this study was to analyze how sport physicians decide, in their daily practice, when an ACL reconstructed professional soccer player is able to get back to competitive activities.

III. RESULTS

II. METHODS

Sport physicians for professional soccer teams use relevant criteria to assess

player’s ability to return to full sport after ACL reconstruction.

Nevertheless, it appears that there is a lack of consensus about the choice of the assessment parameters and the limit values allowing

doctors to authorize or forbid RTP. This is probably the consequence of a lack of scientific evidence in this research area. Despite the

impressive amount of studies about ACL injury, there is a need for objective criteria before release an athlete to unrestricted activities.

IV. CONCLUSIONS

Thirty-seven physicians (46.3  7.1 years old) for French (League 1 and 2) and Belgian (1st _{Division) professional clubs completed a questionnaire composed of three parts:}

(1) RTP criteria after ACL reconstruction used in daily medical practice (Yes or No – list of 14 criteria + sub-questions), (2) Ranking of RTP criteria, from the most important to the less important criterion,

(3) Consideration advice from professionals (physical therapist, physical coach, football head coach).

More than 80% of the questioned physicians declared to use at least eight criteria to assess player’s ability to return to full soccer (Figure 1). The most important ones were (in order of importance): dynamic knee stability during a specific soccer exercise, muscle strength performance, normalization of knee flexion and extension ranges of motion (Figure 2).

I. INTRODUCTION

fdelvaux@ulg.ac.be François DELVAUX, Department of Sport and Rehabilitation Sciences, University of Liege, ISEPK, B21, 4000 Liège, BELGIUM

Return-To-Play criteria after anterior cruciate ligament reconstruction:

actual medicine practice in professional soccer teams

François Delvaux¹

,

1 _{Department of Sport and Rehabilitation Sciences, ISEPK, University of Liege, Belgium}

² Department of Biology and Sports Medicine, CHU Pontchaillou, Rennes, France; French Federation of Soccer – Professional Football League ³ Department of Public Health, Epidemiology and Health Economics, University of Liege, CHU of Liege, Liege, Belgium

4 _{Department of Orthopaedic Surgery, CHU of Liege, Liege, Belgium}

5 _{Department of Orthopaedic Surgery, Saint-Elisabeth Hospital, Verviers, Belgium}

REFERENCES

[1]

Delvaux F et al. J Sports Sci Med 2014; 13 (3):721-3.

[2]

Barber-Westin SD et al. Arthroscopy 2011;

27(12):1697-1705.

Figure 1: Answers to the following question: “In your daily medical

practice, do you use the following criteria in order to determine when a soccer player, ending a rehabilitation after ACLR, is able to get back to competitive activities?” ("Yes" answers expressed in %).

Figure 2: “Rank the previous criteria according to the importance you

assign to them” (1 = the most important criterion).

Figure 1 : RTP criteria after ACL reconstruction

Figure 4: « What is the maximum deficiency of knee ROM that

you could tolerate before RTP? » (% of responders)

B A

Figure 3: Strength performance assessment: (A) Elements taken in consideration for determining that muscle strength is sufficient – (B) Limits of strength differences between injured and uninjured sides (% of responders)

Figure 2 : RTP criteria ranking

Rank Criteria

1 Dynamic knee stability during a specific soccer exercise

2 Muscle strength

3 Normalization of knee flexion and extension ranges of motion

4 Subjective feeling reported by the player

5 Complete pain relief

0 20 40 60 80 100 %

Bilateral difference between injured and unijured sides H/Q balance

Comparison with past assessment realized by the same athlete before the injury