DEVELOPING AN OBJECTIVE CRITERIA FOR RECOMMENDATIONS TO ATHLETES PRIOR TO A RETURN TO FULL TRAINING FOLLOWING KNEE ACL RECONSTRUCTION

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DEVELOPING AN OBJECTIVE CRITERIA FOR RECOMMENDATIONS TO ATHLETES PRIOR TO A RETURN TO FULL TRAINING FOLLOWING KNEE ACL RECONSTRUCTION

Journal Title: Medicina Sportiva - Year 2014, Vol 18, Issue 4

Abstract

Objective: To determine the cause of the pain and swelling that occurs after a return to training in athletes following reconstruction of the anterior cruciate ligament.Methods: The study involved 42 athletes who had undergone reconstruction of the anterior cruciate ligament, and subsequently made themselves known because of the pain and swelling in the operated knee which occurred after returning to intensive training. All athletes completed their post-operative treatment and provided consent to the workouts.In order to determine the cause of the pain and swelling, medical history, orthopedic and ultrasound exams were conducted followed by isokinetic testing of the knee joints muscle strength at three different velocities (60 °/s,180 °/s, 300 °/s). The minimum criteria for muscle strength prior to a return to training after anterior cruciate ligament reconstruction adopted was: quadriceps strength of 85%; the strength of the knee flexor muscles of the operated joint at 90% or more of contralateral side, and a H/Q ratio of 70% or higher.Results: All athletes cleared to return to intensive training by a doctor were based on the knee stability tests, the range of movement, assessment of pain and swelling and muscle strength using Lovett test. Objective isokinetic muscle strength testing, proprioceptive exam and functional tests were not performed. However, orthopedic and ultrasound exam were normal for all tested athletes who had a quadriceps muscle isokinetic strength less than 85% and the flexor muscles strength less than 90% of contralateral side, while the H/Q ratio for 60°/s was less than 70%.Conclusions: The authors recommend that sports medicine professional’s should ensure that minimal strength levels of the muscles which stabilize the knee after anterior cruciate ligament reconstruction are confirmed by an objective examination using isokinetic dynamometry as the primary criterion after stability assessments for a safe return to sporting activity. We observed that current practice of sports medicine professionals as their criterion assessments for re-admission to sports activity following ACL reconstruction are; stability of the knee joint, assess the joints range of motion, muscle strength testing using the Lovett test, and evaluate pain and swelling. However systematic tests of isokinetic muscle strength, proprioception examination and functional tests are not performed. It is recommended to educate physicians on fulfillment of the proposed criteria for a safe return to the sport after ACL reconstruction. We also identified that the cause of pain and swelling after intensive training following ACL reconstruction which occurs with no changes in the orthopedic and ultrasound exam is strength weakness in the muscles of the operated knee.

Authors and Affiliations

Wojciech Fibiger

Keywords

reconstruction Anterior Cruciate Ligament Pain swelling muscle strength return to sport

EP ID EP74247
DOI 10.5604/17342260.1133104
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