Validation of a Composite Test for Assessment of Readiness for Return to Sports After Anterior Cruciate Ligament Reconstruction: The K-STARTS Test

William G Blakeney, Hervé Ouanezar, Isabelle Rogowski, Gregory Vigne, Meven Le Guen, Jean-Marie Fayard, Mathieu Thaunat, Pierre Chambat, Bertrand Sonnery-Cottet, William G Blakeney, Hervé Ouanezar, Isabelle Rogowski, Gregory Vigne, Meven Le Guen, Jean-Marie Fayard, Mathieu Thaunat, Pierre Chambat, Bertrand Sonnery-Cottet

Abstract

Background:: There is limited information on the appropriate timing of return to sports after anterior cruciate ligament (ACL) reconstruction. A composite test was developed to assess the athlete's ability to return to sports after ACL reconstruction: the Knee Santy Athletic Return To Sport (K-STARTS) test.

Hypothesis:: The K-STARTS test meets validation criteria for an outcome score assessing readiness for return to sports after ACL reconstruction.

Study design:: Diagnostic study.

Level of evidence:: Level 3.

Methods:: A prospective comparative study identified 410 participants: 371 participants who had undergone ACL reconstruction and a control group of 39 healthy participants. The K-STARTS score is calculated as the sum of 7 tests (8 components), for a maximal value of 21 points. Construct validity, internal consistency, discriminant validity, and sensitivity to change were used to validate this new test.

Results:: The K-STARTS assessment showed a high completion rate (100%), high reproducibility (intraclass correlation coefficient, 0.87; coefficient of variation, 7.8%), and high sensitivity to change. There was moderate correlation with the ACL Return to Sports after Injury scale (ACL-RSI) and hop tests. There were no ceiling or floor effects. There was a significant difference between K-STARTS scores assessed at 6 and 8 months postoperatively (11.2 ± 2.7 vs 17.1 ± 3.2; P < 0.001). The K-STARTS score in the control group was significantly higher than that in the ACL reconstruction group (17.3 ± 2.1 and 13.7 ± 3.8, respectively; P < 0.001).

Conclusion:: The K-STARTS test is an objective outcome measure for functional improvement after ACL reconstruction.

Clinical relevance:: It is important for the clinician to determine when return to sports is optimal after ACL reconstruction to reduce the current high risk of reinjury.

Keywords: anterior cruciate ligament reconstruction; outcome measure; return to sports; test validation; timing.

Conflict of interest statement

<?release-delay 12|0>The following authors declared potential conflicts of interest: Jean-Marie Fayard, MD, Mathieu Thaunat, MD, and Bertrand Sonnery-Cottet, MD, are paid consultants for Arthrex. Bertrand Sonnery-Cottet, MD, also receives royalties from Arthrex.

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