Functional Performance Testing After Anterior Cruciate Ligament Reconstruction: A Systematic Review

Geoffrey D Abrams, Joshua D Harris, Anil K Gupta, Frank M McCormick, Charles A Bush-Joseph, Nikhil N Verma, Brian J Cole, Bernard R Bach Jr, Geoffrey D Abrams, Joshua D Harris, Anil K Gupta, Frank M McCormick, Charles A Bush-Joseph, Nikhil N Verma, Brian J Cole, Bernard R Bach Jr

Abstract

Background: When to allow an athlete to return to unrestricted sporting activity after anterior cruciate ligament (ACL) reconstruction remains controversial.

Purpose: To report the results of functional performance testing reported in the literature for individuals at differing time points following ACL reconstruction and to examine differences between graft types.

Study design: Systematic review; Level of evidence, 4.

Methods: A systematic review of Medline, Scopus, and Cochrane Central Register of Controlled Trials was performed using PRISMA guidelines. Inclusion criteria were English-language studies that examined any functional rehabilitation test from 6 months to 2 years following ACL reconstruction. All patient-, limb-, and knee-specific demographics were extracted from included investigations. All functional rehabilitation tests were analyzed and compared when applicable.

Results: The search term returned a total of 890 potential studies, with 88 meeting inclusion and exclusion criteria. A total of 4927 patients were included, of which 66% were male. The mean patient age was 26.5 ± 3.4 years. The predominant graft choices for reconstruction were bone-patellar tendon-bone (BPTB) autograft (59.8%) and hamstring autograft (37.9%). The most commonly reported functional tests were the hop tests. The results of these functional tests, as reported in the Limb Symmetry Index (LSI), improved with increasing time, with nearly all results greater than 90% at 1 year following primary ACL reconstruction. At 6 months postoperatively, a number of isokinetic strength measurements failed to reach 80% LSI, most commonly isokinetic knee extension testing in both BPTB and hamstring autograft groups. The knee flexion strength deficit was significantly less in the BPTB autograft group as compared with those having hamstring autograft at 1 year postoperatively, while no significant differences were found in isokinetic extension strength between the 2 groups.

Conclusion: Hop testing was the most commonly reported functional test following ACL reconstruction. Increases in performance on functional tests were predictably seen as time increased following surgery. Those with hamstring autografts may experience increased strength deficits with knee flexion versus those having BPTB autograft. These data provide information that may assist providers in determining timing of return to unrestricted sporting activity.

Keywords: ACL; anterior; cruciate; functional test; hop; isokinetic; ligament.

Conflict of interest statement

One or more of the authors declared the following potential conflict of interest or source of funding: C.A.B. is an unpaid consultant for The Foundry and is on the editorial board of the American Journal of Sports Medicine. N.N.V. receives royalties from Smith & Nephew; is a paid speaker for Arthrosurface; is a consultant for Smith & Nephew and Arthrex; owns stock options in Omeros; receives research support from Arthrex, Smith & Nephew, Athletico, ConMed Linvatec, Miomed, Mitek, and Arthrosurface; receives royalties/publisher support from Vindico Medical-Orthopedics Hyperguide and Arthroscopy; and is a board member of the Journal of Knee Surgery, Arthroscopy, SLACK Inc, and the Arthroscopy Association Learning Center committee. B.J.C. is a board member of the Arthroscopy Association of North America; is a consultant for Genzyme, Arthrex, Zimmer, Carticept, Regentis, DJO, and Johnson & Johnson; receives research support from Major League Baseball, MTF, OREF, NIH/MIMAS, Arthrex, Zimmer, Arthrosurface, Medipost, and Johnson & Johnson; and receives royalties from Arthrex and DJO. B.R.B. receives research support from Arthrex, ConMed Linvatec, DJ Orthopaedics, Ossur, Smith & Nephew, and Tornier; receives publisher compensation from SLACK Inc; and is a board member of the American Orthopaedic Society for Sports Medicine and Orthopaedics Today.

Figures

Figure 1.
Figure 1.
Systematic review search algorithm within Medline database according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.

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