Abstract
PurposeAthletes who meet return to play (RTP) criteria after anterior cruciate ligament reconstruction (ACLR) rehabilitation still have a substantially increased risk of second ACL injury. One of the contributing factors to this increased risk could be that the RTP criteria are often not tested in an ecologically valid environment and in a fatigued state. The purpose of this cross-sectional case-control study was to investigate the influence of neuromuscular fatigue on both movement quantity and quality in fully-rehabilitated soccer players after ACLR and to compare them with healthy soccer players.MethodsACL-reconstructed soccer players (n = 14) and healthy soccer players (n = 19) participated in the study and were matched by playing level and training hours. RTP measurements were performed on the soccer field, in both a non-fatigued and fatigued state. The RTP measurements focussed on both movement quantity (hop tests) and quality [countermovement jump with a Landing Error Scoring System (LESS) score].ResultsMovement quantity did not differ between ACL-reconstructed and healthy soccer players, both expressed in absolute values and the LSI-D/ND (calculated as dominant/non-dominant*100%). However, movement quality decreased more in the ACL-reconstructed soccer players in the fatigued state compared to the non-fatigued state.ConclusionsIdeally, RTP measurements should focus on movement quality and should be conducted on the soccer field in a fatigued state, creating an ecologically valid environment. The LSI-D/ND can be used as an outcome parameter for RTP measurements of movement quantity and should be at least 95%.Level of evidenceTherapeutic, Level III.
Highlights
Athletes recovering from anterior cruciate ligament reconstruction (ACLR) need to be adequately evaluated during and after their rehabilitation process to ensure a safe return to play (RTP)
One of the contributing factors to this increased risk could be that the RTP criteria are often not tested in ecologically valid environments nor in a fatigued state, despite evidence indicating that neuromuscular fatigue is a risk factor for lower extremity injuries in healthy
Movement quantity did not differ between ACL-reconstructed and healthy soccer players. These findings suggest that movement quality measurement in a fatigued state should be used in RTP testing of ACL-reconstructed soccer players
Summary
Athletes recovering from anterior cruciate ligament reconstruction (ACLR) need to be adequately evaluated during and after their rehabilitation process to ensure a safe return to play (RTP). To aid health professionals in this process, a specific set of evidence-based RTP criteria have been reported [1,2,3]. These criteria consist of functional performance tests based on movement quantity and quality [3, 4]. There is evidence demonstrating that neuromuscular fatigue decreases functional performance, decreases knee stability and increases tibial translation in healthy athletes and athletes after ACLR, resulting in both reduced movement quantity and quality and a probable increased risk of ACL injury [8, 11,12,13,14,15,16,17]
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