Functional progression milestones following anterior cruciate ligament reconstruction are more appropriate than time-bas
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Functional progression milestones following anterior cruciate ligament reconstruction are more appropriate than time‑based criteria: a survey among the ESSKA Alberto Vascellari1 · Alli Gokeler2,3,4 · Alberto Grassi5 · Gian Luigi Canata6 · Stefano Zaffagnini5 · Henrique Jones7,8 Received: 15 November 2019 / Accepted: 23 March 2020 © European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2020
Abstract Purpose The aim of this study was to report current rehabilitation recommendations after ACL reconstruction in ESSKA community, with a particular focus on the specific criteria utilized to guide activity progression Methods A web-based survey was developed to investigate preferences between time-based and functional ACL reconstruction rehabilitation progression milestones of ESSKA community. Results Eight hundred and twenty completed questionnaires were received. Responders were from 86 different countries worldwide, 63% of them from European countries. Functional criteria were considered more appropriate to decide if a patient can start specific activities/exercises by 67% of the responders. Good core and lower extremity neuromuscular control were the most often used functional criteria for decision-making regarding readiness for sport-specific rehabilitation (66%), sportspecific drills without (65%) and with contact (66%). Strength assessed with an isokinetic dynamometer was considered by about half of the responders a determinant to initiate sport-specific drills without (51%—isokinetic strength, LSI > 80%) and with contact (58%—isokinetic strength, LSI > 85–90%). To determine readiness for sport-specific drills, hop tests were used by 40% of respondents for drills without contact and 48% of respondents for drills with contact. Conclusion The results of this survey involving mainly orthopaedic surgeons indicate that functional measures are considered more appropriate than milestones based on time from surgery to guide progression through the postoperative rehabilitation process after ACLR. The main clinical relevance of this study is that updated information on collective agreement could be useful for clinicians and physiotherapists to delineate their postoperative treatments after ACLR. These results should be interpreted with caution, as this sample represents only a small portion of ESSKA community involved in knee surgery and treating patients following ACLR. Level of evidence III. Keywords Anterior cruciate ligament · Rehabilitation · Time-based criteria · Functional criteria · Survey
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00167-020-05960-3) contains supplementary material, which is available to authorized users. * Alberto Vascellari [email protected] 1
Policlinico Città di Udine, Viale Venezia 410, 33100 Udine, Italy
2
Sports Medicine and Science (LIROMS), Luxembourg Institute of Research in Orthopedics, Luxembourg, Luxembourg
3
Department Exercise and Health, Exercise Science and Neuroscience, Univer
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