Return to sport after anterior cruciate ligament injury: Panther Symposium ACL Injury Return to Sport Consensus Group
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Return to sport after anterior cruciate ligament injury: Panther Symposium ACL Injury Return to Sport Consensus Group Sean J. Meredith1,2 · Thomas Rauer2,3 · Terese L. Chmielewski4 · Christian Fink5,12 · Theresa Diermeier8 · Benjamin B. Rothrauff2 · Eleonor Svantesson9,10 · Eric Hamrin Senorski10,11 · Timothy E. Hewett6 · Seth L. Sherman7 · Bryson P. Lesniak2 · The Panther Symposium ACL Injury Return to Sport Consensus Group Received: 8 February 2020 / Accepted: 16 April 2020 © European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2020
Abstract Purpose A precise and consistent definition of return to sport (RTS) after anterior cruciate ligament (ACL) injury is lacking, and there is controversy surrounding the process of returning patients to sports and their previous activity level. The aim of the Panther Symposium ACL Injury RTS Consensus Group was to provide a clear definition of RTS and description of the RTS continuum, as well as to provide clinical guidance on RTS testing and decision-making. Methods An international, multidisciplinary group of ACL experts convened as part of a consensus meeting. Consensus statements were developed using a modified Delphi method. Literature review was performed to report the supporting evidence. Results Key points include that RTS is characterized by achievement of the pre-injury level of sport and involves a criteriabased progression from return to participation to return to sport, and ultimately return to performance. Purely time-based RTS decision-making should be abandoned. Progression occurs along a RTS continuum with decision-making by a multidisciplinary group that incorporates objective physical examination data and validated and peer-reviewed RTS tests, which should involve functional assessment as well as psychological readiness. Consideration should be given to biological healing, contextual factors and concomitant injuries. Conclusion The resultant consensus statements and scientific rationale aim to inform the reader of the complex process of RTS after ACL injury that occurs along a dynamic continuum. Research is needed to determine the ideal RTS test battery, the best implementation of psychological readiness testing and methods for the biologic assessment of healing and recovery. Level of evidence IV. Keywords Return to sport · Anterior cruciate ligament · Consensus statement · Rehabilitation Sean J. Meredith and Thomas Rauer contributed equally to this work. * Sean J. Meredith [email protected] 1
Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
2
UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, 3200 S Water St, Pittsburgh 15203, PA, USA
3
Department of Trauma Surgery, University Hospital Zurich, Zurich, Switzerland
4
TRIA Orthopaedic Center, Bloomington, MN, USA
5
Gelenkpunkt-Sports and Joint Surgery Innsbruck, Innsbruck, Austria
6
Hewett Consulting, Minneapolis & Rochester, MN, USA
7
Department of Orthopae
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