ACL Testing Background

In line with current clinical guidelines, Return to Sport testing should be cleared prior to returning to competitive athletic activity. Specifically, this should include strength testing, functional testing, subjective measures including psychological readiness, and appropriate workload management. This may seem like common sense, yet a recent research publication demonstrated that 42% of protocols use time from surgery as their ONLY criteria. (Burgi et al. 2019)

Of those that actually had objective Return to Sport testing, only 11-33% of patients actually met them. (Paterno et al. 2018, Welling et al. 2019) These numbers are consistent with previous publications showing an average of only 30% of patients meeting testing criteria to be cleared for returning to sport activity. (Herbst et al. 2015, Logerstedt et al, 2014, Toole et al., 2017)

Re-injury rates 29-42% (Paterno et al. 2012, Webster et al., 2016). Of the athletes who went back to sport, 33-38% of those who failed to meet meeting criteria re-tore compared to 5%-10% of those who met all criteria. (Grindem et al 2016, Kyritsis et al. 2016). While we cannot modify certain risk factors, e.g. females have anywhere from 2-8x higher re-injury rates (J Orthop 2016), we must do our very best work to address the modifiable risk factors. We can do better, both as a community and an industry and our athletes deserve the very best. Nevada Physical Therapy not only has the experience and knowledge to help our patients meet criteria guidelines, we also have the most advanced testing equipment in Reno to help drive this process. For more information on why torque matters and why it is essential to test, click the link.

“Given the complexity of some of the tests, as well as the necessary equipment… not all outpatient physical therapy facilities are poised to conduct RTS testing. Athletes may need to be sent to specific RTS testing centers that have the equipment and expertise in order to make the determination.” - Unverzagt et al., 2021

Creating a detailed, evidence-based protocol consistent with both strength and conditioning principles and in line with current rehab guidelines is essential to creating the best opportunity for patients to succeed and you can read more about our testing protocol here. While strength is important as those who did not meet 90% quad strength symmetry were 3x more likely to suffer a contralateral ACL tear within 2 years (Paterno et al., 2019), creating a multifaceted approach to rehab goes beyond just strength.

“An athlete may have perfect limb symmetry and yet be underprepared to compete because both extremities are much weaker or more poorly controlled than a healthy athlete.” - Gokeler, 2017

Our testing not only establishes appropriate strength acquisition but also addresses the psychology of an athlete. Fear of re-injury has consistently been identified as the number one reason athletes do not return to sport; in a recent paper more than 50% of the athletes who did not return to their previous activity cited fear as the main reason (Flanigan et al. 2013). Our protocol focuses on re-establishing the athlete’s identity, their confidence, and tracks psychological readiness throughout the rehab process which no other sports medicine clinic in the Reno-Sparks region offers. How do you measure this? In a variety of ways, one example is the use of the ACL- Return to Sport Index (ACL-RSI). Patients who met ACL-RSI criteria had a 4x higher rate of returning to competitive sports (Webster et al. 2020) and those “demonstrating that lower psychological readiness correlates with a higher risk of second ACL injury when returning to play among younger patients” (McPherson et al. 2019). You can read more about the use of psychological readiness in our blog post here if interested.

When it comes to testing an athlete in the Reno-Sparks area and the greater Northern Nevada region, from knee extension strength to jump skill to psychological readiness, we have you covered. Physical therapy after ACL reconstruction is currently inadequate and ineffective but Nevada Physical Therapy’s mission is to change that and utilizing our testing protocol is one of the most impactful ways we can accomplish that mission.