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Time-only guidelines for return to sport inappropriate in adolescents after ACL reconstruction
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LYON, France — Findings of a study presented at the International Society for Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine Biennial Congress cautioned that guidelines for return to sport based on time only are inappropriate for adolescent patients who undergo primary ACL reconstruction.
“Adolescent patients do not reliably obtain functional movement patterns to permit a safe return to sport at 9 months after ACL reconstruction. From these data, we feel that time-only guidelines are inappropriate, and we would encourage orthopedic surgeons to use functional assessments as a guide to return to sport,” Kathryne J. Stabile, MD, said during her presentation, here. “It is important that maturity-specific rehabilitation programs are used due to these maturity-specific deficits that exist based on these data.”
Stabile and colleagues retrospectively reviewed prospectively collected data for 39 adolescent patients and an adult reference population who underwent primary ACL reconstruction using hamstring autograft. Patients were assessed at 9 months postoperatively using the routine assessment for return to sport at the researchers’ institution, which included a functional movement screen (FMS), Lower Quarter Y-Balance testing and KT-1000 testing.
Of the adolescent patients, 17 were determined to be skeletally immature by MRI, with an average age of 14.2 years, and 22 were skeletally mature with an average age of 17.1 years. The adult reference population included 16 patients with an average age of 27.8 years.
Using the total FMS score, the researchers found all three study groups were at an increased risk for lower extremity injury at 9 months after ACL reconstruction. In addition, the skeletally immature group showed an increased risk of lower extremity injury with poor scores in the Lower Quarter Y-Balance testing. A comparison of all three study groups using KT-1000 scores showed no significant differences, according to the researchers.
In their analysis of specific subscale scores of the FMS, the researchers identified several maturity-specific differences.
“Particularly with active straight-leg raise, there was significant increase in poor scores in the skeletally immature group compared to the other two groups,” Stabile said. “We also identified maturity-specific differences in the trunk stability. Both adolescent groups were significantly worse compared to the adult group.” – by Gina Brockenbrough, MA
Reference:
Stabile KJ, et al. Paper #204. Presented at: ISAKOS; June 7-11, 2015; Lyon, France.
Disclosure: Stabile reports no relevant financial disclosures.