Qualifications of Safe Return to Play Criteria

Anterior cruciate ligament (ACL) injury has various negative implications for thigh muscle function, including reduction of muscle strength and instability of torque. Conservative treatment and / or surgical procedures may be preferred by considering patient’s age, activity level, additional injury and the patient’s expectations. Aim of ACL surgery in athletes is to allow a safe return to preoperative activity level. Literatures have shown different criterias about returning to sports. Some of these criterias are time after surgery, negative Lachman and Pivot shift tests, range of motion, extension/flexion muscle strength of the knee, functional knee tests and lower limb symmetry indexes. Although these criteria provide, second-injury risks are high within 2 years of primary ACL reconstruction. The risk of re-injury rates for the ACL vary between 0 and 19% for the ipsilateral side and between 7 and 24% for the uninjured contralateral knee. The purpose of this study was to investigate value of knee function between the return to normal knee function following ACL reconstruction (ipsilateral and uninjured contralateral side) and the healthy knees, and present recommendation for reduce the risk of rerupture. Totally 14 healthy male and 15 male patients who had unilateral ACL reconstruction, followed knee rehabilitation programme regularly and returned to normal knee function following after minimum 8th month the operation participated in the study. We applied Tegner activity level, Lysholm knee score, operated, intact and healthy knee range of motion, one leg hop test, flamingo balance test, isokinetic muscle strength test and proprioception test in the study. No statistically significant differences were found in the demographic data, activity level, and knee score between groups (p>0,05). The test that assesses passive joint position sense at 30˚ showed statistically significant differences between operated and intact non-operated knee (p<0,05). This data was better at operated knee. There were statistically significant differences in functional tests, isokinetic hamstring muscle test at operated knee and proprioception test between patients and control groups (p<0,05). Arthrogenic muscle inhibition occurs bilaterally after unilateral ACL ruptures. Thus, normal lower limb symmetry determined by tests. On the other hand; muscle strength, motor coordination, proprioception and knee function may be insufficient compared to healthy control groups. For this reason, we should consider that it is important to improve bilateral lower extremity functions at ACL rehabilitation program.