A Return to Sport Test Battery does not Predict Second Injury After Anterior Cruciate Ligament Reconstruction in Adolescent Athletes

BACKGROUND: There is mixed evidence on the effectiveness of return to sport test (RTST) batteries and their ability to predict second Anterior Cruciate Ligament (ACL) injury. The majority of tests in the literature include objective measures of strength, hop test distance, knee range of motion and laxity, and measures of psychological readiness to return. Few RTST batteries include movement quality assessments. PURPOSE: To determine the effectiveness of a RTST test battery, including qualitative movement assessments, to predict second ACL injury in adolescent athletes after primary Anterior Cruciate Ligament Reconstruction (ACLR). METHODS: A retrospective chart review of 77 adolescent athletes who underwent primary ACLR between 2014 and 2018 (55 males, age at surgery 16 + 2 years, BMI 25 ± 5) was conducted. All athletes completed a RTST battery consisting of psychological assessment with the Tampa Scale of Kinesiophobia (TSK-11), lateral step down test (LSDT), Tuck jump assessment (TJA), single leg hop testing (SLHT) including the single, triple, and triple crossover hop for distance, and an evaluation of cutting performance. The LSDT, SLHT’s and cutting task were evaluated using a qualitative movement assessment checklist, which awarded a point for each movement fault identified. Athletes passed the RTST if they scored <19 on the TSK-11, <2 on the LSDT, <3 on all SLHT’s with a Limb Symmetry index > 95%, < 5 on the TJA and, < 2 on the cutting assessment. All variables were analyzed descriptively. For continuous variables, median and interquartile ranges (IQR) were reported and Wilcoxon rank sum test was used to assess the differences. For categorical variables, frequency and proportion were reported and chi-square or Fisher’s exact test was used to assess differences between “no second ACL injury” and “second ACL injury” groups. RESULTS: Overall, 14.2% of athletes (N=11) suffered a second ACL injury (81.8% males). Median Tegner score in both groups was 7 (IQR: 7-9). Median time to RTS clearance was significantly different between the no second ACL injury and second ACL injury groups (10 [IQR: 8-12] vs 8[IQR:8-9] months; p=0.017). A total of 66.2% of athletes (N= 51) passed the RTST. Of those who suffered a second ACL injury, 63.6% passed the RTS. There was no statistically significant difference between those who passed the RTST and those that did not on the occurrence of second ACL injury. CONCLUSION: A RTST battery including qualitative movement assessments does not predict second ACL injury in adolescent athletes after ACLR.