Functional Tests for Determining Return to Play Following Anterior Cruciate Ligament Reconstruction: Systematic Review

Abstract

Functional tests have been widely used for evaluating the ability to determine return to sports after anterior cruciate ligament (ACL) reconstruction. To object of this study is to review the current literatures which use functional tests to determine return to sports after ACL reconstruction. A literature search was conducted using the PubMed database. The inclusion criteria were articles published from 2015 to 2019, the English language, original clinical trials, all levels of evidence, primary ACL reconstruction, skeletal maturity, and >1 functional test used to allow release to sports activities. The exclusion criteria were revision ACL reconstructions or dislocated knees; major concomitant procedures such as high tibial osteotomy, meniscus allograft, other knee ligament reconstructions, immature patients. Twenty-three studies with 5,282 patients were included for this review. Total 47 kinds of tests for determining return to play were used at an average of 8.4 months. Single leg hop test was the most commonly used functional test, which was used in 16 studies, followed by triple hop and cross-over hop tests. Average limb symmetric index of the single leg hop test was 92.5%. Among the muscle strength tests, 60 deg/sec isokinetic knee extension test is the most common, which was used in eight studies, followed by 180 deg/sec isokinetic knee extension test, isometric knee extension test, 60 deg/sec isometric knee flexion test. Ten kinds of functional tests with motion analysis were performed in three studies. Single leg hop test was the most commonly reported functional test for determining return to play following ACL reconstruction and muscle strength test and motion analysis were also used as functional tests.