Quadriceps Strength Testing Practices & Barriers During Return to Sport from ACL Reconstruction: A Survey of Collegiate Athletic Trainers.

Context: Quadriceps strength is a key outcome for guiding rehabilitation and return to sport-specific activities after ACL reconstruction (ACLR) surgery.

Objectives: 1) Describe the quadriceps strength testing practices and barriers college athletic trainers (ATs) are using and experiencing when returning patients to sport-specific activities after ACLR. 2)Compare testing methods between college ATs working in the National Collegiate Athletic Association (NCAA) Division I setting and other college settings.

Design: Cross-sectional.

Setting: Online survey.

Patients or other participants: 243 full-time collegiate ATs who had primarily overseen/directed an ACLR rehabilitation in the past five years (age: 34.8±10.7, years of AT practice: 11.7±9.3, NCAA division I setting: 56%).

Main outcomes: Our survey included four sections: Demographics, General ACLR rehabilitation practices, Quadriceps strength testing methods & criteria, and Quadriceps strength testing barriers.

Results: Knee muscle strength was the most common (98%) outcome collegiate ATs use when determining whether an ACLR patient is ready to progress to sport-specific activities. Manual muscle testing (MMT) was the most used testing method (57%), followed by isokinetic dynamometry (IKD) (48%), repetition max (RM) testing (35%) and handheld dynamometry (HHD) (22%). Most ATs (63-64%) used >90% side-to-side symmetry as their return to sport-specific activities criteria. Lack of equipment needed (83%), lack of financial means (28%), and lack of training/education (20%) were the barriers that most limited ATs use of IKD testing, the gold-standard testing method. Compared to ATs in other settings, a greater proportion of ATs working in the NCAA Division I setting used IKD testing (65% vs 28%) and a smaller proportion used MMT (47% vs 70%).

Conclusions: While almost all college ATs considered knee muscle strength an important outcome to assess when returning patients to sport-specific activities after ACLR, quadriceps strength testing practices were highly variable among ATs and may be impacted by access to necessary resources.