Determination of neuromuscular function before return to sports after ACL reconstruction: Can we reduce the risk of reinjury?

Abstract

The topic of return to sport (RTS) after anterior cruciate ligament (ACL) reconstruction has become the subject of increased scrutiny as a result of publications citing high reinjury rates upon return to high-risk sports postoperatively, as well as disappointing percentages of athletes who are able to RTS. It is unclear whether reinjuries are due to younger patient age or participation in high-risk activities per se; failure to restore normal neuromuscular indices (to both knees) may be one major source of this problem. A test battery is recommended that measures overall knee and neuromuscular function, along with cardiovascular fitness and core strength. Other common barriers for RTS include psychological factors such as fear of reinjury, anxiety, and depression. Validated questionnaires are provided to measure and detect these issues. A comprehensive RTS decision-based model for sports medicine practitioners is discussed that assesses risk of reinjury from multiple factors and determines the clinician's threshold for acceptable risk. Changes in neurocognitive function and cortical activity that occur after ACL injury and reconstruction, and the potential for screening using validated concussion questionnaires, are discussed. Important preoperative, intraoperative, and postoperative factors that may affect successful RTS are summarized.