Criteria for Return to Sport after Anterior Cruciate Ligament reconstruction with lower reinjury risk (CR’STAL study): protocol for a prospective observational study in France

Introduction The decision regarding when to return to sport after an anterior cruciate ligament reconstruction (ACLR) is an important one. Using a variety of subjective and objective parameters, various attempts have been made to determine an optimal timeline for a return to sport after ACLR, but none have been validated. The aim of the present study is therefore to determine which criteria or combination of criteria could allow to return to sport with the lowest possible risk of reinjury. Methods and analysis This study is a prospective cohort, single-centre study, with repeated assessments at 6, 9 and 12 months post-ACL surgical reconstruction and including a 3-year follow-up of patients’ sporting activity and reinjuries. 275 patients will be included to test explanatory variables. Postural control analysis, knee laxity, questionnaires (International Knee Documentation Committee (IKDC), Tampa Scale of Kinesiophobia-11 (TSK-11), Anterior Cruciate Ligament—Return to Sport After Reinjury (ACL-RSI) and Single Assessment Numeric Evaluation (SANE)), modified Star Excursion Balance Test, running and sprinting biomechanics, Hop Tests and Isokinetic Tests will all be used. The primary outcome will be any reinjury during the follow-up period, defined as a graft rupture, a contralateral ACL rupture or any injury necessitating an interruption of training and requiring a medical consultation. Two groups will be constituted during the follow-up, separating reinjured from non-reinjured patients. In addition, classic analysis and data mining approaches will be used to build predictive models. Ethics and dissemination The results of this study will be disseminated through peer-reviewed publications and scientific presentations. Ethical approval was obtained through the ethics committee of the University Hospital of Saint-Etienne (reference number IRBN522015/CHUSTE).

[1]  Peter Brukner,et al.  Magnetic Resonance Imaging Parameters for Assessing Risk of Recurrent Hamstring Injuries in Elite Athletes , 2007, The American journal of sports medicine.

[2]  Amir-Masoud Eftekhari-Moghadam,et al.  Knowledge discovery in medicine: Current issue and future trend , 2014, Expert Syst. Appl..

[3]  K. Khan.  Strength Imbalances and Prevention of Hamstring Injury in Professional Soccer Players: A Prospective Study , 2009 .

[4]  A. Anderson,et al.  The International Knee Documentation Committee Subjective Knee Evaluation Form , 2006, The American journal of sports medicine.

[5]  F R Noyes,et al.  Knee rehabilitation after anterior cruciate ligament reconstruction and repair , 1981, The Journal of orthopaedic and sports physical therapy.

[6]  Andrew D. Lynch,et al.  Consensus criteria for defining ‘successful outcome’ after ACL injury and reconstruction: a Delaware-Oslo ACL cohort investigation , 2013, British Journal of Sports Medicine.

[7]  Thomas M Best,et al.  Accelerated rehabilitation after anterior cruciate ligament reconstruction. , 2005, Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine.

[8]  M. Bourdin,et al.  Mechanical determinants of 100-m sprint running performance , 2012, European Journal of Applied Physiology.

[9]  Heikki Kyröläinen,et al.  A simple method for measuring stiffness during running. , 2005, Journal of applied biomechanics.

[10]  E. Kellis,et al.  Reliability of Single-leg and Double-leg Balance Tests in Subjects with Anterior Cruciate Ligament Reconstruction and Controls , 2015, Research in sports medicine.

[11]  R. Newton,et al.  Isokinetic dynamometry in anterior cruciate ligament injury and reconstruction. , 2008, Annals of the Academy of Medicine, Singapore.

[12]  Assessment: posturography. Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. , 1993, Neurology.

[13]  P. Kannus,et al.  The risk for a cruciate ligament injury of the knee in adolescents and young adults: a population-based cohort study of 46 500 people with a 9 year follow-up , 2008, British Journal of Sports Medicine.

[14]  M. P. Perme,et al.  Inter-rater reliability of the GNRB® knee arthrometer. , 2014, The Knee.

[15]  J. H. Kim,et al.  Test of Intrarater and Interrater Reliability for the Star Excursion Balance Test , 2014, Journal of physical therapy science.

[16]  Lee Herrington,et al.  A comparison of Star Excursion Balance Test reach distances between ACL deficient patients and asymptomatic controls. , 2009, The Knee.

[17]  K. Shelbourne,et al.  Correlation of a Single Assessment Numeric Evaluation (SANE) Rating With Modified Cincinnati Knee Rating System and IKDC Subjective Total Scores for Patients After ACL Reconstruction or Knee Arthroscopy , 2012, The American journal of sports medicine.

[18]  C. Harris,et al.  Psychometric properties of the Tampa Scale for Kinesiophobia-11 (TSK-11). , 2012, The journal of pain : official journal of the American Pain Society.

[19]  Joanna Kvist,et al.  Rehabilitation Following Anterior Cruciate Ligament Injury , 2004, Sports medicine.

[20]  S. Rodeo,et al.  Macrophages accumulate in the early phase of tendon–bone healing , 2005, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[21]  Kate E Webster,et al.  Return to sport following anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis of the state of play , 2011, British Journal of Sports Medicine.

[22]  S. Hetzel,et al.  Comparison of IKDC and SANE Outcome Measures Following Knee Injury in Active Female Patients , 2013, Sports health.

[23]  Gregory D Myer,et al.  Risk of Secondary Injury in Younger Athletes After Anterior Cruciate Ligament Reconstruction , 2016, The American journal of sports medicine.

[24]  J B Morin,et al.  Direct measurement of power during one single sprint on treadmill. , 2010, Journal of biomechanics.

[25]  J. Morin,et al.  Technical ability of force application as a determinant factor of sprint performance. , 2011, Medicine and science in sports and exercise.

[26]  J. Bellemans,et al.  The “Ligamentization” Process in Anterior Cruciate Ligament Reconstruction , 2011, The American journal of sports medicine.

[27]  M. Pierrynowski,et al.  Fear and Avoidance of Movement in People with Chronic Pain: Psychometric Properties of the 11-Item Tampa Scale for Kinesiophobia (TSK-11). , 2012, Physiotherapy Canada. Physiotherapie Canada.

[28]  J. Hertel,et al.  Using the Star Excursion Balance Test to assess dynamic postural-control deficits and outcomes in lower extremity injury: a literature and systematic review. , 2012, Journal of athletic training.

[29]  F. Noyes,et al.  Objective Criteria for Return to Athletics After Anterior Cruciate Ligament Reconstruction and Subsequent Reinjury Rates: A Systematic Review , 2011, The Physician and sportsmedicine.

[30]  T. V. van Tienen,et al.  Evidence-based clinical practice update: practice guidelines for anterior cruciate ligament rehabilitation based on a systematic review and multidisciplinary consensus , 2016, British Journal of Sports Medicine.

[31]  B. F. Morrey,et al.  Clinical Results and Risk Factors for Reinjury 15Years After Anterior Cruciate Ligament Reconstruction: A Prospective Study of Hamstring and Patellar Tendon Grafts , 2012 .

[32]  P. Stratford,et al.  Hop Testing Provides a Reliable and Valid Outcome Measure During Rehabilitation After Anterior Cruciate Ligament Reconstruction , 2007, Physical Therapy.

[33]  L. Engebretsen,et al.  Lower Risk of Revision With Patellar Tendon Autografts Compared With Hamstring Autografts , 2014, The American journal of sports medicine.

[34]  T. Hewett,et al.  Incidence of Contralateral and Ipsilateral Anterior Cruciate Ligament (ACL) Injury After Primary ACL Reconstruction and Return to Sport , 2012, Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine.

[35]  R Bahr,et al.  Return to play guidelines after anterior cruciate ligament surgery , 2005, British Journal of Sports Medicine.

[36]  Kate E. Webster,et al.  Younger Patients Are at Increased Risk for Graft Rupture and Contralateral Injury After Anterior Cruciate Ligament Reconstruction , 2014, The American journal of sports medicine.

[37]  B. Gagnière,et al.  A new knee arthrometer, the GNRB: experience in ACL complete and partial tears. , 2009, Orthopaedics & traumatology, surgery & research : OTSR.

[38]  อนิรุธ สืบสิงห์,et al.  Data Mining Practical Machine Learning Tools and Techniques , 2014 .

[39]  M. Reijman,et al.  Risk factors of recurrent hamstring injuries: a systematic review , 2011, British Journal of Sports Medicine.

[40]  Stefano Zaffagnini,et al.  Development of a test battery to enhance safe return to sports after anterior cruciate ligament reconstruction , 2016, Knee Surgery, Sports Traumatology, Arthroscopy.

[41]  K. Webster,et al.  Satisfaction With Knee Function After Primary Anterior Cruciate Ligament Reconstruction Is Associated With Self-Efficacy, Quality of Life, and Returning to the Preinjury Physical Activity. , 2016, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[42]  M. Collette,et al.  Objective evaluation of anterior knee laxity; comparison of the KT-1000 and GNRB® arthrometers , 2012, Knee Surgery, Sports Traumatology, Arthroscopy.

[43]  D. Altchek,et al.  Anterior cruciate ligament revision: double-bundle augmentation of primary vertical graft. , 2006, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[44]  T. Chmielewski,et al.  Return to preinjury sports participation following anterior cruciate ligament reconstruction: contributions of demographic, knee impairment, and self-report measures. , 2012, The Journal of orthopaedic and sports physical therapy.

[45]  Marcie Harris-Hayes,et al.  Variables associated with return to sport following anterior cruciate ligament reconstruction: a systematic review , 2013, British Journal of Sports Medicine.

[46]  R. Clark,et al.  Dynamic Single-Leg Postural Control Is Impaired Bilaterally Following Anterior Cruciate Ligament Reconstruction: Implications for Reinjury Risk. , 2016, The Journal of orthopaedic and sports physical therapy.

[47]  Ian H. Witten,et al.  Data mining: practical machine learning tools and techniques, 3rd Edition , 1999 .

[48]  W. Müller,et al.  Evaluation of knee ligament injuries with the IKDC form , 2005, Knee Surgery, Sports Traumatology, Arthroscopy.

[49]  K. Webster,et al.  Fifty-five per cent return to competitive sport following anterior cruciate ligament reconstruction surgery: an updated systematic review and meta-analysis including aspects of physical functioning and contextual factors , 2014, British Journal of Sports Medicine.

[50]  Bruce Walker,et al.  The test-retest reliability of centre of pressure measures in bipedal static task conditions--a systematic review of the literature. , 2010, Gait & posture.

[51]  G. Monnier,et al.  Analysis of return to competition and repeat rupture for 298 anterior cruciate ligament reconstructions with patellar or hamstring tendon autograft in sportspeople. , 2010, Annals of physical and rehabilitation medicine.

[52]  J. Morin,et al.  Sprint running performance: comparison between treadmill and field conditions , 2011, European Journal of Applied Physiology.

[53]  Brendan M Marshall,et al.  Isokinetic muscle strength and readiness to return to sport following anterior cruciate ligament reconstruction: is there an association? A systematic review and a protocol recommendation , 2015, British Journal of Sports Medicine.

[54]  Andrew D. Lynch,et al.  Self-reported knee function can identify athletes who fail return-to-activity criteria up to 1 year after anterior cruciate ligament reconstruction: a delaware-oslo ACL cohort study. , 2014, The Journal of orthopaedic and sports physical therapy.

[55]  B. Gojanovic,et al.  2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern , 2016, British Journal of Sports Medicine.

[56]  M. Bizzini,et al.  Reliability of knee extension and flexion measurements using the Con‐Trex isokinetic dynamometer , 2007, Clinical physiology and functional imaging.

[57]  S. Brown,et al.  Determining return-to-sport status with a multi-component assessment strategy: a case study in rugby. , 2014, Physical therapy in sport : official journal of the Association of Chartered Physiotherapists in Sports Medicine.

[58]  K. Webster,et al.  Eighty-three per cent of elite athletes return to preinjury sport after anterior cruciate ligament reconstruction: a systematic review with meta-analysis of return to sport rates, graft rupture rates and performance outcomes , 2017, British Journal of Sports Medicine.

[59]  Nicholas C. Clark.  Functional performance testing following knee ligament injury , 2001 .

[60]  K. Wilk.  Anterior Cruciate Ligament Injury Prevention and Rehabilitation: Let's Get It Right. , 2015, The Journal of orthopaedic and sports physical therapy.

[61]  R. Wright,et al.  Rehabilitation after anterior cruciate ligament reconstruction: a systematic review. , 2012, The Journal of bone and joint surgery. American volume.

[62]  G. Barrett,et al.  Age, Graft Size, and Tegner Activity Level as Predictors of Failure in Anterior Cruciate Ligament Reconstruction With Hamstring Autograft , 2013, The American journal of sports medicine.

[63]  Kevin R Ford,et al.  Incidence of Second ACL Injuries 2 Years After Primary ACL Reconstruction and Return to Sport , 2014, The American journal of sports medicine.

[64]  M. Inacio,et al.  Reconstruction of the anterior cruciate ligament: association of graft choice with increased risk of early revision. , 2013, The bone & joint journal.

[65]  C. Kaeding,et al.  Activity Level and Graft Type as Risk Factors for Anterior Cruciate Ligament Graft Failure , 2009, The American journal of sports medicine.

[66]  K. Shelbourne,et al.  Incidence of Subsequent Injury to Either Knee within 5 Years after Anterior Cruciate Ligament Reconstruction with Patellar Tendon Autograft , 2009, The American journal of sports medicine.

[67]  F. Noyes,et al.  Prevalence of Nonanatomical Graft Placement in a Series of Failed Anterior Cruciate Ligament Reconstructions , 2010, The American journal of sports medicine.

[68]  T. Hewett,et al.  Biomechanical Measures during Landing and Postural Stability Predict Second Anterior Cruciate Ligament Injury after Anterior Cruciate Ligament Reconstruction and Return to Sport , 2010, The American journal of sports medicine.

[69]  L. Engebretsen,et al.  Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study , 2016, British Journal of Sports Medicine.

[70]  Catherine Combes,et al.  Clustering using principal component analysis applied to autonomy-disability of elderly people , 2013, Decis. Support Syst..

[71]  C. Armstrong,et al.  The reliability of the star-excursion test in assessing dynamic balance. , 1998, The Journal of orthopaedic and sports physical therapy.

[72]  K. Refshauge,et al.  Incidence and risk factors for graft rupture and contralateral rupture after anterior cruciate ligament reconstruction. , 2005, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[74]  Roald Bahr,et al.  Likelihood of ACL graft rupture: not meeting six clinical discharge criteria before return to sport is associated with a four times greater risk of rupture , 2016, British Journal of Sports Medicine.

[75]  Li Felländer-Tsai,et al.  A Population-Based Nationwide Study of Cruciate Ligament Injury in Sweden, 2001-2009 , 2012, The American journal of sports medicine.

[76]  S. Woby,et al.  Psychometric properties of the TSK-11: A shortened version of the Tampa Scale for Kinesiophobia , 2005, Pain.

[77]  L. Engebretsen,et al.  Increased Risk of Revision With Hamstring Tendon Grafts Compared With Patellar Tendon Grafts After Anterior Cruciate Ligament Reconstruction , 2014, The American journal of sports medicine.

[78]  G. Reurink,et al.  2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern , 2016, British Journal of Sports Medicine.

[79]  Gregory D Myer,et al.  The American Academy of Orthopaedic Surgeons evidence-based guideline on management of anterior cruciate ligament injuries. , 2015, The Journal of bone and joint surgery. American volume.

[80]  K. Webster,et al.  A prospective longitudinal study to assess psychological changes following anterior cruciate ligament reconstruction surgery , 2008, British Journal of Sports Medicine.

[81]  T. Hewett,et al.  Are Female Soccer Players at an Increased Risk of Second Anterior Cruciate Ligament Injury Compared With Their Athletic Peers? , 2016, The American journal of sports medicine.

[82]  F R Noyes,et al.  Abnormal lower limb symmetry determined by function hop tests after anterior cruciate ligament rupture , 1991, The American journal of sports medicine.

[83]  L. Salmon,et al.  Fifteen-Year Outcome of Endoscopic Anterior Cruciate Ligament Reconstruction With Patellar Tendon Autograft for “Isolated” Anterior Cruciate Ligament Tear , 2011, The American journal of sports medicine.

[84]  Dean C Taylor,et al.  Graft size and patient age are predictors of early revision after anterior cruciate ligament reconstruction with hamstring autograft. , 2012, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.