Return to sport after anterior cruciate ligament reconstruction : A scoping review

Bakgrund: Skador på det främre korsbandet (anterior cruciate ligament, ACL) är vanligt och sker framför allt under idrottsutövning. Ungefär hälften av de som drabbas genomgår korsbandsrekonstruktion (ACLR). När det gäller rehabilitering efter ACLR finns en kunskapslucka i litteraturen gällande hur denna skall struktureras, vad den ska innehålla, samt hur rehabiliteringen skall utvärderas innan återgång till idrott (return to sport, RTS) tillåts. Syfte: Syftet med litteraturöversikten var att studera rehabilitering av individer som genomgått ACLR, de tester som görs, samt hur vanligt det är att den studerade populationen kan återgå till idrott. Metod: Litteratursökning genomfördes i tre databaser (PubMed, MEDLINE, Sage Journals) i november 2023 enligt flexibel sökstrategi. 22 studier kvalitetsgranskades enligt SBUs granskningsmall och 17 inkluderades sedermera i litteraturöversikten. Resultat: Inför återgång till idrott förekom ett testbatteri, där bland annat enbenshopp ingick, i 11 av de granskade artiklarna. När det gäller att utvärdera muskelstyrka förekom olika isometriska och isokinetiska tester av quadriceps och hamstrings i 10 av de granskade artiklarna. Gällande enkäter användes International Knee Documentation Committe (IKDC) och ACL-return to sport after injury scale (ACL-RSI) respektive i 11 av de granskade artiklarna. Idrottare med goda hopptestresultat, limb symmetry index LSI ≥85%, samt LSI ≥85% för isokinetiskt styrketest, återvänder till idrott oftare än idrottare med sämre resultat (LSI <85%). Få testdeltagare klarar RTS-tester 6 månader postoperativt, men desto fler klarar samma tester 12-24 månader postoperativt. Konklusion: Ytterligare studier behövs för att konkretisera ett vetenskapligt belagt rehabiliteringsprotokoll gällande såväl utformandet av träning som metodval när det gäller RTS-tester.Background: Injuries to the anterior cruciate ligament (ACL) are common and occur most often during sports participation. Approximately half of those affected undergo anterior cruciate ligament reconstruction (ACLR). When it comes to rehabilitation there is a knowledge-gap in the literature regarding how it should be best structured, what it should contain, and how it should be evaluated before allowing the athlete to return to sport. Purpose: The purpose of this study was to study the rehabilitation of athletes who have undergone ACLR, the RTS tests that have been performed, and to what extent the athletes have returned to sport. Method: A scoping review of current literature (from 2019 and forward) was conducted. In November 2023 a literature search with a flexible search strategy was made, across three databases (PubMed, MEDLINE, Sage Journals). Twenty-two studies were checked for quality and subsequently 17 studies were included in the review. Result: Prior to the RTS phase the athletes undergo a series of tests. Single leg jumps performance was assessed in 11 of the included articles. Muscle strength tests of the hamstrings and the quadriceps, including isometric and isokinetic tests of the hamstrings and the quadriceps were conducted in 10 of the included articles. Surveys, most commonly International Knee Documentation Committee (IKDC) and ACL-return to sport after injury scale (ACL-RSI) were employed in 11 of the included articles. Athletes with good results (limb symmetry index, LSI ≥85%) in the jump tests, and LSI ≥85% in the isokinetic strength test, returned to sport more often than those athletes with poorer results (LSI <85%). Few athletes passed all the RTS tests six months post-surgery, however a higher number achieved a passing grade on the tests 12-24 months post-surgery. Conclusion: Further studies are needed to verify the best scientifically based rehab-protocol following ACLR. Additionally, there is a need to identify a well-structured test-battery that can safely determine athlete’s readiness to return to sport post-ACLR.