Predicting Secondary Injury Risk Following Anterior Cruciate Ligament Reconstruction: A Literature Review

Abstract

Background: The anterior cruciate ligament (ACL) is the most commonly ruptured knee ligament. Surgical reconstruction offers the best prognosis for recovery by increasing stability and decreasing complications. Unfortunately, after an athlete resumes activity, there is an increased risk of injury to both the graft, and the contralateral ACL. Previous studies have investigated return to sport (RTS) assessment tools’ capability to foresee secondary ACL injury, largely providing no concrete evidence as to which tools are predictive of secondary ACL injury. Objective: This study aimed to evaluate existing RTS assessment tools’ capability of predicting a secondary ACL injury in athletes who RTS. This study sought to identify tools that orthopedic surgeons and physician assistants could utilize to aid clinical decision making when considering RTS following surgical reconstruction. Methods: This literature review searched the PubMed database from 2015-present, using search terms related to ACL reconstruction and RTS. All abstracts were screened against inclusion criteria. The primary outcome measured was RTS tools’ capability to predict secondary ACL injury. Results: Five articles met the selection criteria. Two studies concluded that passing RTS criteria did not significantly decrease the risk of secondary ACL injury. Two studies indicated that available literature was insufficient to confidently determine the predictive validity of RTS for secondary ACL injury. Only one study found an association between passing RTS criteria and reduced secondary ACL risk; functional, psychologic, and radiologic tests were identified to have capability in predicting secondary ACL injury. This data was used to create an evidencebased RTS battery consisting of tests, cut-off points and predictive capability of secondary ACL injury. Conclusion: Based on the heterogeneity of the results, there is a need for more research to determine the best RTS battery and the associated predictive capability for secondary ACL injury. A preliminary evidence-based RTS battery incorporating functional, psychological, and radiological measures was proposed; large scale studies are required to validate this tool.