ORIGINAL PAPER
Factors and criteria considered by Saudi physical therapists for a safe return to sport after anterior cruciate ligament reconstruction: a mixed model approach
1
Department of Physical Therapy and Rehabilitation, Ibin Sina Hospital, Makkah Health Cluster, Ministry of Health, Makkah, Saudi Arabia
2
Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdul Aziz University, Jeddah, Saudi Arabia
These authors had equal contribution to this work
Submission date: 2024-03-21
Acceptance date: 2024-10-03
Online publication date: 2025-12-10
Corresponding author
Abdullah Ahmed Mohammed Alessa
Department of Physical Therapy and Rehabilitation, Ibin Sina Hospital, Makkah Health Cluster, Makkah, Saudi Arabia
Department of Physical Therapy and Rehabilitation, Ibin Sina Hospital, Makkah Health Cluster, Makkah, Saudi Arabia
KEYWORDS
TOPICS
ABSTRACT
Objective:
Anterior cruciate ligament (ACL) injury is common among athletes, especially those engaged in high levels of physical activities. The prevalence of re-injury after ACL reconstruction is frequently reported among athletes. This study aims to identify the significant factors considered and criteria used by Saudi physical therapists for safe return to sport (RTS) after anterior cruciate ligament reconstruction (ACLR).
Methods:
This research examined physical therapists’ knowledge and practices related to helping patients safely RTS after ACLR surgery. The study design involved a mixed-method approach, using both online questionnaires and in-person interviews with physical therapists. We developed the questions asked based on items from other research and had them reviewed by experienced physical therapists for accuracy and relevance. A total of 252 physical therapists participated in the study.
Results:
We found that most specialist therapists suggest that age, psychological support, and patient adherence to rehabilitation are crucial for a safe RTS. They believe RTS should be 6 to 9 months after ACLR. Other factors that could influence the safe RTS are checking the isokinetic muscle strength before RTS and ensuring adequate knee range of motion (ROM).
Conclusions:
The most crucial factors used by Saudi physical therapists for a safe RTS included the patient’s adherence to a suitable rehabilitation program (safe RTS could be 6–9 months after ACLR), the patient’s age, and proper psychological support.
Anterior cruciate ligament (ACL) injury is common among athletes, especially those engaged in high levels of physical activities. The prevalence of re-injury after ACL reconstruction is frequently reported among athletes. This study aims to identify the significant factors considered and criteria used by Saudi physical therapists for safe return to sport (RTS) after anterior cruciate ligament reconstruction (ACLR).
Methods:
This research examined physical therapists’ knowledge and practices related to helping patients safely RTS after ACLR surgery. The study design involved a mixed-method approach, using both online questionnaires and in-person interviews with physical therapists. We developed the questions asked based on items from other research and had them reviewed by experienced physical therapists for accuracy and relevance. A total of 252 physical therapists participated in the study.
Results:
We found that most specialist therapists suggest that age, psychological support, and patient adherence to rehabilitation are crucial for a safe RTS. They believe RTS should be 6 to 9 months after ACLR. Other factors that could influence the safe RTS are checking the isokinetic muscle strength before RTS and ensuring adequate knee range of motion (ROM).
Conclusions:
The most crucial factors used by Saudi physical therapists for a safe RTS included the patient’s adherence to a suitable rehabilitation program (safe RTS could be 6–9 months after ACLR), the patient’s age, and proper psychological support.
REFERENCES (37)
1.
Montalvo AM, Schneider DK, Webster KE, Yut L, Galloway MT, Heidt RS, Kaeding CC, Kremcheck TE, Magnussen RA, Parikh SN, Stanfield DT, Wall EJ, Myer GD. Anterior cruciate ligament injury risk in sport: a systematic review and meta-analysis of injury incidence by sex and sport classification. J Athl Train. 2019;54(5):472–82; doi: 10.4085/1062-6050-407-16.
2.
Sonesson S, Kvist J. Rehabilitation after ACL injury and reconstruction from the patients’ perspective. Phys Ther Sport. 2021;53:158–65; doi: 10.1016/j.ptsp.2021.10.001.
3.
Filbay SR, Grindem H. Evidence-based recommendations for the management of anterior cruciate ligament (ACL) rupture. Best Pract Res Clin Rheumatol. 2019;33(1):33–47; doi: 10.1016/j.berh.2019.01.018.
4.
Meunier A, Odensten M, Good L. Long-term results after primary repair or non-surgical treatment of anterior cruciate ligament rupture: a randomized study with a 15-year follow-up. Scand J Med Sci Sports. 2007;17:230–7; doi: 10.1111/j.1600-0838.2006.00547.x.
5.
Tsoukas D, Fotopoulos V, Basdekis G, Makridis KG. No difference in osteoarthritis after surgical and non-surgical treatment of ACL-injured knees after 10 years. Knee Surg Sport Traumatol Arthrosc. 2015;24(9):2953–9; doi: 10.1007/s00167-015-3593-9.
6.
Wong JM-L, Khan T, Jayadev C, Khan W, Johnstone D. Anterior cruciate ligament rupture and osteoarthritis progression. Open Orthop J. 2012;6:295–300; doi: 10.2174/1874325001206010295.
7.
Joreitz R, Lynch A, Popchak A, Irrgang J. Criterion-based rehabilitation program with return to sport testing following acl reconstruction: a case series. Int J Sports Phys Ther. 2020;15(6):1151–73; doi: 10.26603/ijspt20201151.
8.
Jayabalan P, Ihm J. Rehabilitation strategies for the athletic individual with early knee osteoarthritis. Curr Sports Med Rep. 2016;15(3):177–83; doi: 10.1249/JSR.0000000000000260.
9.
Cavanaugh JT, Powers M. ACL rehabilitation progression: where are we now?. Curr Rev Musculoskelet Med. 2017;10(3):289–96; doi: 10.1007/s12178-017-9426-3.
10.
Bahr R, Holme I. Risk factors for sports injuries – a methodological perspective. Br J Sports Med. 200337(5):384–92; doi: 10.1136/bjsm.37.5.384.
11.
Yusoff MSB. ABC of response process validation and face validity index calculation. Educ Med J. 2019;11(3):55–61; doi: 10.21315/eimj2019.11.3.6.
12.
Korakakis V, Kotsifaki A, Korakaki A, Karanasios S, Whiteley R. Current perspectives and clinical practice of physiotherapists on assessment, rehabilitation, and return to sport criteria after anterior cruciate ligament injury and reconstruction. Phys Ther Sport. 2021;52:103–14; doi: 10.1016/j.ptsp.2021.08.012.
13.
Kaeding CC, Pedroza A, Reinke E, Huston LJ, Spindler KP. Risk factors and predictors of subsequent ACL injury after ACL reconstruction: prospective analysis of 2801 primary ACL reconstructions. Orthop J Sports Med. 2015;3:2325967115578836; doi: 10.1177/0363546515578836.
14.
Grindem H, Snyder-Mackler L, Moksnes H, Engebretsen L, Risberg MA. Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study. Br J Sports Med. 2016;50(13):804–8; doi: 10.1136/bjsports-2016-096031.
15.
Edwards P, Ebert J, Joss B, Ackland T, Annear P, Buelow J-U, Hewitt B. Patient characteristics and predictors of return to sport at 12 months after anterior cruciate ligament reconstruction: the importance of patient age and postoperative rehabilitation. Orthop J Sport Med. 2018;6; doi: 10.1177/2325967118797575.
16.
Dingenen B, Billiet B, De Baets L, Bellemans J, Truijen J, Gokeler A. Rehabilitation strategies of Flemish physical therapists before and after anterior cruciate ligament reconstruction: an online survey. Phys Ther Sport. 2021;49:68–76; doi: 10.1016/j.ptsp.2021.02.003.
17.
Greenberg EM, Greenberg ET, Albaugh J, Storey E, Ganley TJ. Rehabilitation practice patterns following anterior cruciate ligament reconstruction: a survey of physical therapists. J Orthop Sport Phys Ther. 2018;48(10):801–11; doi: 10.2519/jospt.2018.8264.
18.
Ebert JR, Webster KE, Edwards PK, Joss BK, D’Alessandro P, Janes G, Annaer P. Current perspectives of Australian therapists on rehabilitation and return to sport after anterior cruciate ligament reconstruction: a survey. Phys Ther Sport. 2019;35(1):139–45; doi: 10.1016/j.ptsp.2018.12.004.
19.
Fausett WA, Reid DA, Larmer PJ. Current perspectives of New Zealand physiotherapists on rehabilitation and return to sport following anterior cruciate ligament reconstruction: a survey. Phys Ther Sport. 2022;53:166–72; doi: 10.1016/j.ptsp.2021.10.012.
20.
Beischer S, Gustavsson L, Hamrin Senorski E, Karlsson J, Thomeé C, Samuelsson K, Thomeé R. Young athletes who return to sport before 9 months after anterior cruciate ligament reconstruction have a rate of new injury 7 times that of those who delay return. J Orthop Sport Phys Ther. 2020;50(2):83–90; doi: 10.2519/jospt.2020.9071.
21.
Dingenen B, Truijen J, Bellemans J, Gokeler A. Test-retest reliability and discriminative ability of forward, medial and rotational single-leg hop tests. Knee. 2019;26(5):978–87; doi: 10.1016/j.knee.2019.06.010.
22.
Meredith S, Rauer T, Chmielewski T, Fink C, Diermeier T, Rothrauff B, Svantesson E, Senorski EH, Hewett TE, Sherman SL, Lesniak BP; The Panther Symposium ACL Injury Return to Sport Consensus Group. Return to sport after anterior cruciate ligament injury: Panther symposium ACL injury return to sport consensus group. J ISAKOS Jt Disord Orthop Sport Med. 2021;28(8):2403–14; doi: 10.1007/s00167-020-06009-1.
23.
Van Melick N, van Cingel REH, Brooijmans F, Neeter C, van Tienen T, Hullegie W, Nijhuis-van der Sanden MWG. Evidence-based clinical practice update: practice guidelines for anterior cruciate ligament rehabilitation based on a systematic review and multidisciplinary consensus. Br J Sports Med. 2016;50(24):1506–15; doi: 10.1136/bjsports-2015-095898.
24.
Królikowska A, Sikorski Ł, Czamara A, Reichert P. Effects of postoperative physiotherapy supervision duration on clinical outcome, speed, and agility in males 8 months after anterior cruciate ligament reconstruction. Med Sci Monit. 2018;24:6823–31; doi: 10.12659/MSM.912162.
25.
Herrington L, Myer G, Horsley I. Task based rehabilitation protocol for elite athletes following anterior cruciate ligament reconstruction: a clinical commentary. Phys Ther Sport. 2013;14(4):188–98; doi: 10.1016/j.ptsp.2013.08.001.
26.
Kyritsis P, Bahr R, Landreau P, Miladi R, Witvrouw E. 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. Br J Sports Med. 2016;50(15):946–51; doi: 10.1136/bjsports-2015-095908.
27.
Isberg J, Faxén E, Brandsson S, Eriksson B, Kärrholm J, Karlsson J. Early active extension after anterior cruciate ligament reconstruction does not result in increased laxity of the knee. Knee Surg Sports Traumatol Arthrosc. 2006;14:1108–15; doi: 10.1007/s00167-006-0138-2.
28.
Heijne A, Axelsson K, Werner S, Biguet G. Rehabilitation and recovery after anterior cruciate ligament reconstruction: patients’ experiences. Scand J Med Sci Sports. 2008;18(3):325–35; doi: 10.1111/j.1600-0838.2007.00700.x.
29.
Miles J, King E, Falvey E, Daniels K. Patellar and hamstring autografts are associated with different jump task loading asymmetries after ACL reconstruction. Scand J Med Sci Sports. 2019; 29(8):1212–22; doi: 10.1111/sms.13441.
30.
Read PJ, Auliffe SM, Wilson MG, Graham-Smith P. Lower limb kinetic asymmetries in professional soccer players with and without anterior cruciate ligament reconstruction: nine months is not enough time to restore “functional” symmetry or return to performance. Am J Sports Med. 2020;48(6):1365–73; doi: 10.1177/0363546520912218.
31.
Sims M, Mulcahey MK. Sex-specific differences in psychological response to injury and return to sport following ACL reconstruction. JBJS Rev. 2018;6(7):e9; doi: 10.2106/JBJS.RVW.17.00170.
32.
Kaplan Y, Witvrouw E. When is it safe to return to sport after acl reconstruction? reviewing the criteria. Sports Health. 2019;11(4):301–5; doi: 10.1177/1941738119846502.
33.
Aquino CF, Ocarino JM, Cardoso VA, Resende RA, Souza TR, Rabelo LM, Fonseca ST. Current clinical practice and return-to-sport criteria after anterior cruciate ligament reconstruction: a survey of Brazilian physical therapists. Br J Phys Ther. 2021;25(3):242–50; doi: 10.1016/j.bjpt.2020.05.014.
34.
Buckthorpe M. Optimising the late-stage rehabilitation and return-to-sport training and testing process after ACL reconstruction. Sport Med. 2019;49(7):1043–58; doi: 10.1007/s40279-019-01102-z.
35.
Welling W, Benjaminse A, Seil R, Lemmink KAPM, Zaffagnini S, Gokeler A. Low rates of patients meeting return to sport criteria 9 months after anterior cruciate ligament reconstruction: a prospective longitudinal study. Knee Surg Sport Traumatol Arthrosc. 2018;26(12):3636–44; doi: 10.1007/s00167-018-4916-4.
36.
Wright R, Haas A, Anderson J, Calabrese G, Cavanaugh J, Hewett T, Lorring D, McKenzie C, Preston E, Williams G; MOON Group. Anterior cruciate ligament reconstruction rehabilitation: MOON guidelines. Sport Health. 2015; 7(3):239–43; doi: 10.1177/1941738113517855.
37.
Mille P, Osmak J. Performance: bridging the gap after ACL surgery. Curr Rev Musculoskelet Med. 2017; 10(3):297–306; doi: 10.1007/s12178-017-9419-2.
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