Progress in evaluation of return to sports after anterior cruciate ligament reconstruction_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SHI Zhengliang ,  LI Yanlin , YU Yang , WANG Guoliang , NING Ziwen , HE Renjie , TANG Wenting , WANG Kun

Department of Sports Medicine, the First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650032, P. R. China;

Corresponding author：

LI Yanlin, Email: 852387873@qq.com

Keywords：

Anterior cruciate ligament reconstruction; return to sport; evaluation method

DOI：

10.7507/1002-1892.202301029

Video：

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Objective To summarize the evaluation methods of return to sports (RTS) after anterior cruciate ligament reconstruction (ACLR) in recent years, in order to provide reference for clinical practice. Methods The literature related to the RTS after ACLR was searched from CNKI, Wanfang, PubMed, and Foreign Medical Information Resources Retrieval Platform (FMRS) databases. The retrieval range was from 2010 to 2023, and 66 papers were finally included for review. The relevant literature was summarized and analyzed from the aspects of RTS time, objective evaluation indicators, and psychological evaluation. Results RTS is the common desire of patients with ACL injury and doctors, as well as the initial intention of selecting surgery. A reasonable and perfect evaluation method of RTS can not only help patients recover to preoperative exercise level, but also protect patients from re-injury. At present, the main criterion for clinical judgement of RTS is time. It is basically agreed that RTS after 9 months can reduce the re-injury. In addition to time, it is also necessary to test the lower limb muscle strength, jumping, balance, and other aspects of the patient, comprehensively assess the degree of functional recovery and determine the different time of RTS according to the type of exercise. Psychological assessment plays an important role in RTS and has a good clinical predictive effect. Conclusion RTS is one of the research hotspots after ACLR. At present, there are many related evaluation methods, which need to be further optimized by more research to build a comprehensive and standardized evaluation system.

Citation： SHI Zhengliang, LI Yanlin, YU Yang, WANG Guoliang, NING Ziwen, HE Renjie, TANG Wenting, WANG Kun. Progress in evaluation of return to sports after anterior cruciate ligament reconstruction. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(4): 495-501. doi: 10.7507/1002-1892.202301029 Copy

1.	Ardern CL, Taylor NF, Feller JA, 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. Br J Sports Med, 2014, 48(21): 1543-1552.
2.	Ardern CL, Webster KE, Taylor NF, et al. Return to sport following anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis of the state of play. Br J Sports Med, 2011, 45(7): 596-606.
3.	Ohji S, Aizawa J, Hirohata K, et al. The gap between subjective return to sports and subjective athletic performance intensity after anterior cruciate ligament reconstruction. Orthop J Sports Med, 2020, 8(9): 2325967120947402. doi: 10.1177/2325967120947402.
4.	Roe C, Jacobs C, Hoch J, et al. Test batteries after primary anterior cruciate ligament reconstruction: A systematic review. Sports Health, 2022, 14(2): 205-215.
5.	Ardern CL, Glasgow P, Schneiders AG, et al. Infographic: 2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern. Br J Sports Med, 2017, 51(13): 995. doi: 10.1136/bjsports-2016-097468.
6.	Dingenen B, Gokeler A. Optimization of the return-to-sport paradigm after anterior cruciate ligament reconstruction: A critical step back to move forward. Sports Med, 2017, 47(8): 1487-1500.
7.	Burgi CR, Peters S, Ardern CL, et al. Which criteria are used to clear patients to return to sport after primary ACL reconstruction? A scoping review. Br J Sports Med, 2019, 53(18): 1154-1161.
8.	Webster KE, Feller JA. Who passes return-to-sport tests, and which tests are most strongly associated with return to play after anterior cruciate ligament reconstruction? Orthop J Sports Med, 2020, 8(12): 2325967120969425. doi: 10.1177/2325967120969425.
9.	Zhu W, Wang D, Han Y, et al. Anterior cruciate ligament (ACL) autograft reconstruction with hamstring tendons: clinical research among three rehabilitation procedures. Eur J Orthop Surg Traumatol, 2013, 23(8): 939-943.
10.	杨涛, 周敬滨, 陈天午, 等. 优秀运动员前交叉韧带重建后何时重返运动: 一项基于等速肌力和多种单脚跳测试的研究. 中国运动医学杂志, 2018, 37(3): 185-191.
11.	Turk R, Shah S, Chilton M, et al. Return to sport after anterior cruciate ligament reconstruction requires evaluation of >2 functional tests, psychological readiness, quadriceps/hamstring strength, and time after surgery of 8 months. Arthroscopy, 2023, 39(3): 790-801.
12.	Kitaguchi T, Tanaka Y, Takeshita S, et al. Preoperative quadriceps strength as a predictor of return to sports after anterior cruciate ligament reconstruction in competitive athletes. Phys Ther Sport, 2020, 45: 7-13.
13.	Buckthorpe M, Della Villa F. Optimising the ‘mid-stage’ training and testing process after ACL reconstruction. Sports Med, 2020, 50(4): 657-678.
14.	Török L, Jávor P, Török K, et al. Early return to play after anterior cruciate ligament reconstruction: Is it worth the risk? Ann Rehabil Med, 2022, 46(2): 97-107.
15.	Sonnery-Cottet B, Saithna A, Cavalier M, et al. Anterolateral ligament reconstruction is associated with significantly reduced ACL graft rupture rates at a minimum follow-up of 2 years: A prospective comparative study of 502 patients from the SANTI Study Group. Am J Sports Med, 2017, 45(7): 1547-1557.
16.	Meredith SJ, Rauer T, Chmielewski TL, et al. Return to sport after anterior cruciate ligament injury: Panther Symposium ACL Injury Return to Sport Consensus Group. J ISAKOS, 2021, 6(3): 138-146.
17.	Werner JL, Burland JP, Mattacola CG, et al. Decision to return to sport participation after anterior cruciate ligament reconstruction, Part Ⅱ: Self-reported and functional performance outcomes. J Athl Train, 2018, 53(5): 464-474.
18.	Ebert JR, Edwards P, Yi L, et al. Strength and functional symmetry is associated with post-operative rehabilitation in patients following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc, 2018, 26(8): 2353-2361.
19.	Maestroni L, Papadopoulos K, Turner A, et al. Relationships between physical capacities and biomechanical variables during movement tasks in athletic populations following anterior cruciate ligament reconstruction. Phys Ther Sport, 2021, 48: 209-218.
20.	Kyritsis P, Bahr R, Landreau P, 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. Br J Sports Med, 2016, 50(15): 946-951.
21.	van der Horst N, Denderen RV. Isokinetic hamstring and quadriceps strength interpretation guideline for football (soccer) players with ACL reconstruction: a Delphi consensus study in the Netherlands. Sci Med Footb, 2022, 6(4): 434-445.
22.	Zaffagnini S, Bruni D, Marcheggiani Muccioli GM, et al. Single-bundle patellar tendon versus non-anatomical double-bundle hamstrings ACL reconstruction: a prospective randomized study at 8-year minimum follow-up. Knee Surg Sports Traumatol Arthrosc, 2011, 19(3): 390-397.
23.	van Melick N, Pronk Y, Nijhuis-van der Sanden M, et al. Meeting movement quantity or quality return to sport criteria is associated with reduced second ACL injury rate. J Orthop Res, 2022, 40(1): 117-128.
24.	Ohji S, Aizawa J, Hirohata K, et al. Single-leg hop distance normalized to body height is associated with the return to sports after anterior cruciate ligament reconstruction. J Exp Orthop, 2021, 8(1): 26. doi: 10.1186/s40634-021-00344-z.
25.	Nawasreh Z, Logerstedt D, Cummer K, et al. Functional performance 6 months after ACL reconstruction can predict return to participation in the same preinjury activity level 12 and 24 months after surgery. Br J Sports Med, 2018, 52(6): 375. doi: 10.1136/bjsports-2016-097095.
26.	Willigenburg N, Hewett TE. Performance on the functional movement screen is related to hop performance but not to hip and knee strength in collegiate football players. Clin J Sport Med, 2017, 27(2): 119-126.
27.	Sousa PL, Krych AJ, Cates RA, et al. Return to sport: Does excellent 6-month strength and function following ACL reconstruction predict midterm outcomes? Knee Surg Sports Traumatol Arthrosc, 2017, 25(5): 1356-1363.
28.	Niederer D, Giesche F, Janko M, et al. Unanticipated jump-landing quality in patients with anterior cruciate ligament reconstruction: How long after the surgery and return to sport does the re-injury risk factor persist? Clin Biomech (Bristol, Avon), 2020, 72: 195-201.
29.	Ohji S, Aizawa J, Hirohata K, et al. Characteristics of landing impact in athletes who have not returned to sports at the pre-injury competition level after anterior cruciate ligament reconstruction. Asia Pac J Sports Med Arthrosc Rehabil Technol, 2021, 25: 47-52.
30.	Oleksy Ł, Mika A, Sulowska-Daszyk I, et al. Standard RTS criteria effectiveness verification using FMS, Y-balance and TJA in footballers following ACL reconstruction and mild lower limb injuries. Sci Rep, 2021, 11(1): 1558. doi: 10.1038/s41598-021-81152-4.
31.	Kotsifaki A, Van Rossom S, Whiteley R, et al. Single leg vertical jump performance identifies knee function deficits at return to sport after ACL reconstruction in male athletes. Br J Sports Med, 2022, 56(9): 490-498.
32.	Read P, Mc Auliffe S, Wilson MG, et al. Better reporting standards are needed to enhance the quality of hop testing in the setting of ACL return to sport decisions: a narrative review. Br J Sports Med, 2021, 55(1): 23-29.
33.	DiFabio M, Slater LV, Norte G, et al. Relationships of functional tests following ACL reconstruction: Exploratory factor analyses of the lower extremity assessment protocol. J Sport Rehabil, 2018, 27(2): 144-150.
34.	Schmitt LC, Brunst C, Ithurburn M, et al. Identification and predictors of age-relevant and activity-relevant hop test targets in young athletes after anterior cruciate ligament reconstruction. J Athl Train, 2022, 57(9-10): 946-954.
35.	Gribble PA, Hertel J, Plisky P. Using the Star Excursion Balance Test to assess dynamic postural-control deficits and outcomes in lower extremity injury: a literature and systematic review. J Athl Train, 2012, 47(3): 339-357.
36.	Gribble PA, Kelly SE, Refshauge KM, et al. Interrater reliability of the star excursion balance test. J Athl Train, 2013, 48(5): 621-626.
37.	Collings TJ, Bourne MN, Barrett RS, et al. Risk factors for lower limb injury in female team field and court sports: a systematic review, meta-analysis, and best evidence synthesis. Sports Med, 2021, 51(4): 759-776.
38.	Garrison JC, Bothwell JM, Wolf G, et al. Y Balance Test^TM anterior reach symmetry at three months is related to single leg functional performance at time of return to sports following anterior cruciate ligament reconstruction. Int J Sports Phys Ther, 2015, 10(5): 602-611.
39.	Saper M, Wong C, Strauss N. Adolescent patients exhibit significant improvements in strength and functional performance from 6 to 9 months after acl reconstruction with quadriceps autograft. Arthrosc Sports Med Rehabil, 2021, 3(3): e837-e843.
40.	Della Villa F, Andriolo L, Ricci M, et al. Compliance in post-operative rehabilitation is a key factor for return to sport after revision anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc, 2020, 28(2): 463-469.
41.	Besier TF, Lloyd DG, Ackland TR, et al. Anticipatory effects on knee joint loading during running and cutting maneuvers. Med Sci Sports Exerc, 2001, 33(7): 1176-1181.
42.	Seehafer L, Morrison S, Severin R, et al. A multi-systems approach to human movement after acl reconstruction: the cardiopulmonary system. Int J Sports Phys Ther, 2021, 17(1): 60-73.
43.	Almeida AM, Santos Silva PR, Pedrinelli A, et al. Aerobic fitness in professional soccer players after anterior cruciate ligament reconstruction. PLoS One, 2018, 13(3): e0194432. doi: 10.1371/journal.pone.0194432.
44.	Oleksy Ł, Mika A, Królikowska A, et al. Composite score of readiness (CSR) as holistic profiling of functional deficits in footballers following acl reconstruction. J Clin Med, 2021, 10(16): 3570. doi: 10.3390/jcm10163570.
45.	Lucas K, Todd P, Ness BM. A multi-systems approach to human movement after ACL reconstruction: the integumentary system. Int J Sports Phys Ther, 2021, 17(1): 74-80.
46.	Larson D, Vu V, Ness BM, et al. A multi-systems approach to human movement after acl reconstruction: the musculoskeletal system. Int J Sports Phys Ther, 2021, 17(1): 27-46.
47.	Fältström A, Hägglund M, Kvist J. Patient-reported knee function, quality of life, and activity level after bilateral anterior cruciate ligament injuries. Am J Sports Med, 2013, 41(12): 2805-2813.
48.	Klasan A, Putnis SE, Grasso S, et al. Tegner level is predictive for successful return to sport 2 years after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc, 2021, 29(9): 3010-3016.
49.	Connell R, Paton B, Milne R. Return to play following anterior cruciate ligament reconstruction: incorporating fatigue into a return to play functional battery. Part A: treadmill running. BMJ Open Sport Exerc Med, 2019, 5(1): e000375. doi: 10.1136/bmjsem-2018-000375.
50.	Graziano J, Chiaia T, de Mille P, et al. Return to sport for skeletally immature athletes after ACL reconstruction: preventing a second injury using a quality of movement assessment and quantitative measures to address modifiable risk factors. Orthop J Sports Med, 2017, 5(4): 2325967117700599. doi: 10.1371/journal.pone.0194432.
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1. Ardern CL, Taylor NF, Feller JA, 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. Br J Sports Med, 2014, 48(21): 1543-1552.
2. Ardern CL, Webster KE, Taylor NF, et al. Return to sport following anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis of the state of play. Br J Sports Med, 2011, 45(7): 596-606.
3. Ohji S, Aizawa J, Hirohata K, et al. The gap between subjective return to sports and subjective athletic performance intensity after anterior cruciate ligament reconstruction. Orthop J Sports Med, 2020, 8(9): 2325967120947402. doi: 10.1177/2325967120947402.
4. Roe C, Jacobs C, Hoch J, et al. Test batteries after primary anterior cruciate ligament reconstruction: A systematic review. Sports Health, 2022, 14(2): 205-215.
5. Ardern CL, Glasgow P, Schneiders AG, et al. Infographic: 2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern. Br J Sports Med, 2017, 51(13): 995. doi: 10.1136/bjsports-2016-097468.
6. Dingenen B, Gokeler A. Optimization of the return-to-sport paradigm after anterior cruciate ligament reconstruction: A critical step back to move forward. Sports Med, 2017, 47(8): 1487-1500.
7. Burgi CR, Peters S, Ardern CL, et al. Which criteria are used to clear patients to return to sport after primary ACL reconstruction? A scoping review. Br J Sports Med, 2019, 53(18): 1154-1161.
8. Webster KE, Feller JA. Who passes return-to-sport tests, and which tests are most strongly associated with return to play after anterior cruciate ligament reconstruction? Orthop J Sports Med, 2020, 8(12): 2325967120969425. doi: 10.1177/2325967120969425.
9. Zhu W, Wang D, Han Y, et al. Anterior cruciate ligament (ACL) autograft reconstruction with hamstring tendons: clinical research among three rehabilitation procedures. Eur J Orthop Surg Traumatol, 2013, 23(8): 939-943.
10. 杨涛, 周敬滨, 陈天午, 等. 优秀运动员前交叉韧带重建后何时重返运动: 一项基于等速肌力和多种单脚跳测试的研究. 中国运动医学杂志, 2018, 37(3): 185-191.
11. Turk R, Shah S, Chilton M, et al. Return to sport after anterior cruciate ligament reconstruction requires evaluation of >2 functional tests, psychological readiness, quadriceps/hamstring strength, and time after surgery of 8 months. Arthroscopy, 2023, 39(3): 790-801.
12. Kitaguchi T, Tanaka Y, Takeshita S, et al. Preoperative quadriceps strength as a predictor of return to sports after anterior cruciate ligament reconstruction in competitive athletes. Phys Ther Sport, 2020, 45: 7-13.
13. Buckthorpe M, Della Villa F. Optimising the ‘mid-stage’ training and testing process after ACL reconstruction. Sports Med, 2020, 50(4): 657-678.
14. Török L, Jávor P, Török K, et al. Early return to play after anterior cruciate ligament reconstruction: Is it worth the risk? Ann Rehabil Med, 2022, 46(2): 97-107.
15. Sonnery-Cottet B, Saithna A, Cavalier M, et al. Anterolateral ligament reconstruction is associated with significantly reduced ACL graft rupture rates at a minimum follow-up of 2 years: A prospective comparative study of 502 patients from the SANTI Study Group. Am J Sports Med, 2017, 45(7): 1547-1557.
16. Meredith SJ, Rauer T, Chmielewski TL, et al. Return to sport after anterior cruciate ligament injury: Panther Symposium ACL Injury Return to Sport Consensus Group. J ISAKOS, 2021, 6(3): 138-146.
17. Werner JL, Burland JP, Mattacola CG, et al. Decision to return to sport participation after anterior cruciate ligament reconstruction, Part Ⅱ: Self-reported and functional performance outcomes. J Athl Train, 2018, 53(5): 464-474.
18. Ebert JR, Edwards P, Yi L, et al. Strength and functional symmetry is associated with post-operative rehabilitation in patients following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc, 2018, 26(8): 2353-2361.
19. Maestroni L, Papadopoulos K, Turner A, et al. Relationships between physical capacities and biomechanical variables during movement tasks in athletic populations following anterior cruciate ligament reconstruction. Phys Ther Sport, 2021, 48: 209-218.
20. Kyritsis P, Bahr R, Landreau P, 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. Br J Sports Med, 2016, 50(15): 946-951.
21. van der Horst N, Denderen RV. Isokinetic hamstring and quadriceps strength interpretation guideline for football (soccer) players with ACL reconstruction: a Delphi consensus study in the Netherlands. Sci Med Footb, 2022, 6(4): 434-445.
22. Zaffagnini S, Bruni D, Marcheggiani Muccioli GM, et al. Single-bundle patellar tendon versus non-anatomical double-bundle hamstrings ACL reconstruction: a prospective randomized study at 8-year minimum follow-up. Knee Surg Sports Traumatol Arthrosc, 2011, 19(3): 390-397.
23. van Melick N, Pronk Y, Nijhuis-van der Sanden M, et al. Meeting movement quantity or quality return to sport criteria is associated with reduced second ACL injury rate. J Orthop Res, 2022, 40(1): 117-128.
24. Ohji S, Aizawa J, Hirohata K, et al. Single-leg hop distance normalized to body height is associated with the return to sports after anterior cruciate ligament reconstruction. J Exp Orthop, 2021, 8(1): 26. doi: 10.1186/s40634-021-00344-z.
25. Nawasreh Z, Logerstedt D, Cummer K, et al. Functional performance 6 months after ACL reconstruction can predict return to participation in the same preinjury activity level 12 and 24 months after surgery. Br J Sports Med, 2018, 52(6): 375. doi: 10.1136/bjsports-2016-097095.
26. Willigenburg N, Hewett TE. Performance on the functional movement screen is related to hop performance but not to hip and knee strength in collegiate football players. Clin J Sport Med, 2017, 27(2): 119-126.
27. Sousa PL, Krych AJ, Cates RA, et al. Return to sport: Does excellent 6-month strength and function following ACL reconstruction predict midterm outcomes? Knee Surg Sports Traumatol Arthrosc, 2017, 25(5): 1356-1363.
28. Niederer D, Giesche F, Janko M, et al. Unanticipated jump-landing quality in patients with anterior cruciate ligament reconstruction: How long after the surgery and return to sport does the re-injury risk factor persist? Clin Biomech (Bristol, Avon), 2020, 72: 195-201.
29. Ohji S, Aizawa J, Hirohata K, et al. Characteristics of landing impact in athletes who have not returned to sports at the pre-injury competition level after anterior cruciate ligament reconstruction. Asia Pac J Sports Med Arthrosc Rehabil Technol, 2021, 25: 47-52.
30. Oleksy Ł, Mika A, Sulowska-Daszyk I, et al. Standard RTS criteria effectiveness verification using FMS, Y-balance and TJA in footballers following ACL reconstruction and mild lower limb injuries. Sci Rep, 2021, 11(1): 1558. doi: 10.1038/s41598-021-81152-4.
31. Kotsifaki A, Van Rossom S, Whiteley R, et al. Single leg vertical jump performance identifies knee function deficits at return to sport after ACL reconstruction in male athletes. Br J Sports Med, 2022, 56(9): 490-498.
32. Read P, Mc Auliffe S, Wilson MG, et al. Better reporting standards are needed to enhance the quality of hop testing in the setting of ACL return to sport decisions: a narrative review. Br J Sports Med, 2021, 55(1): 23-29.
33. DiFabio M, Slater LV, Norte G, et al. Relationships of functional tests following ACL reconstruction: Exploratory factor analyses of the lower extremity assessment protocol. J Sport Rehabil, 2018, 27(2): 144-150.
34. Schmitt LC, Brunst C, Ithurburn M, et al. Identification and predictors of age-relevant and activity-relevant hop test targets in young athletes after anterior cruciate ligament reconstruction. J Athl Train, 2022, 57(9-10): 946-954.
35. Gribble PA, Hertel J, Plisky P. Using the Star Excursion Balance Test to assess dynamic postural-control deficits and outcomes in lower extremity injury: a literature and systematic review. J Athl Train, 2012, 47(3): 339-357.
36. Gribble PA, Kelly SE, Refshauge KM, et al. Interrater reliability of the star excursion balance test. J Athl Train, 2013, 48(5): 621-626.
37. Collings TJ, Bourne MN, Barrett RS, et al. Risk factors for lower limb injury in female team field and court sports: a systematic review, meta-analysis, and best evidence synthesis. Sports Med, 2021, 51(4): 759-776.
38. Garrison JC, Bothwell JM, Wolf G, et al. Y Balance Test^TM anterior reach symmetry at three months is related to single leg functional performance at time of return to sports following anterior cruciate ligament reconstruction. Int J Sports Phys Ther, 2015, 10(5): 602-611.
39. Saper M, Wong C, Strauss N. Adolescent patients exhibit significant improvements in strength and functional performance from 6 to 9 months after acl reconstruction with quadriceps autograft. Arthrosc Sports Med Rehabil, 2021, 3(3): e837-e843.
40. Della Villa F, Andriolo L, Ricci M, et al. Compliance in post-operative rehabilitation is a key factor for return to sport after revision anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc, 2020, 28(2): 463-469.
41. Besier TF, Lloyd DG, Ackland TR, et al. Anticipatory effects on knee joint loading during running and cutting maneuvers. Med Sci Sports Exerc, 2001, 33(7): 1176-1181.
42. Seehafer L, Morrison S, Severin R, et al. A multi-systems approach to human movement after acl reconstruction: the cardiopulmonary system. Int J Sports Phys Ther, 2021, 17(1): 60-73.
43. Almeida AM, Santos Silva PR, Pedrinelli A, et al. Aerobic fitness in professional soccer players after anterior cruciate ligament reconstruction. PLoS One, 2018, 13(3): e0194432. doi: 10.1371/journal.pone.0194432.
44. Oleksy Ł, Mika A, Królikowska A, et al. Composite score of readiness (CSR) as holistic profiling of functional deficits in footballers following acl reconstruction. J Clin Med, 2021, 10(16): 3570. doi: 10.3390/jcm10163570.
45. Lucas K, Todd P, Ness BM. A multi-systems approach to human movement after ACL reconstruction: the integumentary system. Int J Sports Phys Ther, 2021, 17(1): 74-80.
46. Larson D, Vu V, Ness BM, et al. A multi-systems approach to human movement after acl reconstruction: the musculoskeletal system. Int J Sports Phys Ther, 2021, 17(1): 27-46.
47. Fältström A, Hägglund M, Kvist J. Patient-reported knee function, quality of life, and activity level after bilateral anterior cruciate ligament injuries. Am J Sports Med, 2013, 41(12): 2805-2813.
48. Klasan A, Putnis SE, Grasso S, et al. Tegner level is predictive for successful return to sport 2 years after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc, 2021, 29(9): 3010-3016.
49. Connell R, Paton B, Milne R. Return to play following anterior cruciate ligament reconstruction: incorporating fatigue into a return to play functional battery. Part A: treadmill running. BMJ Open Sport Exerc Med, 2019, 5(1): e000375. doi: 10.1136/bmjsem-2018-000375.
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