ACL injuries are a current hot-button topic in the world of athletics, orthopedics, and sports medicine, and for good reason. They are a devastating, season-ending injury that require months of rehabilitation and hard-work before returning to play. Perhaps even more alarming to us as rehab specialists and to the patients mentally, a significant percentage of athletes suffer re-injury or are unable to compete at the same level post-operatively. I believe a simple reason exists behind the majority of these disappointing re-injuries; patients are being rushed back onto the field before they are ready or have been properly cleared.
Over the past 1-2 years, I have read multiple studies confirming the role of isokinetic testing as an integral part of a battery of tests an athlete should undergo before returning to play. Isokinetic testing is typically performed on a Biodex machine, a piece of equipment we proudly boast amongst our arsenal of tools here at Furnace Brook PT. While many may gloss over the Biodex as “non-functional” or “out-dated”, I have long been a believer of Biodex testing since being introduced to it during my schooling. Though it is certainly an expensive piece of equipment, I believe it is an essential tool when used properly to gather quantitative data regarding lower extremity strength asymmetries following surgery. Studies conclusively show that patients’ who display < 10% quadriceps strength deficit before returning to sport are significantly less likely to suffer re-injury. Manual muscle testing is simply not enough, due to its lack of precision, to use in isolation in return to sport criteria. Quantitative strength measurements are necessary to prevent sending our athletes back on the field while still at risk.
I am, unequivocally, not advocating using the Biodex as the sole determinant for when an athlete is capable of returning to play. Quadriceps strength is useless if the athlete does not know how to use or control it biomechanically. However, I am advocating for its inclusion as a key part of return to sports criteria in conjunction with other tests such as the Y-Balance Test, T-Test for time, 3 cone drill for time, and single leg hop for time / distance. With a more standardized regimen of testing, we can decrease the percentage of athletes who suffer a catastrophic re-injury.
Blog by Ryan Sheedy, DPT, OCS
- 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
Polyvios Kyritsis1, Roald Bahr1,2, Philippe Landreau1, Riadh Miladi1, Erik Witvrouw - A Necessary Tool for Optimal Return to Sport (RTS)
Inadequate Strength Testing Leads to Premature RTS Clearance
Nate Bothfeld PT, DPT, CSCS - https://www.myrehabexpert.com/biodex-return-to-sport/3 Simple decision rules can reduce re-injury risk by 84% after ACL 3. reconstruction: the Delaware-Oslo ACL cohort study
Hege Grindem1, Lynn Snyder-Mackler2, Håvard Moksnes3, Lars Engebretsen3,4, May Arna Risberg1,When Can I Return To Sport After - ACL Surgery?
June 1, 2016
Mick Hughes
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