Lower extremity return to sport testing: A systematic review

Lower extremity injuries account for an enormous portion of sports medicine cases in the United States each year. Unfortunately, there are no uniform criteria for athletes to complete prior to returning to sport (RTS) following a lower extremity injury. Therefore, the purpose of this systematic review is to review current literature for joint-specific and global lower extremity testing to determine the most valid functional test that can be utilized to reduce the risk of re-injury as athletes RTS.

A systematic search of PubMed, PubMed Central, Cochrane Library, OVID, and Embase databases was conducted for studies prior to May 2024 following PRISMA guidelines. ROBINS-I Tool was utilized for the risk of bias assessment.

Of 19,189 studies, 114 (0.6%) studies published prior to May of 2024 met inclusion criteria and were analyzed. Eighty five percent of articles discussed RTS for individuals with knee pathology. Furthermore, 82% specifically analyzed RTS following ACL reconstruction. The most common RTS test was isokinetic dynamometry testing which is seen in 73% of studies. Only 6.2% of studies analyzed RTS for individuals with hip pathology and only two studies analyzed RTS for patients with ankle injuries.

Even with the enormous amount of literature that exists regarding ACL injuries and testing there is no standardized criterion for RTS clearance. The suggested test batteries from this review can serve as a framework for future research and validation for joint-specific RTS functional testing.