Lower extremity return to sport testing: A systematic review.

Area of Science:

• Sports Medicine
• Orthopedic Surgery
• Rehabilitation Science

Background:

• Lower extremity injuries are prevalent in sports, leading to significant healthcare utilization.
• Current return to sport (RTS) protocols lack uniform criteria, increasing re-injury risk.
• A need exists for validated functional tests to guide safe RTS following lower extremity injuries.

Approach:

• A systematic literature search was performed across major biomedical databases (PubMed, Cochrane, Embase, etc.) following PRISMA guidelines.
• Studies published up to May 2024 were included, with risk of bias assessed using the ROBINS-I tool.
• 114 studies met inclusion criteria, focusing on joint-specific and global lower extremity functional testing for RTS.

Key Points:

• The majority of reviewed literature (85%) focused on knee injuries, particularly anterior cruciate ligament (ACL) reconstruction (82%).
• Isokinetic dynamometry was the most frequently analyzed RTS assessment method (73%).
• Limited research exists on RTS criteria for hip (6.2%) and ankle pathologies.

Conclusions:

• Despite extensive literature on ACL injuries, standardized RTS criteria remain absent.
• This systematic review provides a framework for developing and validating joint-specific RTS functional testing batteries.
• Further research is needed to establish comprehensive and reliable RTS protocols for diverse lower extremity injuries.