Quality of Movement for Athletes 6 Months After ACL Reconstruction

Anterior cruciate ligament (ACL) injury prevention programs address quality of movement to identify and correct high-risk movement patterns. However, return-to-play decisions after ACL reconstruction (ACLR) are often based on non-sport related quantitative measures such as isokinetic tests, jump testing, and/or time from surgery, with 6 to 9 months a common expectation for progressing to sport-specific training and return to play.

To identify the presence in each limb of movement patterns associated with ACL injury in athletes 6 months post-ACLR using a quality-of-movement assessment.

Cross-sectional study; Level of evidence: 3.

A quality-of-movement assessment including 10 dynamic tasks progressing from double- to single-limb and vertical to horizontal movements was administered to 148 athletes at 6 months after ACLR. Tasks were viewed live from the frontal and sagittal planes by a physical therapist and certified strength and conditioning specialist. Movements were evaluated for strategy, depth, alignment, symmetry, and control. The proportion of patients exhibiting faulty movement patterns for each task was assessed in the involved and uninvolved leg and between sex, meniscal injury status, and age. To examine the differences in age, patients were divided into age groups based on their age at the time of surgery (<14 years, 14-18, 19-25, 26-34, and ≥35 years).

Mean time of testing was 6.4 months after ACLR. All patients exhibited faulty movement patterns for ≥1 task on the involved leg. On the involved leg, the proportion of patients demonstrating faulty movement patterns for a task ranged from 52% to 95%. Forward stepdown (P < .001), single-leg squat (P = .03), side-to-side jump (P = .03), and hop to opposite (P = .04) demonstrated higher frequency of faulty movement patterns in the involved versus the uninvolved leg. Rates of faulty movement patterns were not different between sex or meniscal injury status. Single-leg stance on the involved leg (P = .05) and single-leg bridge (uninvolved leg) (P = .02) differed between age groups.

Athletes demonstrated multiple faulty movement patterns that have been associated with both initial and second noncontact ACL injury. Faulty movement patterns were evident in tasks as simple as single-leg stance. The rates of faulty movement were similar in both male and female patients, as well as in the involved and uninvolved limb.