Clearance Criteria for Determining Eligibility for Force Plate Testing After Anterior Cruciate Ligament...

Background and Objectives: Throughout the return-to-play process after anterior cruciate ligament reconstruction (ACLR), clearance criteria and limb symmetry indices (LSI) play an important role in clinical decision-making by helping evaluate patient readiness and informing safe activity progressions, with the goal of reducing re-injury risk. How clearance criteria are implemented in research studies to evaluate patient readiness, specifically in force plate jumping studies, is currently unknown. This scoping review was a focused examination of clearance criteria and limb symmetry indices in studies performing force plate-based jumping assessments with ACLR patients. The research questions guiding this scoping review were as follows: (1) What clearance criteria are reported in studies involving primary ACLR patients who participate in jumping assessments on force plates? (2) What LSI are reported in force plate studies, and what level of symmetry is deemed acceptable to allow for safe participation of ACLR patients who participate in jumping assessments of force plates? Materials and Methods: Nine databases were searched on 7 or 8 September 2024 for three concepts: ACLR, force plates, and movement properties. Inclusion criteria were as follows: (a) primary ACLR patients at least 6 months post-surgery; (b) performing a countermovement or drop jump; (c) collecting at least one kinetic parameter using a force plate. Clearance criteria was operationally defined as a time from surgery boundary, functional or performance-based testing criteria, medical evaluation, or completion/participation in a rehabilitation program. Results: Thirty-five studies were included. Time from surgery was the most frequently reported clearance criteria (26/35; 74.3%), followed by medical evaluation (18/35; 51.4%), and completion of rehabilitation (10/35; 28.6%). Use of LSI as clearance criteria was limited (5/35; 14.3%). Minimum required LSI ranged from 85 to 90% in quadriceps strength and hop testing. Conclusions: Clearance criteria varied by jump type and post-surgical time frame when the participant was tested. Standardized rehabilitation was common prior to 2 years post-surgery, whereas medical clearance was common after 2 years post-surgery. Single leg jumps typically required 2-3 clearance criteria, whereas double leg jumps required 1-2 clearance criteria. Limb symmetry indices were used in combination with two other clearance criteria in studies with single-leg countermovement or drop jumps. Improvements in clearance criteria and adverse event reporting may help improve patient safety and interpretation of findings across studies.