Is it time to develop specific return to running criteria for ACL rehabilitation? An international survey of physiotherapists criteria for return to running following ACL injury

Timothy A Sayer; Nicky van Melick; Jerome Riera; Jeremy Jackson; Adam Bryant; Rob Bogie; Nicholas Cross; Pascal Edouard; Alexandre Rambaud

doi:10.1016/j.ptsp.2024.02.005

Is it time to develop specific return to running criteria for ACL rehabilitation? An international survey of physiotherapists criteria for return to running following ACL injury

Phys Ther Sport. 2024 Mar 1:67:19-24. doi: 10.1016/j.ptsp.2024.02.005. Online ahead of print.

Authors

Timothy A Sayer¹, Nicky van Melick², Jerome Riera³, Jeremy Jackson⁴, Adam Bryant⁵, Rob Bogie², Nicholas Cross⁴, Pascal Edouard³, Alexandre Rambaud³

Affiliations

¹ Melbourne CBD Physiotherapy and Sports Medicine Clinic, Melbourne, Victoria, Australia; Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia. Electronic address: timothy@melbournecbdsportsmed.com.au.
² Sports & Orthopedics Research Center, Anna Hospital, Geldrop, the Netherlands.
³ Centre Hopitalier Universitaire de Saint Etienne, Saint Etienne, France.
⁴ Melbourne CBD Physiotherapy and Sports Medicine Clinic, Melbourne, Victoria, Australia.
⁵ Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia.

PMID: 38457997
DOI: 10.1016/j.ptsp.2024.02.005

Abstract

Objective: To determine return to running criteria currently used by physiotherapists following anterior cruciate ligament (ACL) injury.

Design: Self-reported online international survey.

Methods: An online survey of physiotherapists across Australia, the Netherlands and France.

Results: A total of 476 respondants participated in the survey across Australia (n = 153), the Netherlands (n = 162), and France (n = 161). For return to running criteria following a non-operative approach, the majority of respondents chose swelling (40.55%, n = 193/476), pain (38.24%, n = 182/476), knee extensor strength (34.34%, n = 163/476), single leg squat (31.93%, n = 152/476) and knee flexor strength (29.83%, n = 142/476). After ACL reconstruction, the highest responses were also swelling (41.18%, n = 196/476), pain (37.18%, n = 177/476), knee extensor strength (37.18%, n = 177/476) and single leg squat (33.19%, n = 158/476). From the identified themes the most common cutoff variables were pain between 0 and 3/10, swelling < grade 1+ and limb symmetry on strength and hop tests >70 %.

Conclusion: Physiotherapists in Australia, France, and the Netherlands use many different return to running criteria and most of them use more than one criterion. Despite this, there was little consensus on the cut-off physiotherapists use to apply these criteria.

Keywords: Anterior cruciate ligament; Physiotherapist; Running; Survey.