RTS

Question 1

late phase RTS management general

Answer 1

running progression
- running>sprinting

agility/plyometrics
- cutting/pivoting
- jumping/landing

Question 2

late phase RTS management - sport specific

Answer 2

what do they need to do? practice drills?

incorporate ball/defender

unanticipated movement

Question 3

research says LE RTS testing

Answer 3

85% of studies for RTS testing were for knee injury (82% were ACL)
6.2% studies looked at RTS after hip
2 studies looked at RTS after ankle sprain

Question 4

most RTS criterion lack validity T or F

Answer 4

T

Question 5

1 risk factor for injury

Answer 5

1 risk factor for having an injury is previously having that injury

Question 6

RTS testing goal

Answer 6

Determine physical and psychological readiness
- While respecting biological healing

Reduce risk of re-injury

Question 7

passing RTS criteria means

Answer 7

It means they are cleared to begin a RTS progression
does not mean the athlete can go right back to game play

Question 8

RTS rates for ACL

Answer 8

Return to any sport: 82%
Return to pre-injury sport: 63%
Return to pre-injury competition level: 44%!!!!
Second ACL injury rates (Wiggins 2016 AJSM)
Under 25 yo and RTS: 23%!!!!!

Question 9

problem

Answer 9

Only 13% of studies used some sort of objective measure

Even worse: of those 13% the majority used a Lachman as their ONLY objective measure

Question 10

general principles of RTS testing

Answer 10

time (biology)

symmetry (ROM full - unless risk factor. Strength 90% contralateral at MIN)

objective measures
- ROM
- strength
- functional testing

patient reported
- function
- fear/confidence

Question 11

RTS testing time (biology)

Answer 11

Follow tissue healing timeframes
Ligamentization, Bone Bruise, Mechanoreceptors
We can’t rush biology… yet
Time alone does NOT guarantee physical readiness

Question 12

RTS testing - patient reported

Answer 12

function: make sure the tool you use is appropriate for the population - sport specific, body region specific

fear/confidence - growing literature base exploring psychological effects

Question 13

general LE

Answer 13

strength training
- mmt is NOT good enough, use HHD 1RM, dynamometer

negative clinical exam
- special tests, ORM, effusion, etc

functional testing
- compare to uninvolved limb or norms if not healthy

Question 14

LE ACL necessary measures

Answer 14

recommended objective cut off - 90% contralateral side

even if passing, can still fail for poor quality of movement

ACL-RSI score above 56

KOS score 90% or higher

Question 15

LE ACL outcomes of symmetrical strength

Answer 15

6 months - 20% common deficits
12 months - 10-20% deficits
24 months 1/3 have > 10%

the problem - athletes return 6-12 months likely with deficits

quad strength -
associated with function and critical to dynamic knee stability - prolonged deficits to a critical dynamic stabilizer

Question 16

lower limb symmetry index

Answer 16

single hop for distance

triple hop for distance

cross over hop for distance

6m hop for time

Question 17

what are the findings ACL

Answer 17

in the first.2 yrs after ACLR, 30% of people who returned to level 1 sports sustained a reinjury compared with 8% of those who practiced in lower level sports

for every month that RTS was delayed, until 9. months after ACLR, the rate of knee reinjury was reduced by 51%

more symmetrical quad strength prior to RTS significant reduced reinjury rate

Question 18

LE ACL conclusions

Answer 18

RTS does reduce second injury risk
Need to objectively measure
Can’t Assume
Time alone is not enough

Question 19

RTS progression - graded exposure

Answer 19

Return to practice drills
Return to practice contact drills
Return to game (limited time)
Return to game full time

Progress using intensity, opponents, time/volume
There is a large gap in our healthcare system for this population
Solutions?

Question 21

UE RTS recommendations

Answer 21

Very little evidence
75% use only time

Current Recommendations:(afrer shoulder dislocation?)
No pain/instability ( -apprehension)
Full ROM
90%+ strength (Higher if dominant arm is the involved arm)
No symptoms with sport specific exercise/drills
6 Months post-op for shoulder instability

Question 22

UE throwers

Answer 22

Return to throwing progression (elbow or shoulder)
Progress intensity and/or distance, throw type

Question 23

on field

Answer 23

After cleared for significant injury
ABC’s -> Bleeding -> Spinal/head injury -> Fracture/dislocation

Question 24

on field if player wants to return

Answer 24

Determine if continuing to play will increase risk of injury severity
- Rules sometimes bent depending on the importance of the game

Determine if there are any impairments and if they can play safely with those
-Protective strength
-Neuromuscular control
-Protective sensation
-Functional testing: Running, cutting, jumping, push-up (Sport & Position specific)