I'm now at the University of Utah. This data was collected at the University of Virginia. So when you think about ACL reconstruction, we talk about return to sport testing. A lot of times this is no longer kind of a red or a green light for full activity clearance. Rather it's to help us guide our athletes into this return to sport progression where this is a little more individualized, dependent on the activity and sport demands that these athletes are going back into. The most common literature we see tests of patient-reported outcomes, we see quadriceps and hamstrings strength and symmetry, and then we see more functional measures of single leg hopping and drop landing. The problem with the way these return to sport tests are currently administered is oftentimes they are collected after our patients are out of the supervision of rehab specialists. So a recent study in OJSM found that 90% of our physical therapy visits were happening in around 16 weeks following our ACL reconstruction. And a small cohort of 60 individuals from our lab self-reported their last physical therapy visit being at five and a half months following their ACL reconstruction. So if we're identifying a lot of these functional deficits, six to nine months, we have to be asking ourselves, who's addressing this? Who's fixing these problems before these individuals are getting back to sport? So that kind of leads us straight into our purpose. We kind of adapted our protocol a little bit to add an interim assessment while these patients were under the supervision of rehab specialists. And the purpose of the study is quite simple, is we wanted to compare this return to sport testing between these two groups. So one group that their first visit, that single return to sport visit, was at six to eight months, and another group who had an interim assessment at least two months prior. So just jumping straight into our results, we can look at our outcomes and we see better patient-reported outcomes in this group that had an interim assessment, this repeat return to sport group. We also see stronger quadriceps, stronger hamstrings, and better hamstring symmetry. However, if we look at the demographics of these groups, there's a couple things yelling at us, specifically the time since surgery. We know that there's a very strong relationship between time since surgery and our functional outcomes, so this is something that definitely needs to be considered. So what we did is we matched our patients. So we matched them on four variables that we know influences patient function, those being age, activity level, graft type, and most importantly, time since surgery. And so it will probably hurt a couple people in here, including my co-authors, to see a large cohort of 303 individuals be reduced down to 69. However, the comparison between these two groups, I'm much more confident in drawing clinical conclusions from them being matched. So from these matched groups, we're just going to go over these comparisons again, and we see similar results, that these patients that had an interim assessment, they reported a greater subjective function. And that's kind of our goal with any treatment with any patient that we see, is we want them feeling well. Also, we see that they are stronger in their hamstrings, and then we also see a more symmetrical hamstring group. And when we look at the demographics, that time since surgery right there at the bottom, it's a lot more comparable, it makes me feel better, confident about these results. So in conclusion, adding in an interim functional assessment prior to the return to support progression improved patient outcomes. We saw this in many measures of subjective function. We also saw this with lower extremity strength, however, we didn't see this within the quadriceps, just our hamstrings. And when we think about this group, it is pretty commonly reported that around six to eight months following ACL reconstruction, our quadriceps, they are still recovering. However, with that flexor group, our hamstrings, we have identified factors that influences hamstring strength at the time point of return to support, such as graft height, nerve block, sex. So the ability to identify hamstring function while they're under the supervision of rehab specialists could improve their outcomes moving forward. So clinical takeaways, return to support testing is good, this is something we should be doing. Serial testing is better. From serial assessments, we're comparing apples to apples, we can see how patients are responding to therapy and where we should adapt our treatment mechanisms to intervene on these deficits that we identify. And then lastly, our research has shown that when repeat testing is being performed, it should be no less than two months apart. So whatever your terminal time point for return to support testing in ACL reconstructed patients, consider adding in an interim assessment no less than two months prior. Thank you.

return to sport testing

ACL reconstruction

limitations of testing methods

interim assessment

patient-reported outcomes