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PURPOSE: Risk factors for the development of symptomatic cyclops lesion after anterior cruciate ligament reconstruction (ACLR) surgery are not entirely identified yet. This study aimed to investigate whether the choice of hamstring graft (semitendinosus-gracilis; STG vs. semitendinosus; ST) affects the risk of developing a symptomatic cyclops lesion after ACLR. METHODS: This retrospective cohort study included 1416 patients receiving either an ST graft (n = 1209) or an STG graft (n = 207) ACLR with a follow-up of at least 2 years. A persisting extension limitation was clinically determined, and cyclops lesions were confirmed by magnetic resonance imaging (MRI) and second-look arthroscopy. Graft-specific incidence of cyclops lesions was examined with χ2 test and combined with the factors number of graft bundles, graft diameter and sex evaluated with a binominal logistic regression model. RESULTS: In total, 46 patients developed symptomatic cyclops lesions (3.2%), with 36 having ACLR with an ST graft (3.0%) and 10 with an STG graft (4.8%) (n.s). The mean time from ACLR to the second-look arthroscopy for cyclops removal was 1.1 ± 0.6 years. Female patients were 2.5 times more likely to develop a cyclops lesion than male patients. Patients with an STG graft and larger graft diameters did not have a higher risk of developing cyclops lesions. Patients who received an STG graft with both tendons folded four times (double-quadruple) had significantly higher risk of developing a cyclops compared with all other numbers of graft bundles combined (8.3%, respectively 3.0%; p = 0.014). CONCLUSION: This study could not prove an increased risk of developing a symptomatic cyclops lesion for patients with an STG graft compared with an ST graft used for ACLR. However, patients with a double-quadruple ACLR had a higher percentage of cyclops lesions compared with all other numbers of graft bundles. Female sex was associated with an increased risk of developing cyclops lesions. LEVEL OF EVIDENCE: Level III.

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OBJECTIVE: To synthesize and present reference values for double-leg and single-leg jump tests in healthy athletes who play pivoting sports, and athletes with anterior cruciate ligament reconstruction (ACLR) who play pivoting sports. DESIGN: Scoping review. LITERATURE SEARCH: We searched PubMed, the Cochrane Library, MEDLINE, Embase, and Web of Science until April 7, 2023. STUDY SELECTION CRITERIA: We included reference values in 2 different categories: (1) double-leg and/or single-leg jump test outcomes in pivoting-sport athletes with ACLR at a specific time point during rehabilitation, and (2) double-leg and/or single-leg jump test outcomes in healthy pivoting-sport athletes. DATA SYNTHESIS: We performed data synthesis for reference values from double-leg jump tests (squat jump and countermovement jump) and single-leg jump tests (vertical hop, single hop for distance, triple hop for distance, crossover hop for distance, medial triple hop for distance, lateral triple hop for distance, 6-m timed hop, side hop, drop jump, and 10-second repeated hop) that were performed according to a standardized test description. We summarized the data for type of sport, sex, sport participation level, and age group. RESULTS: Of the 27 included studies, nine reported reference values from healthy soccer players, six from healthy basketball players, and eleven from other healthy pivoting-sport athletes. LSI dominant/nondominant (LSI-D/ND) ranged between 97% and 106% for healthy soccer players, and between 99% and 120% for healthy basketball players. Four studies reported reference values from pivoting-sport athletes with ACLR from 7 to 10 months postsurgery. CONCLUSION: This scoping review summarizes double-leg and single-leg jump test reference values for athletes who play common pivoting sports, including soccer and basketball. J Orthop Sports Phys Ther 2024;54(6):1-14. Epub 20 March 2024. doi:10.2519/jospt.2024.12374.

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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.

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PURPOSE: To investigate the association between hamstring autograft diameter and ACL graft failure rate in athletes who successfully returned to pivoting sports after ACL reconstruction. METHODS: Retrospective evaluation of ACL graft failure rates in athletes who underwent ACL reconstruction with all-inside hamstring autograft and successfully returned to pivoting sports following postoperative rehabilitation. Athletes were divided into a ≤ 8 mm group and a > 8 mm group. Data about return to pivoting sports and ACL graft failures after ACL reconstruction were collected via a digital questionnaire. ACL graft failures were in all cases confirmed by an orthopaedic surgeon and/or MRI. The association between hamstring autograft diameter and ACL graft failure rate was investigated using a Fisher's exact test in the subgroup of athletes who completed the digital questionnaire and returned to pivoting sports. RESULTS: Two-hundred and twenty-nine of the 422 athletes who completed the digital questionnaire (54.2%) returned to a pivoting sport and were included for final analyses. Ninety-seven (42.4%) of the athletes who returned to sport were in the ≤ 8 mm group (8 graft failures) and 132 (57.6%) in the > 8 mm group (10 graft failures). There were significantly more women (49.5 and 13.6% respectively; p < 0.001) and significantly smaller (1.75 and 1.81 m respectively; p < 0.001), lighter (72.2 and 79.6 kg respectively; p < 0.001) and younger (23.6 and 26.1 years old respectively; p = 0.015) athletes in the ≤ 8 mm group compared to the > 8 mm group. There was no significant association between hamstring autograft diameter and ACL graft failure rate. CONCLUSION: A hamstring autograft diameter of ≤ 8 mm is a legitimate option for smaller, lighter and female athletes without increasing the risk for ACL graft failure. LEVEL OF EVIDENCE: III.

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Background: There are 2 treatment options for adolescent athletes with anterior cruciate ligament (ACL) injuries-rehabilitation alone (nonsurgical treatment) or ACL reconstruction plus rehabilitation. However, there is no clear consensus on how to include strength and neuromuscular training during each phase of rehabilitation. Purpose: To develop a practical consensus for adolescent ACL rehabilitation to help provide care to this age group using an international Delphi panel. Study Design: Consensus statement. Methods: A 3-round online international Delphi consensus study was conducted. A mix of open and closed literature-based statements were formulated and sent out to an international panel of 20 ACL rehabilitation experts. Statements were divided into 3 domains as follows: (1) nonsurgical rehabilitation; (2) prehabilitation; and (3) postoperative rehabilitation. Consensus was defined as 70% agreement between panel members. Results: Panel members agreed that rehabilitation should consist of 3 criterion-based phases, with continued injury prevention serving as a fourth phase. They also reached a consensus on rehabilitation being different for 10- to 16-year-olds compared with 17- and 18-year-olds, with a need to distinguish between prepubertal (Tanner stage 1) and mid- to postpubertal (Tanner stages 2-5) athletes. The panel members reached a consensus on the following topics: educational topics during rehabilitation; psychological interventions during rehabilitation; additional consultation of the orthopaedic surgeon; duration of postoperative rehabilitation; exercises during phase 1 of nonsurgical and postoperative rehabilitation; criteria for progression from phase 1 to phase 2; resistance training during phase 2; jumping exercises during phase 2; criteria for progression from phase 2 to phase 3; and criteria for return to sports (RTS). The most notable differences in recommendations for prepubertal compared with mid- to postpubertal athletes were described for resistance training and RTS criteria. Conclusion: Together with available evidence, this international Delphi statement provides a framework based on expert consensus and describes a practice guideline for adolescent ACL rehabilitation, which can be used in day-to-day practice. This is an important step toward reducing practice inconsistencies, improving the quality of rehabilitation after adolescent ACL injuries, and closing the evidence-practice gap while waiting for further studies to provide clarity.

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OBJECTIVES: To examine the validity and reliability of the Dutch language short Anterior Cruciate Ligament-Return to Sport after Injury scale (short ACL-RSI-NL) in recreational athletes undergoing rehabilitation after ACL injury or ACL reconstruction (ACLR). METHODS: The original 12-item version of the ACL-RSI had been translated into Dutch. Short ACL-RSI-NL items were derived from this 12-item Dutch version. Content validity was evaluated by a team consisting of eight ACL experts and eight athletes. A cohort of 115 athletes with ACL injury or after ACLR completed the short ACL-RSI-NL and related questionnaires at various time points during their rehabilitation. Construct validity (hypothesis testing using Spearman correlations), internal consistency (Cronbach's alpha), floor and ceiling effects (percentage of athletes having the lowest or highest score possible), and structural validity (exploratory factor analysis) were evaluated in the entire ACL athlete group. Test-retest reliability (using intra-class correlation, ICC; standard error of measurement, SEM; smallest detectable change, SDC, at both group and individual levels) was investigated in a subgroup of athletes with a stable outcome on psychological readiness within a two-week interval (n â€‹= â€‹27). RESULTS: The short ACL-RSI-NL demonstrated good construct validity (83% of hypotheses confirmed). Internal consistency was excellent (Cronbach's alpha 0.84), and there were no floor and ceiling effects (≤13.9% lowest or highest score). Test-retest reliability was good (ICC 0.89 with 95% CI 0.77-0.95, SEM 6.93, SDC individual level 19.2, SDC group level 3.7). Exploratory factor analysis confirmed the presence of a single underlying factor (accounting for 56.4% of the total variance of the score). CONCLUSION: The short ACL-RSI-NL exhibited good to excellent construct validity, internal consistency, and test-retest reliability. An averaged score ranging from 0 to 100 can be used to measure psychological readiness to return to sport. The short ACL-RSI-NL has potential for use in day-to-day practice to assess the psychological readiness of recreational athletes to return to sport after ACL injury or ACLR during their rehabilitation process. LEVEL OF EVIDENCE: Level II.

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BACKGROUND: Determining readiness to return to sport after anterior cruciate ligament (ACL) reconstruction is challenging. OBJECTIVES: To develop models to predict initial (directly after rehabilitation) and sustainable (one year after rehabilitation) return to sport and performance in individuals after ACL reconstruction. METHODS: We conducted a multicentre, prospective cohort study and included 208 participants. Potential predictors - demographics, pain, effusion, knee extension, muscle strength tests, jump tasks and three sport-specific questionnaires - were measured at the end of rehabilitation and 12 months post discharge from rehabilitation. Four prediction models were developed using backward logistic regression. All models were internally validated by bootstrapping. RESULTS: All 4 models shared 3 predictors: the participant's goal to return to their pre-injury level of sport, the participant's psychological readiness and ACL injury on the non-dominant leg. Another predictor for initial return to sport was no knee valgus, and, for sustainable return to sport, the single-leg side hop. Bootstrapping shrinkage factor was between 0.91 and 0.95, therefore the models' properties were similar before and after internal validation. The areas under the curve of the models ranged from 0.74 to 0.86. Nagelkerke's R2 varied from 0.23 to 0.43 and the Hosmer-Lemeshow test results varied from 2.7 (p = 0.95) to 8.2 (p = 0.41). CONCLUSION: Initial and sustainable return to sport and performance after anterior cruciate ligament reconstruction rehabilitation can be easily predicted by the sport goal formulated by the individual, the individual's psychological readiness, and whether the affected leg is the dominant or non-dominant leg.

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PURPOSE: Neuromuscular training (NMT) is effective at reducing football injuries. The purpose of this study was to document the use of NMT to prevent anterior cruciate ligament injuries and lateral ankle sprains in adult amateur football and to identify barriers for using NMT. METHODS: A preseason and in-season online survey was completed by players and coaches of 164 football teams. The survey contained questions concerning injury history, type and frequency of NMT, and barriers when NMT was not used. RESULTS: A total of 2013 players (40% female) and 180 coaches (10% female) completed the preseason survey, whereas 1253 players and 140 coaches completed the in-season survey. Thirty-four percent (preseason) to 21% (in-season) of players used NMT, but only 8% (preseason) to 5% (in-season) performed adequate NMT (i.e. both balance and plyometric exercises, at least twice per week). In the subpopulation of players with an injury history, 12% (preseason) and 7% (in-season) performed adequate NMT. With respect to the coaches, only 5% (preseason) and 2% (in-season) implemented adequate NMT. Most important barriers for using NMT for both players and coaches were a lack of belief in its effectiveness, a lack of knowledge, the belief that stretching is sufficient, and not feeling the need for it. CONCLUSION: Most amateur football teams do not implement essential components of NMT. The results highlight the urgent need for developing strategies to enhance the adequate use of NMT in amateur football. LEVEL OF EVIDENCE: II.

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OBJECTIVE: To synthesize and present reference values for quadriceps and hamstrings strength tests in healthy athletes who play pivoting sports and in athletes with anterior cruciate ligament reconstruction (ACLR) who play pivoting sports. DESIGN: Scoping review. LITERATURE SEARCH: We searched PubMed, the Cochrane Library, MEDLINE, Embase, and Web of Science up to January 26, 2021. STUDY SELECTION CRITERIA: We included reference values in 2 different categories: (1) quadriceps and hamstrings strength test outcomes in healthy pivoting-sport athletes, and (2) quadriceps and hamstrings strength test outcomes in pivoting-sport athletes with ACLR at a specific time point during rehabilitation. DATA SYNTHESIS: We performed a qualitative synthesis for reference values from isokinetic (at 60°/s, 180°/s, and 300°/s) and isometric quadriceps and hamstrings strength tests. We summarized the data for type of sport, sex, sport participation level, and age group. RESULTS: Of the 42 included studies, 26 reported reference values from healthy soccer players, 4 from healthy basketball players, 4 from healthy handball players, and 11 from other healthy pivoting-sport athletes. The limb symmetry index dominant/nondominant limb (LSI-D/ND) ranged from 98% to 114% for healthy athletes. Six studies reported reference values in pivoting-sport athletes with ACLR at a specific time point during rehabilitation. After 7 months, strength values for athletes with ACLR were comparable to those of healthy pivoting-sport athletes. CONCLUSION: This scoping review summarizes quadriceps and hamstrings strength reference values for athletes who play the most common pivoting sports, including soccer, basketball, and handball. J Orthop Sports Phys Ther 2022;52(3):142-155. Epub 31 Dec 2021. doi:10.2519/jospt.2022.10693.

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The purposes of this prospective cohort study were (1) to assess if second anterior cruciate ligament (ACL) injury rate 2 years after ACL reconstruction (ACLR) in those who returned to pivoting sport was associated with meeting (a) quantitative return to sport (RTS) criteria, (b) qualitative RTS criteria, and (c) combined quantitative and qualitative RTS criteria, and (2) to determine why athletes did not return to their preinjury (level of) sport. Athletes after ACLR performed RTS tests immediately before RTS: seven movement quantity (strength and hop test battery) and two movement quality (countermovement jump with LESS score and hop-and-hold test) tests. A 2-year postoperative questionnaire asked for RTS, reasons for not returning to the same (level of) sport and second ACL injuries. One hundred and forty-four athletes (82%) completed the questionnaire and 97 of them returned to a pivoting sport. Seven of these athletes had a second ACL injury. Meeting the hop test battery RTS criterion (absolute risk reduction 11%; p = .047) and hop-and-hold test RTS criterion (absolute risk reduction 15%; p = .031) were both significantly associated with a reduced second ACL injury rate. Meeting combined RTS criteria were not significantly associated with second ACL injury rate. Therefore, RTS tests after ACLR should at least comprise a hop test battery or the hop-and-hold test to reduce second ACL injury risk after return to pivoting sport. Also, one-third of all athletes mentioned fear of reinjury as the main reason for not returning to their preinjury (level of) sport. This psychological component should be taken seriously and discussed during rehabilitation.

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Background and purpose - A guideline committee of medical specialists and a physiotherapist was formed on the initiative of the Dutch Orthopedic Association (NOV) to update the Guideline Arthroscopy of the Knee: Indications and Treatment 2010. This next Guideline was developed between June 2017 and December 2019. In part 1 we focused on the meniscus; this part 2 addresses all other aspects of knee arthroscopy.Methods - The guideline was developed in accordance with the criteria of the AGREE instrument (AGREE II: Appraisal of Guidelines for Research and Evaluation II) with support of a professional methodologist from the Dutch Knowledge Institute of Medical Specialists. The scientific literature was searched and systematically analyzed. Conclusions and recommendations were formulated according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method. Recommendations were developed considering the balance of benefits and harms, the type and quality of evidence, the values and preferences of the people involved, and the costs.

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Background and purpose - A guideline committee of medical specialists and a physiotherapist was formed on the initiative of the Dutch Orthopedic Association (NOV) to update the guideline Arthroscopy of the Knee: Indications and Treatment 2010. This next guideline was developed between June 2017 and December 2019. In this Part 1 we focus on the meniscus, in Part 2 on all other aspects of knee arthroscopy.Methods - The guideline was developed in accordance with the criteria of the AGREE instrument (AGREE II: Appraisal of Guidelines for Research and Evaluation II) with support of a professional methodologist from the Dutch Knowledge Institute of Medical Specialists. The scientific literature was searched and systematically analyzed. Conclusions and recommendations were formulated according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method. Recommendations were developed considering the balance of benefits and harms, the type and quality of evidence, the values and preferences of the people involved, and the costs.

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Specific return to sport criteria for children and adolescents after anterior cruciate ligament injury and reconstruction are unknown. The aim of this scoping review is to provide an overview of current tests regarding return to sport for children and adolescents. This scoping review was performed according to the PRISMA statement. A systematic search was performed on PubMed and EMBASE. The inclusion criteria were diagnostic and prognostic studies evaluating tests regarding return to sport after ACL injury and reconstruction in children/adolescents (age < 18 years). Twenty-six studies were included, of which 22 studies evaluated tests in the age category of 16 to 18 years. All studies evaluated tests after ACL reconstruction, no studies have been conducted in non-operative patients. Strength tests, movement quality and patient reported outcomes measures (PROMs) are investigated most frequently. Clearance for return to sport should be based on a test battery including strength tests, movement quality during sport-specific tasks and (paediatric) patient reported outcome measures. There are no recommendations on which specific tests regarding quantity and quality of movement should be used. Future research should aim at at developing and validating a test battery including movement quality and neuromotor control in a sport-specific context for both younger children and adolescents after both operative and non-operative treatment.

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BACKGROUND: Self-efficacy is related to outcome after anterior cruciate ligament (ACL) tears. The Knee Self Efficacy Scale (K-SES) available in Swedish and English, was developed to measure self-efficacy in present (K-SESpresent) and future (K-SESfuture) functioning. The objective of this study was to determine measurement properties of the K-SES in Dutch patients. METHODS: The K-SES was translated and structural validity, internal consistency, test-retest reliability, and measurement error were assessed in three patient samples: one group completed the questionnaire and additional measures pre-surgery (N = 200), and one group post-surgery (N = 58). The third group (post-surgery) completed the K-SES twice (N = 50). RESULTS: Exploratory factor analysis distinguished two underlying important factors: K-SESpresent and K-SESfuture. However, the distinction was not confirmed in Confirmatory Factor Analysis (CFA). Internal consistency for both subscales was excellent (Cronbach's alpha > .80). Test-retest reliability absolute agreement was 0.95. A-priori formulated hypotheses on the relation between Knee Self Efficacy Scale Dutch (K-SES-D) and related constructs were confirmed. Moderate to high correlations (r > 0.50) were reported with Knee Injury and Osteoarthritis Outcome Score (KOOS) before reconstruction. High negative correlation was found with fear of movement and pain catastrophizing (r < - 0.60), and low correlation (r < 0.50) with locus of control and measures of distress. CONCLUSION: Acceptability, internal consistency and test-retest reliability of the K-SES-D subscales are satisfactory. Construct validity of both subscales was confirmed by exploratory factor analysis and hypothesis testing. However, construct validity was not confirmed in CFA. Further research is needed to test responsiveness.

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OBJECTIVE: To investigate the clinical outcomes after hamstring tendon autograft ACL reconstruction (ACLR) with accelerated, brace-free rehabilitation. DESIGN: Systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. DATA SOURCES: Embase, MEDLINE Ovid, Web of Science, Cochrane CENTRAL and Google scholar from 1 January 1974 to 31 January 2017. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Study designs reporting outcomes in adults after arthroscopic, primary ACLR with hamstring autograft and accelerated, brace-free rehabilitation. RESULTS: Twenty-four studies were included in the review. The clinical outcomes after hamstring tendon autograft ACLR with accelerated brace-free rehabilitation were the following: (1) early start of open kinetic exercises at 4 weeks in a limited range of motion (ROM, 90°-45°) and progressive concentric and eccentric exercises from 12 weeks did not alter outcomes, (2) gender and age did not influence clinical outcomes, (3) anatomical reconstructions showed better results than non-anatomical reconstructions, (4) there was no difference between single-bundle and double-bundle reconstructions, (5) femoral and tibial tunnel widening occurred, (6) hamstring tendons regenerated after harvest and (7) biological knowledge did not support return to sports at 4-6 months. CONCLUSIONS: After hamstring tendon autograft ACLR with accelerated brace-free rehabilitation, clinical outcome is similar after single-bundle and double-bundle ACLR. Early start of open kinetic exercises at 4 weeks in a limited ROM (90°-45°) and progressive concentric and eccentric exercises from 12 weeks postsurgery do not alter clinical outcome. Further research should focus on achievement of best balance between graft loading and graft healing in the various rehabilitation phases after ACLR as well as on validated, criterion-based assessments for safe return to sports. LEVEL OF EVIDENCE: Level 2b; therapeutic outcome studies.

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CONTEXT: Since decades leg dominance is suggested to be important in rehabilitation and return to play in athletes with anterior cruciate ligament injuries. However, an ideal method to determine leg dominance in relation to task performance is still lacking. OBJECTIVE: To test the agreement between self-reported and observed leg dominance in bilateral mobilizing and unilateral stabilizing tasks, and to assess whether the dominant leg switches between bilateral mobilizing tasks and unilateral stabilizing tasks. DESIGN: Cross-sectional study. PARTICIPANTS: Forty-one healthy adults: 21 men aged 36 ± 17 years old and 20 women aged 36 ±15 years old. MEASUREMENT AND ANALYSIS: Participants self-reported leg dominance in the Waterloo Footedness Questionnaire-Revised (WFQ-R), and leg dominance was observed during performance of four bilateral mobilizing tasks and two unilateral stabilizing tasks. Descriptive statistics and crosstabs were used to report the percentages of agreement. RESULTS: The leg used to kick a ball had 100% agreement between the self-reported and observed dominant leg for both men and women. The dominant leg in kicking a ball and standing on one leg was the same in 66.7% of the men and 85.0% of the women. The agreement with jumping with one leg was lower: 47.6% for men and 70.0% for women. CONCLUSIONS: It is appropriate to ask healthy adults: "If you would shoot a ball on a target, which leg would you use to shoot the ball?" to determine leg dominance in bilateral mobilizing tasks. However, a considerable number of the participants switched the dominant leg in a unilateral stabilizing task.

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BACKGROUND: Fear of harm (FoH) after Anterior Cruciate Ligament Reconstruction (ACLR) should be addressed in physical therapy as it hampers return to sports. However, there are no instruments assessing FoH specific for ACLR. The objective of this study is to describe the development and measurement properties of the Photograph Series of Sports Activities for ACLR (PHOSA-ACLR) measuring ACL injury related FoH. METHODS: Based on literature and opinion of physical therapists with extensive experience in ACLR treatment, photographs depicting FoH inducing situations in ACL injury were considered for inclusion in the instrument. For each photograph the patients is asked to report perceived harmfulness. The set of photographs was completed by two samples of patients with ACLR: 1 cross-sectional sample (n = 55), and 1 test-retest reliability sample (n = 58). Internal consistency and structural validity were assessed in 109 patients. In 58 patients criterion validity was assessed by calculating pearson correlations with the Tampa Scale of Kinesiophobia (TSK). Correlations with self-reported knee function (KOOS and Lysholm score), and Knee Self-efficacy Scale (K-SES) were computed for hypothesis testing. Test-retest reliability was determined in a group of 55 patients, assessed twice with 1 week between assessments. RESULTS: Twelve photographs depicting sports related movements that are likely to invoke FoH after ACLR were selected. Two items were deleted because of lack of discrimination. The remaining 10 items were included in the PHOSA-ACLR, and the scale showed excellent internal consistency (Cronbach's Alpha is .95). Items reflected one dimension, and was strongly correlated with TSK (r = .59). A priori formulated hypotheses are confirmed and test-retest correlation was excellent (ICC = .86). CONCLUSION: The PHOSA-ACLR showed acceptable measurement properties. The PHOSA-ACLR gives specific information about fear invoking sports situations that are not measured by other kinesophobia measures. Therefore, the PHOSA-ACLR might be a valuable additional tool in rehabilitation of ACLR patients. Additional research is needed to determine responsiveness to change.

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PURPOSE: The purpose of this cross-sectional study was to provide descriptive data on functional performance in men and women with ACLR, to compare bone-patellar tendon-bone (BPTB) with semitendinosus/gracilis (STG) within the same sex and to compare the ACLR subjects with healthy controls. METHODS: Eligible participants comprised 100 men (43 % BPTB) and 84 women (41 % BPTB) after ACLR, of whom 30 men (STG n = 19; BPTB n = 11) and 18 women (STG n = 12; BPTB n = 6) were untraceable/not willing and 15 men (STG n = 9; BPTB n = 6) and 18 women (STG n = 12; BPTB n = 3) were not able to take part in the measurements because of injury. Besides men BPTB (n = 24), men STG (n = 27), women BPTB (n = 23) and women STG (n = 23), healthy men (n = 22) and women (n = 22) participated. Measurements consisted of questionnaires, isokinetic peak torque and endurance tests, a hop test battery and drop jump including video analysis. RESULTS: Only the occurrence of dynamic knee valgus differed between ACLR and healthy subjects. CONCLUSION: Two to nine years after ACLR, 16 % of athletes could not participate because of a lower extremity injury. In the remaining group, this study showed similar results for males and females with BPTB compared with STG. Also, similar results are found for quantity of movement comparing operated and healthy subjects. For quality of movement, only the occurrence of dynamic knee valgus in landing from a jump is higher in operated subjects compared with healthy controls. This supports the relevance of a focus on quality of movement as part of ACLR rehabilitation programmes and return to sports criteria. LEVEL OF EVIDENCE: III.

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AIM: The Royal Dutch Society for Physical Therapy (KNGF) instructed a multidisciplinary group of Dutch anterior cruciate ligament (ACL) experts to develop an evidence statement for rehabilitation after ACL reconstruction. DESIGN: Clinical practice guideline underpinned by systematic review and expert consensus. DATA SOURCES: A multidisciplinary working group and steering group systematically reviewed the literature and wrote the guideline. MEDLINE and the Cochrane Library were searched for meta-analyses, systematic reviews, randomised controlled trials and prospective cohort studies published between January 1990 and June 2015. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Included literature must have addressed 1 of 9 predetermined clinical topics: (1) preoperative predictors for postoperative outcome, (2) effectiveness of physical therapy, (3) open and closed kinetic chain quadriceps exercises, (4) strength and neuromuscular training, (5) electrostimulation and electromyographic feedback, (6) cryotherapy, (7) measurements of functional performance, (8) return to play and (9) risk for reinjury. SUMMARY: Ninety studies were included as the basis for the evidence statement. Rehabilitation after ACL injury should include a prehabilitation phase and 3 criterion-based postoperative phases: (1) impairment-based, (2) sport-specific training and (3) return to play. A battery of strength and hop tests, quality of movement and psychological tests should be used to guide progression from one rehabilitation stage to the next. Postoperative rehabilitation should continue for 9-12 months. To assess readiness to return to play and the risk for reinjury, a test battery, including strength tests, hop tests and measurement of movement quality, should be used.

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PURPOSE: The purpose of this systematic review was to identify the measurements that are used in clinical practice to assess the quantity and quality of functional performance in men and women more than 2 years after ACL reconstruction with bone patellar-tendon bone (BPTB) or semitendinosus/gracilis (STG) graft. METHODS: A systematic literature search was performed in Medline (Pubmed), EMBASE (OVID), the Cochrane Library and PEDro to identify relevant articles from 1990 up to 2010. Articles were included if they described functional performance after BPTB or STG reconstruction and had a follow-up of more than 2 years. Two authors screened the selected articles for title, abstract and full-text in accordance with predefined inclusion and exclusion criteria. The methodological quality of all articles was assessed by checklists of the Cochrane Library by two authors. Only the articles with good methodological quality were considered for further analysis. RESULTS: A total of 27 studies were included by full-text. According to their methodological quality six were rated as good. Different authors used different study designs for muscle testing which led to different outcomes that could not be compared. Besides strength, a single-leg hop for distance was used as a measurement for quantity of functional performance. No measurements for quality of functional performance were reported. CONCLUSIONS: Measurement of functional performance more than 2 years after ACL reconstruction consists of concentric or isometric strength, the single-leg hop for distance or a combination. The Limb Symmetry Index is used as the main outcome parameter to compare the involved leg with the uninvolved. In all studies the results of men and woman are combined. Based on our findings and previous studies that discussed additional important parameters a more extensive test battery to assess functional performance is suggested.

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