Return to Preinjury Function Following Knee Injury

in International Journal of Athletic Therapy and Training

Click name to view affiliation

Aaron D. Sciascia Eastern Kentucky University

Search for other papers by Aaron D. Sciascia in
Current site
Google Scholar
PubMed Close
*
,
Arthur J. Nitz University of Kentucky

Search for other papers by Arthur J. Nitz in
Current site
Google Scholar
PubMed Close
*
,
Patrick O. McKeon Ithaca College

Search for other papers by Patrick O. McKeon in
Current site
Google Scholar
PubMed Close
*
,
Jennifer Havens University of Kentucky

Search for other papers by Jennifer Havens in
Current site
Google Scholar
PubMed Close
*
, and
Timothy L. Uhl University of Kentucky

Search for other papers by Timothy L. Uhl in
Current site
Google Scholar
PubMed Close
*
DOI:
https://doi.org/10.1123/ijatt.2019-0100
Keywords:
athlete; outcome; return to play
First Published Online:
04 Jun 2020
In Print:
Volume 26: Issue 1
Page Range:
47–58
Restricted access

Athletic preinjury function is typically determined via patient recall, however obtaining preinjury function before injury occurs should be attempted. The purpose of this study was to obtain preinjury physical function baseline values using the Knee Injury and Osteoarthritis Outcome Score (KOOS), single-leg hop for distance (SLH), and Star Excursion Balance Test (SEBT) anterior reach to determine if athletes return to those baseline values following knee injury. Out of 27 qualifying injuries, KOOS scores were significantly reduced at initial injury compared to baseline and all follow-up points (p ≤ .02). In most instances, baseline KOOS scores were not met at the discharge time point. SLH and SEBT recovered to baseline values by discharge. Injury severity and previous injury created variations in KOOS scores across multiple time points. Subjective and objective preinjury function can be re-established following knee injury but recovery may not occur at discharge from rehabilitation.

Sciascia is with Eastern Kentucky University, Richmond, KY, USA. Nitz, Havens, and Uhl are with the University of Kentucky, Lexington, KY, USA. McKeon is with Ithaca College, Ithaca, NY, USA.

Sciascia (aaron.sciascia@eku.edu) is corresponding author.
  • Collapse
  • Expand

International Journal of Athletic Therapy and Training

Cover International Journal of Athletic Therapy and Training
  • 1.

    Sauers EL, Snyder AR. A team approach: demonstrating sport rehabilitation’s effectiveness and enhancing patient care through clinical outcomes assessment. J Sport Rehabil. 2011;20(1):3–7. PubMed ID: 21411818 doi:10.1123/jsr.20.1.3

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Davidson M, Keating J. Patient-reported outcome measures (PROMs): how should I interpret reports of measurement properties? a practical guide for clinicians and researchers who are not biostatisticians. Br J Sports Med. 2014;48:792–796. PubMed ID: 23258849 doi:10.1136/bjsports-2012-091704

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Reiman MP, Manske RC. The assessment of function: how is it measured? a clinical perspective. J Man Manip Ther. 2011;19(2):91–99. PubMed ID: 22547919 doi:10.1179/106698111X12973307659546

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4.

    Michener LA. Patient- and clinician-rated outcome measures for clinical decision making in rehabilitation. J Sport Rehabil. 2011;20(1):37–45. PubMed ID: 21411821 doi:10.1123/jsr.20.1.37

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Evans TA, Lam KC. Clinical outcomes assessment in sport rehabilitation. J Sport Rehabil. 2011;20(1):8–16. PubMed ID: 21411819 doi:10.1123/jsr.20.1.8

  • 6.

    Sciascia AD. A basic construct for improving outcomes in rehabilitation. Int J Athl Ther Train. 2013;18(3):14–19. doi:10.1123/ijatt.18.3.14

  • 7.

    Sciascia AD, Myers N, Kibler WB, Uhl TL. Return to pre-injury levels of play following superior labral repair in overhead athletes: a systematic review. J Athl Train. 2015;50(7):767–777. PubMed ID: 25946167 doi:10.4085/1062-6050-50.3.06

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8.

    Smith FW, Rosenlund EA, Aune AK, MacLean JA, Hillis SW. Subjective functional assessments and the return to competitive sport after anterior cruciate ligament reconstruction. Br J Sports Med. 2004;38:279–284. PubMed ID: 15155426 doi:10.1136/bjsm.2002.001982

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Kovacic J, Bergfeld J. Return to play issues in upper extremity injuries. Clin J Sport Med. 2005;15:448–452. PubMed ID: 16278550 doi:10.1097/01.jsm.0000188208.00727.0b

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Creighton DW, Shrier I, Schultz R, Meeuwisse WH, Matheson GO. Return-to-play in sport: a decision-based model. Clin J Sport Med. 2010;20:379–385. PubMed ID: 20818198 doi:10.1097/JSM.0b013e3181f3c0fe

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11.

    Clover J, Wall J. Return-to-play criteria following sports injury. Clin Sports Med. 2010;29:169–175. PubMed ID: 19945592 doi:10.1016/j.csm.2009.09.008

  • 12.

    Ardern CL, Webster KE, Taylor NF, Feller JA. Return to sport following anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis of the state of play. Br J Sports Med. 2011;45:596–606. PubMed ID: 21398310 doi:10.1136/bjsm.2010.076364

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Matheson GO, Shultz R, Bido J, Mitten MJ, Meeuwisse WH, Shrier I. Return-to-play decisions: are they the team physician’s responsibility? Clin J Sport Med. 2011;21:25–30. PubMed ID: 21200167 doi:10.1097/JSM.0b013e3182095f92

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14.

    Ardern CL, Webster KE, Taylor NF, Feller JA. Return to the preinjury level of competitive sport after anterior cruciate ligament reconstruction surgery: two-thirds of patients have not returned by 12 months after surgery. Am J Sports Med. 2011;39(3):538–543. PubMed ID: 21098818 doi:10.1177/0363546510384798

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Hootman JM, Dick R, Agel J. Epidemiology of collegiate injuries for 15 sports: summary and recommendations for injury prevention initiatives. J Athl Train. 2007;42(2):311–319. PubMed ID: 17710181

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Dick R, Putukian M, Agel J, Evans TA, Marshall SW. Descriptive epidemiology of collegiate women’s soccer injuries: National Collegiate Athletic Association injury surveillance system, 1988-1989 through 2002–2003. J Athl Train. 2007;42(2):278–285. PubMed ID: 17710177

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Agel J, Evans TA, Dick R, Putukian M, Marshall SW. Descriptive epidemiology of collegiate men’s soccer injuries: National Collegiate Athletic Association injury surveillance system, 1988-1989 through 2002–2003. J Athl Train. 2007;42(2):270–277. PubMed ID: 17710176

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Dick R, Hertel J, Agel J, Grossman J, Marshall SW. Descriptive epidemiology of collegiate men’s basketball injuries: National Collegiate Athletic Association injury surveillance system, 1988-1989 through 2002–2003. J Athl Train. 2007;42(2):194–201. PubMed ID: 17710167

    • Search Google Scholar
    • Export Citation
  • 19.

    Dick R, Ferrara MS, Agel J, et al. Descriptive epidemiology of collegiate men’s football injuries: National Collegiate Athletic Association injury surveillance system, 1988-1989 through 2002–2003. J Athl Train. 2007;42(2):221–233. PubMed ID: 17710170

    • Search Google Scholar
    • Export Citation
  • 20.

    Agel J, Olson DE, Dick R, Arendt EA, Marshall SW, Sikka RS. Descriptive epidemiology of collegiate women’s basketball injuries: National Collegiate Athletic Association injury surveillance system, 1988-1989 through 2002–2003. J Athl Train. 2007;42(2):202–210. PubMed ID: 17710168

    • Search Google Scholar
    • Export Citation
  • 21.

    Ardern CL, Taylor NF, Feller JA, Webster KE. Fear of re-injury in people who have returned to sport following anterior cruciate ligament reconstruction surgery. J Sci Med Sport. 2012;15:488–495. PubMed ID: 22695136 doi:10.1016/j.jsams.2012.03.015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Ardern CL, Taylor NF, Feller JA, Webster KE. Fifty-five percent return to competitive sport following anterior cruciate ligament reconstruction surgery: an updated systematic review and meta-analysis including aspects of physicial functioning and contextual factors. Br J Sports Med. 2014;48:1543–1552. PubMed ID: 25157180 doi:10.1136/bjsports-2013-093398

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 23.

    Cameron KL, Thompson BS, Peck KY, Owens BD, Marshall SW, Svoboda SJ. Normative values for the KOOS and WOMAC in a young athletic population: history of knee ligament injury is associated with lower scores. Am J Sports Med. 2013;41(3):582–589. PubMed ID: 23328737 doi:10.1177/0363546512472330

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 24.

    Sciascia A, Haegele LE, Lucas J, Uhl TL. Preseason perceived physical capability and previous injury. J Athl Train. 2015;50(9):937–943. PubMed ID: 26287492 doi:10.4085/1062-6050-50.7.05

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    de Visser HM, Reijman M, Heijboer MP, Bos PK. Risk factors of recurrent hamstring injuries: a systematic review. Br J Sports Med. 2012;46:124–130. PubMed ID: 22011915 doi:10.1136/bjsports-2011-090317

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 26.

    Nadler SF, Malanga GA, Feinberg JH, Rubianni M, Moley P, Foye P. Functional performance deficits in athletes with previous lower extremity injury. Clin J Sport Med. 2002;12:73–78. PubMed ID: 11953552 doi:10.1097/00042752-200203000-00002

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27.

    Gabbe BJ, Bennell KL, Finch CF, Wajswelner H, Orchard JW. Predictors of hamstring injury at the elite level of Australian football. Scand J Med Sci Sports. 2006;16:7–13. PubMed ID: 16430675 doi:10.1111/j.1600-0838.2005.00441.x

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    Hagglund M, Walden M, Ekstrand J. Previous injury as a risk factor for injury in elite football: a prospective study over two consecutive seasons. Br J Sports Med. 2006;40:767–772. PubMed ID: 16855067 doi:10.1136/bjsm.2006.026609

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    Jacobsson J, Timpka T, Kowalski J, et al. Injury patterns in Swedish elite athletics: annual incidence, injury types and risk factors. Br J Sports Med. 2013;47:941–952. PubMed ID: 23543425 doi:10.1136/bjsports-2012-091651

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30.

    Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD. Knee Injury and Osteoarthritis Outcome Score (KOOS)–development of a self-administered outcome measure. J Orthop Sports Phys Ther. 1998;28(2):88–96. PubMed ID: 9699158 doi:10.2519/jospt.1998.28.2.88

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31.

    Frobell RB, Roos EM, Roos HP, Ranstam J, Lohmander LS. A randomized trial of treatment for acute anterior cruciate ligament tears. N Engl J Med. 2010;363(4):331–342. PubMed ID: 20660401 doi:10.1056/NEJMoa0907797

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32.

    Roos E. Knee injury and osteoarthritis: development, evaluation and clinical application of patient-relevant questionnaires. Acta Orthop Scand. 1999;(suppl 284):78.

    • Search Google Scholar
    • Export Citation
  • 33.

    Ostenberg A, Roos H. Injury risk factors in female European football. A prospective study of 123 players during one season. Scand J Med Sci Sports. 2000;10(5):279–285. PubMed ID: 11001395 doi:10.1034/j.1600-0838.2000.010005279.x

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34.

    Ageberg E, Forssblad M, Herbertsson P, Roos E. Sex differences in patient-reported outcomes after anterior cruciate ligament reconstruction: data from the Swedish Knee Ligament Register. Am J Sports Med. 2010;38(7):1334–1342. PubMed ID: 20410376 doi:10.1177/0363546510361218

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35.

    Collins NJ, Misra D, Felson DT, Crossley KM, Roos EM. Measures of knee function. Arthritis Care Res. 2011;63(suppl 11):S208–S228. doi:10.1002/acr.20632

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 36.

    Ingelsrud LH, Granan LP, Terwee CB, Engebretsen L, Roos EM. Proportion of patients reporting acceptable symptoms or treatment failure and their associated KOOS values at 6 to 24 months after anterior cruciate ligament reconstruction: a study from the Norwegian knee ligament registry. Am J Sports Med. 2015;43:1902–1907. PubMed ID: 25977523 doi:10.1177/0363546515584041

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37.

    Barber SD, Noyes FR, Mangine RE, McCloskey JW, Hartman W. Quantitative assessment of functional limitations in normal and anterior cruciate ligament-deficient knees. Clin Orthop Relat Res. 1990;255:204–214. PubMed ID: 2347154

    • Search Google Scholar
    • Export Citation
  • 38.

    Gribble PA, Hertel J, Plisky P. Using the star excursion balance test to assess dynamic postural-control deficits and outcomes in lower extremity injury: a literature and systematic review. J Athl Train. 2012;47(3):339–357. PubMed ID: 22892416 doi:10.4085/1062-6050-47.3.08

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 39.

    Birmingham TB. Test-retest reliability of lower extremity functional instability measures. Clin J Sport Med. 2000;10(4):264–268. PubMed ID: 11086752 doi:10.1097/00042752-200010000-00007

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 40.

    Augustsson J, Thomee R, Linden C, Folkesson M, Tranberg R, Karlsson J. Single-leg hop testing following fatiguing exercise: reliability and biomechanical analysis. Scand J Med Sci Sports. 2006;16:111–120. PubMed ID: 16533349 doi:10.1111/j.1600-0838.2005.00446.x

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 41.

    English R, Brannock M, Chik WT, Eastwood LS, Uhl T. The relationship between lower extremity isokinetic work and single-leg functional hop-work test. J Sport Rehabil. 2006;15:95–104. doi:10.1123/jsr.15.2.95

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 42.

    Kockum B, Heijne AI. Hop performance and leg muscle power in athletes: reliability of a test battery. Phys Ther Sport. 2015;16:222–227. PubMed ID: 25891995 doi:10.1016/j.ptsp.2014.09.002

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 43.

    Stiffler MR, Bell DR, Sanfilippo JL, Hetzel SJ, Pickett KA, Heiderscheit BC. Star excursion balance test anterior asymmetry is associated with injury status in division I collegiate athletes. J Orthop Sports Phys Ther. 2017;47(5):339–346. PubMed ID: 28355980 doi:10.2519/jospt.2017.6974

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 44.

    Clarsen B, Bahr R. Matching the choice of injury/illness definition to study setting, purpose, and design: one size does not fit all! Br J Sports Med. 2014;48:510–512. PubMed ID: 24620038 doi:10.1136/bjsports-2013-093297

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 45.

    Cohen J. Statistical Power Analysis for the Behavioral Sciences. 2nd ed. Hillsdale, NJ: Lawrence Erlbaum Associates, Inc; 1988.

  • 46.

    Dunlop W, Cortina J, Vaslow J, Burke M. Meta-analysis of experiments with matched groups or repeated measures designs. Psychol Methods. 1996;1(2):170–177. doi:10.1037/1082-989X.1.2.170

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 47.

    Fuller CW, Bahr R, Dick RW, Meeuwisse WH. A framework for recording recurrences, reinjuries, and exacerbations in injury surveillance. Clin J Sport Med. 2007;17(3):197–200. PubMed ID: 17513911 doi:10.1097/JSM.0b013e3180471b89

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 48.

    De Vos RJ, Reurink G, Goudswaard GJ, Moen MH, Weir A, Tol JL. Clinical findings just after return to play predict hamstring re-injury, but baseline MRI findings do not. Br J Sports Med. 2014;48:1377–1384. PubMed ID: 25037201 doi:10.1136/bjsports-2014-093737

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 49.

    Ardern CL, Glasgow P, Schneiders A, et al. 2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern. Br J Sports Med. 2016;50:853–864. PubMed ID: 27226389 doi:10.1136/bjsports-2016-096278

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 50.

    Hallen A, Ekstrand J. Return to play following muscle injuries in professional footballers. J Sports Sci. 2014;32(13):1229–1236. PubMed ID: 24784885 doi:10.1080/02640414.2014.905695

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 51.

    Arnason A, Sigurdsson SB, Gudmundsson A, Holme I, Engebretsen L, Bahr R. Risk factors for injuries in football. Am J Sports Med. 2004;32:5S–16S. PubMed ID: 14754854 doi:10.1177/0363546503258912

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 52.

    Brophy RH, Marx RG. The treatment of traumatic anterior instability of the shoulder: nonoperative and surgical treatment. Arthroscopy. 2009;25(3):298–304. PubMed ID: 19245994 doi:10.1016/j.arthro.2008.12.007

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 53.

    Owens BD, Agel J, Mountcastle SB, Cameron KL, Nelson BJ. Incidence of glenohumeral instability in collegiate athletics. Am J Sports Med. 2009;37(9):1750–1754. PubMed ID: 19556471 doi:10.1177/0363546509334591

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 54.

    Owens BD, Dickens JF, Kilcoyne KG, Rue JP. Management of mid-season traumatic anterior shoulder instability in athletes. J Am Acad Orthop Surg. 2012;20(8):518–526. PubMed ID: 22855854 doi:10.5435/JAAOS-20-08-518

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 55.

    Cameron KL, Mountcastle SB, Nelson BJ, et al. History of shoulder instability and subsequent injury during four years of follow-up: a survival analysis. J Bone Joint Surg. 2013;95:439–445. PubMed ID: 23467867 doi:10.2106/JBJS.L.00252

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 56.

    Monk PA, Roberts PG, Logishetty K, et al. Evidence in managing traumatic anterior shoulder instability: a scoping review. Br J Sports Med. 2015;49(5):307–311. PubMed ID: 23966417 doi:10.1136/bjsports-2013-092296

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 57.

    Ward JP, Bradley JP. Decision making in the in-season athlete with shoulder instability. Clin Sports Med. 2013;32:685–696. PubMed ID: 24079428 doi:10.1016/j.csm.2013.07.005

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 58.

    Hegedus EJ, McDonough S, Bleakley C, Cook CE, Baxter GD. Clinician-friendly lower extremity physical performance measures in athletes: a systematic review of measurement properties and correlation with injury, part 1. The tests for knee function including the hop tests. Br J Sports Med. 2015;49:642–648. PubMed ID: 25497489 doi:10.1136/bjsports-2014-094094

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 59.

    Hegedus EJ, McDonough S, Bleakley C, Baxter D, Cook CE. Clinician-friendly lower extremity physical performance tests in athletes: a systematic review of measurement properties and correlation with injury. Part 2—the tests for the hip, thigh, foot and ankle including the star excursion balance test. Br J Sports Med. 2015;49:649–656. PubMed ID: 25614536 doi:10.1136/bjsports-2014-094341

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 60.

    Ardern CL, Kvist J, Webster KE. Psychological aspects of anterior cruciate ligament injuries. Oper Tech Sports Med. 2016;24(1):77–83. doi:10.1053/j.otsm.2015.09.006

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 61.

    Muller B, Yabroudi MA, Lynch A, et al. Defining thresholds for the patient acceptable symptom state for the IKDC subjective knee form and KOOS for patients who underwent ACL reconstruction. Am J Sports Med. 2016;44:2820–2826. PubMed ID: 27474383 doi:10.1177/0363546516652888

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 62.

    Roos EM, Boyle E, Frobell RB, Lohmander LS, Ingelsrud LH. It is good to feel better, but better to feel good: whether a patient finds treatment ‘successful’ or not depends on the questions researchers ask. Br J Sports Med. 2019;53:1474–1478. PubMed ID: 31072841 doi:10.1136/bjsports-2018-100260

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 63.

    Wellsandt E, Failla MJ, Snyder-Mackler L. Limb symmetry indexes can overestimate knee function after ACL injury. J Orthop Sports Phys Ther. 2017;47:334–338. PubMed ID: 28355978 doi:10.2519/jospt.2017.7285

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 1477 438 11
Full Text Views 182 10 0
PDF Downloads 115 3 2