Reha Kongresse 2018
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P16

Strength tests after anterior cruciate ligament repair for return to sports – a systematic review

J. Glättli1, C. Reinhard1, A. Blasimann1 (1Bern)


Einleitung
Anterior cruciate ligament (ACL) tears are frequent in sporty people and will be treated surgically or conservatively. Post-surgery, ACL patients often suffer from strength loss caused by arthrogenic inhibition and loss of muscle fibres due to immobilization. An evidence- and criterion-based rehabilitation program is essential for a successful return to sports (RTS). Objective criteria, to assess strength for example, are important to reach the next rehabilitation stage, but also to document treatment success. However, there are many different tests done. Therefore, the aim of this systematic review was to get an overview of different strength tests in people with an ACL repair to judge upon readiness to RTS.
Methodik
In May 2018, the Physiotherapy Evidence Database (PEDro), PubMed and Cochrane were searched systematically. Randomized-controlled trials (RCTs) with people after an ACL repair, testing strength between 3 and 24 months after ACL surgery and comparing two different rehabilitation programs were included. Two authors independently screened the hits for inclusion following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. To assess risk of bias, the Critical Appraisal Skills Program (CASP) checklist was used.
Resultate
From 246 references found, seven RCTs with 390 people after an ACL repair were included. The included RCTs scored a mean of 7 out of maximum 9 points with the CASP checklist. In six studies, strength testing was done with an isokinetic dynamometer. However, the protocols and outcomes varied among studies. Mainly, the knee extensor muscles were tested.
Schlussfolgerungen
As only studies with people after an ACL repair were included, the results are not valid for all people with an ACL injury. Moreover, the intervention groups and test protocols were heterogeneous. Strength as outcome was not used in every study to judge upon RTS. Therefore, no standardized test for strength nor a cut-off value which would guarantee a safe RTS could be suggested. Future studies should focus on easy usable, valid and standardized strength measurements after ACL injury.
Bedeutung
The isokinetic dynamometer is the gold standard for strength testing. However, it is time-consuming, not very functional, without standardized test protocol, and therefore not useful for daily practice. Eventually, the hand-held dynamometer or similar tools could be an alternative to assess strength after ACL repair.