Anterior cruciate ligament rehabilitation in the elite soccer player
Geel, C.D. van
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First abstract involves narrative review the second the research study 1) Abstract Anterior cruciate ligament (ACL) ruptures commonly occur in soccer players. Most likely an ACL reconstruction takes place which often leads to a long and intensive rehabilitation process. The aims of the entire rehabilitation process are to reach static and functional stability and a complete range of motion, to improve strength and functional level and to prevent the risk of recidivism. To identify an athlete’s ability to tolerate the physical demands of a sport specific activity different outcome measures are developed. However, no currently known outcome measure is capable of measuring all aforementioned parameters in one test. Therefore a combination of tests is necessary to enable a more complete comprehensive evaluation of outcome. In this review, 27 outcome measures were found. Seven of these were subjective and twenty were objective measurements. Subjective outcome measures as the Lysholm, the Tegner and the Cincinnati knee rating system appeared to be highly valid were measurements as the KOOS did not. On reliability, the KOOS was the only one with negative results. The Cincinnati knee rating system has low ceiling effect and kept changing significantly over time. Different results on validity and reliability are presented for the objective measurements. The isokinetic tests as the Biodex or the Cybex are presented as golden standard. More active tests as the Hop tests are frequently described with varying results on validity but are highly reliable. More tests are necessary in order to make profound statements. Tests suggested in literature are several hop tests, strength test and a subjective questionnaire such as the CKRS. 2) Abstract Objective: To determine strength through isokinetic and functional testing in elite soccer players who underwent anterior cruciate ligament (ACL) reconstruction and to determine the relation between isokinetic and functional testing. Design: Retrospective study. Method: Eighteen elite soccer players from the Dutch soccer league were measured at four months and at the end of their rehabilitation for isokinetic testing. Functional test were solely done at the end of rehabilitation. For the isokinetic tests a Cybex 6000 was used. Functional testing consisted out the one legged hop test for distance, the triple hop test for distance and the six meter timed hop test. Results: Significant differences are seen between all tests at four months and at the end of the rehabilitation (p ≤ 0,05). Strength in the ACL reconstructed leg was within ten percent range on the leg symmetry score and therefore indicated to be normal. Compared to healthy elite soccer players the patients after ACL reconstruction had significantly less quadriceps strength and the hamstring strength was significantly more. Conclusions: At the end of the rehabilitation, 41 weeks after ACL reconstruction, the knee strength of elite soccer players do not level up to those of elite soccer players without ACL reconstruction. The limb symmetry indices, however, are above 90%. This counts both for the isokinetic as the functional testing. The relationship between these tests was not proven.