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The primary outcome of this scoping review will be to investigated ACL reconstruction rehabilitation-both home-based, gym-based, and clinic-based interventions, considering the strength training section within the intervention for data extraction purposes and further analysis. A secondary aim will be to compare the ACLR programme literature to the current standard of reporting strength training exercise descriptors.

OBJECTIVE: The objective of this study was to examine the association of quadriceps strength symmetry and surgical status (ACL reconstruction or nonoperative management) with early clinical knee OA 5 years after ACL injury or reconstruction. METHODS: 204/300 athletes were analyzed 5 years after ACL injury or reconstruction (ACLR). Quadriceps strength was measured and reported as a limb symmetry index. We identified participants with early clinical knee OA using criteria that two of four Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales score ≤85% (Luyten et al. 2018). We calculated odds ratios (OR) and 95% confidence intervals (CI) using logistic regression, adjusted for age, sex, meniscal injury, and BMI, to examine the associations between quadriceps strength and surgical status with clinical knee OA. RESULTS: 21% of participants met KOOS criteria for clinical knee OA (Luyten et al. 2018). For every 1% increase in quadriceps limb symmetry index, there was 4% lower odds of clinical OA (adjusted OR 0.96, 95% CI 0.93–0.99) at 5 years. Surgical status was not associated with clinical knee OA (adjusted OR 0.58, 95% CI 0.23, 1.50). CONCLUSIONS: More symmetrical quadriceps strength, but not surgical status, 5 years after ACL injury or reconstruction was associated with lower odds of clinical knee OA.

Supplemental material, sj-pdf-1-ajs-10.1177_03635465221116313 for Four Distinct 5-Year Trajectories of Knee Function Emerge in Patients Who Followed the Delaware-Oslo ACL Cohort Treatment Algorithm by Marie Pedersen, Hege Grindem, Bjørnar Berg, Lars Engebretsen, Michael J. Axe, Lynn Snyder-Mackler and May Arna Risberg in The American Journal of Sports Medicine

Anterior cruciate ligament (ACL) rupture occurs most commonly in young and active individuals and can have negative long-term physical and psychological impacts. The diagnosis is made with a combination of patient's history, clinical examination, and, if appropriate, magnetic resonance imaging. The objectives of management are to restore knee function, address psychological barriers to activity participation, prevent further injury and osteoarthritis, and optimize long-term quality of life. The three main treatment options for ACL rupture are (1) rehabilitation as first-line treatment (followed by ACL reconstruction (ACLR) in patients, who develop functional instability), (2) ACLR and post-operative rehabilitation as the first-line treatment, and (3) pre-operative rehabilitation followed by ACLR and post-operative rehabilitation. We provide practical recommendations for informing and discussing management options with patients, and describe patient-related factors associated with a worse ACL-rupture outcome. Finally, we define evidence-based rehabilitation and present phase-specific rehabilitation recommendations and criteria to inform return to sport decisions.

OBJECTIVES: (1) To assess prognostic factors for patient-reported outcome measures (PROMs) and physical activity two to ten years after anterior cruciate ligament reconstruction (ACLR) or injury, and (2) to assess differences in prognostic factors between patients treated with ACLR and with rehabilitation alone. DESIGN: Prognosis systematic review. LITERATURE SEARCH: Systematic searches in PubMed, Web of Science and SPORTDiscus. STUDY SELECTION CRITERIA: We selected prospective cohort studies and randomised clinical trials that included adults/adolescents undergoing either ACLR or rehabilitation alone after ACL rupture. Studies had to assess for a statistical association between potential prognostic factors (factors related to patient characteristics, injury or knee symptoms/function measured at baseline or within one year) and outcomes (PROMS and physical activity). DATA SYNTHESIS: Our search yielded 997 references. Twenty studies met inclusion criteria. Seven studies with low or moderate risk of bias remained for data synthesis. RESULTS: There was moderate certainty evidence that concomitant meniscus and cartilage injuries were prognostic factors for worse PROMs two to ten years after ACLR. There was very low certainty evidence that BMI, smoking and baseline PROMs were prognostic factors for worse outcome. There was very low certainty evidence that female sex and worse baseline Marx Activity Rating Scale (Marx) were prognostic factors for worse Marx two to ten years after ACLR. There was a lack of studies on prognostic factors after rehabilitation alone. CONCLUSION: Concomitant meniscus and cartilage injuries were prognostic factors for worse long-term PROMs after ACLR. The certainty was very low for other prognostic factors.

BACKGROUND: Some athletes demonstrate excellent dynamic stability after anterior cruciate ligament (ACL) rupture and return to sport without ACL reconstruction (copers). Others demonstrate persistent instability despite rehabilitation (non-copers) and require surgical stabilization. Testing to determine coper classification can identify potential copers early after rupture. It is unclear how coper classification changes after a brief intervention, and how early classification relates to long-term outcomes. HYPOTHESIS/PURPOSE: (1) To evaluate the consistency of early coper classification (potential coper vs. non-coper) before and after progressive neuromuscular and strength training (NMST) in athletes early after acute ACL rupture and (2) to evaluate the association of early coper classification with two-year success after ACL rupture. STUDY DESIGN: Prospective cohort study METHODS: This was a prospective analysis from the Delaware-Oslo ACL cohort study, a cohort of athletes consecutively enrolled early after ACL rupture. Participants (n=271) were tested and classified as potential copers or non-copers using established criteria before and after a 10-session NMST program. Success two years after ACL reconstruction (ACLR) or non-operative rehabilitation (Non-Op) was defined as meeting/exceeding sex- and age-matched norms for knee function, no ACL graft rupture, and ≤1 episode of giving way within the previous year. McNemar’s test evaluated changes in coper classification pre- to post-training. Logistic regression adjusted for baseline characteristics was used to evaluate the association of early coper classification and surgical status with two-year success. RESULTS: Of 300 athletes enrolled, 271 (90%) completed the post-training data collection and 219 (73%) returned for the two-year follow-up. The coper classifications were different between timepoints; nearly half of those classified initially as non-copers became potential copers (p

Supplemental material, DS_10.1177_0363546519837935 for Knee Pathology in Young Adults After Pediatric Anterior Cruciate Ligament Injury: A Prospective Case Series of 47 Patients With a Mean 9.5-Year Follow-up by Guri Ranum Ekås, Marit Mjelde Laane, Arne Larmo, Håvard Moksnes, Hege Grindem, May Arna Risberg and Lars Engebretsen in The American Journal of Sports Medicine

Supplemental material, DS_10.1177_0363546519825500 for Coper Classification Early After Anterior Cruciate Ligament Rupture Changes With Progressive Neuromuscular and Strength Training and Is Associated With 2-Year Success: The Delaware-Oslo ACL Cohort Study by Louise M. Thoma, Hege Grindem, David Logerstedt, Michael Axe, Lars Engebretsen, May Arna Risberg and Lynn Snyder-Mackler in The American Journal of Sports Medicine

Background: More than 50% of highly active patients with an anterior cruciate ligament (ACL) injury who choose nonsurgical treatment (active rehabilitation alone) have successful 2-year outcomes and comparable knee function to an uninjured population. Early predictive factors for a successful outcome may aid treatment decision making in this population. Purpose: To identify early predictors of a successful 2-year outcome in those who choose nonsurgical treatment of an ACL injury. Study Design: Cohort study; Level of evidence, 2. Methods: This prospective cohort study consisted of ACL-injured athletes who were consecutively screened for inclusion. A total of 300 patients were included from 2 sites (Oslo, Norway, and Delaware, USA), and the 118 patients who initially chose not to undergo ACL reconstruction were included. All patients participated in pivoting sports before the injury, and none had significant concomitant injuries. A successful 2-year outcome was defined as having 2-year International Knee Documentation Committee (IKDC) scores ≥15th normative percentile and not undergoing ACL reconstruction. Multivariable logistic regression models were built using demographic and knee function data (quadriceps muscle strength, 4 single-leg hop tests, IKDC score, and Knee Outcome Survey–Activities of Daily Living Scale [KOS-ADLS] score) collected at baseline or after a 5-week neuromuscular and strength training (NMST) rehabilitation program. Results: After 2 years, 52 of 97 (53.6%) patients had a successful outcome. In the multivariable baseline model, older age, female sex, better performance on the single-leg hop test, and a higher KOS-ADLS score were significantly associated with successful 2-year outcomes. After the 5-week NMST rehabilitation program, older age, female sex, and a higher IKDC score increased the odds of a successful 2-year outcome. The 2 models had comparable predictive accuracy (post-NMST area under the curve [AUC], 0.78 [95% CI, 0.68-0.88]; baseline AUC, 0.81 [95% CI, 0.72-0.89]). Conclusion: Clinicians and patients can be more confident in a nonsurgical treatment choice (active rehabilitation alone) in athletes who are female, are older in age, and have good knee function, as measured by single-leg hop tests and patient-reported outcome measures, early after an ACL injury. Prediction models that include measures of knee function, assessed either before or after rehabilitation, can estimate 2-year prognoses for nonsurgical treatment and thereby assist shared treatment decision making.