Secondary prevention for athletes after an anterior cruciate ligament reconstruction -- an evidence summary.

Introduction: A rupture of the anterior cruciate ligament (ACL) is a common knee injury in athletes, often followed by surgical reconstruction. A high percentage returns to high-impact sports, however, up to 25% of those athletes sustain an ACL reinjury.1 Objectives: To summarize evidence-based training modalities as secondary prevention measures after ACL recon- struction Study design: Evidence summary based on a systematic literature review. Methods: Systematic literature search in the databases PubMED and Web of Science with the keywords «ACL, anterior cruciate ligament, reconstruction, reinjury, second injury, rerupture, secondary, prevention, sports» from 2013 to May 2023. Two authors screened the hits independently for title and abstract, followed by full-text reading. Predefined inclusion (adults, professional and amateur athletes after ACL reconstruction), and exclusion criteria (conservative treatment, ACL suture, concomitant or secondary injuries, cadaver or animal study) were used. Injury of the contralateral side, rerupture of the reconstructed ACL and modification of risk factors for ACL reinjury were chosen as outcomes. The final study selection was made by consensus. Included studies were assessed for risk of bias by using the Critical Appraisal Skills Programme checklist.2 Results: From 923 hits, seven studies with a total of 560 athletes, one systematic literature review, three randomized controlled trials and three cohort studies were included for qualitative analysis. The included literature showed moderate to high quality. Secondary prevention programs with neuromuscular training, eccentric training and plyometric exercises and core strenghtening showed a positive impact on spine, knee and hip joint biomechanics, functional and clinical outcomes in patients after ACL reconstruction. Conclusions: The interventions in the included literature were shown to reduce various risk factors for ACL reinjury. However, the included studies were heterogeneous regarding interventions and outcomes. As ACL reinjury is multifactorial, it is recommended not to focus on one specific risk factor or outcome. [ABSTRACT FROM AUTHOR]