Development and Implementation of a Modular Return-to-Play Test Battery After ACL Reconstruction

Several studies in football have demonstrated a significant reduction of injuries through various preventive measures. However, even under ideal conditions, injuries will occur in contact team sports like football. As injuries are expected to be part of the game, there is a certain need to develop proper concepts for secondary and tertiary prevention. In this context the return-to-play decision is a decisive aspect, in particular with regard to frequently reoccurring as well as severe injuries like ACL tears. Rather than time, which is an important factor in biological healing, objective parameters are needed to monitor, control, and optimize the rehabilitation process. Especially when it comes to the final return-to-play decision after an ACL injury, it is advisable to carry out a comprehensive test battery that considers clinical, physiological, and psychological aspects. Moreover, this testing should anticipate the specificity of the sport the injured athlete is returning to. With regard to the right timing of the comeback, individual baseline values from pre-injury screenings are superior to the frequently used limb symmetry index (LSI) or data from reference populations. Particularly in football where lower limb asymmetries due to leg dominances have to be taken into consideration when interpreting test results, solely usage of the LSI seems to be questionable. In the light of the ambitions to develop a standardized test battery, the Verwaltungs-Berufsgenossenschaft (VBG), the statutory accident insurance for German professional sports, conducted a consensus conference bringing together accredited experts and working groups from all professions that are typically involved in the rehabilitation process. As a result of this conference, a modular test battery was introduced for multicentric test implementation in real-world sports settings.