Standard RTS criteria effectiveness verification using FMS, Y-balance and TJA in footballers following ACL reconstruction and mild lower limb injuries

The anterior cruciate ligament (ACL) is the most frequently injured knee ligament. In previous studies, it was demonstrated that patients following ACL reconstruction may present motor deficits which may be related to increased risk of injury. The objective of the study was to determine whether players who have passed RTS assessment still have deficits in movement patterns or in neuromuscular control after such a serious injury as ACL rupture and reconstruction,. Sixty-five male football players (age 18-25 years), recruited from regional teams, were divided into three groups: (1) ACL group-subjects after ACL rupture and reconstruction (n=24); (2) Mild Injury (MI) group-subjects after mild lower limb injuries (n=21); and (3) Control (C) group-subjects without injuries (n=20). For all groups, the Y-balance test, Functional Movement Screen (FMS) and Tuck Jump Assessment (TJA) were performed. For the Y-balance test in ACL group for the injured leg, significantly lower values were demonstrated for anterior reach ((ACL) 69.2 +/- 5.7% vs. (MI) 74.8 +/- 4.5% vs. (C) 74.0 +/- 5.6%), at posterior-lateral reach ((ACL) 103.2 +/- 6.4% vs. (C) 108.5 +/- 6.0%) and composite score ((ACL) 93.9 +/- 4.4% vs. (MI) 97.9 +/- 4.3%) in comparison to the remaining two groups. In the FMS test, the ACL group had significantly lower composite score (12 +/- 4 points) compared to the C group (15 +/- 2 points). Also, compared to the remaining groups, subjects following ACL reconstruction demonstrated significantly lower performance in the TJA test related to the following elements: thighs do not reach parallel, thighs not equal side-to-side, foot placement not shoulder width apart, technique declines prior to 10 s and lower extremity valgus at landing. The authors have observed that athletes after ACL reconstruction still have deficits in movement patterns or in neuromuscular control despite passing the RTS and being cleared to perform sports. Creating a set of sufficiently sensitive assessment methods may significantly reduce the potential risk of injury due to the fact that diagnosed and monitored deficits may be treated on an ongoing basis. The authors suggest that individual elements of the Y-balance and TJA tests may be suitable for such specific assessment.