Segundo ACL em Atletas Jovens

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journal of orthopaedic & sports physical therapy | volume 50 | number 2 | february 2020 | 83
[ research report ]
A
pproximately 1 in 4 patients who are 25 years of age 
or younger and return to high-risk sport (eg, soccer 
and team handball) after primary anterior cruciate 
ligament (ACL) reconstruction sustain a second ACL 
injury.28 Given that younger patients return to sport after ACL 
reconstruction in greater numbers than older patients, their greater
exposure may explain the elevat-
ed reinjury risk.3,4,17,27
There are conflicting find-
ings regarding the relationship 
between passing specific return-
to-sport tests and the risk of second ACL 
injury.10,15,19 Among youth athletes with a 
mean age of 17 years, there were no dif-
ferences in strength and hop performance 
at the time of return-to-sport clearance 
between those who successfully resumed 
their preinjury sports participation and 
those who sustained a second ACL in-
jury.15 Professional athletes who did not 
meet 6 discharge criteria before return-
ing to sport had 4 times the risk of graft 
rupture compared to their peers who met 
the discharge criteria.19 In addition, pa-
tients with more symmetrical quadriceps 
strength and who returned to sport at 
least 9 months after surgery had an 84% 
reduction in the rate of knee injuries.10
Key considerations when interpreting 
previous research on the relationship be-
tween passing return-to-sport discharge 
criteria and second ACL injury include the 
heterogeneous populations (eg, profession-
	U OBJECTIVE: To investigate the association 
between sustaining a second anterior cruciate liga-
ment (ACL) injury and (1) time to return to sport, (2) 
symmetrical muscle function, and (3) symmetrical 
quadriceps strength at the time of return to sport in 
young athletes after primary ACL reconstruction.
	U DESIGN: Prospective cohort study.
	U METHODS: Patient demographics and results 
from 5 tests of muscle function (2 strength tests 
and 3 hop tests) were extracted from a rehabilita-
tion registry. A questionnaire was sent to athletes 
(15-30 years old) who were involved in knee-stren-
uous sport before the injury and had undergone 
primary ACL reconstruction to determine time of 
return to knee-strenuous sport (preinjury Tegner 
Activity Scale score of 6 or greater). We used 
the Cox proportional hazard regression model to 
analyze time to event.
	U RESULTS: One hundred fifty-nine (32% of the 
initial sample) athletes (mean ± SD age, 21.5 ± 4.4 
years; 50% female) were included. Athletes with 
a higher preinjury Tegner Activity Scale score had 
a higher rate of second ACL injury (hazard ratio 
= 2.1; 95% confidence interval: 1.2, 3.6; P24:1. .
[Crossref]
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	Feb2020-RR-Beischer
	50-07 Corrigendum“Have you, since your primary ACL re-
construction, reached any of these lev-
els of physical activity?” (yes/no) (TABLE 
1). If the athlete answered “yes,” then he 
or she was asked, “Please specify when 
[month/year] you returned to at least 
level 6” (on the Tegner Activity Scale). We 
calculated the variable “time (months) of 
return to knee-strenuous sport” based 
on the questionnaire responses. We pilot 
tested the questionnaire with 10 patients 
with ACL injury (not included in the 
study) to improve face validity, and made 
no changes to the questionnaire.
The online questionnaire was sent to 
494 athletes who had fulfilled the inclu-
sion criteria. The athletes who did not 
respond to the questionnaire received up 
to 2 reminders by text message within a 
week of first contact, followed by up to 
2 reminders by e-mail. Finally, nonre-
sponders were contacted by telephone. A 
total of 344 athletes responded.
Achieving Symmetrical Muscle Func-
tion Data from strength and hop tests 
from the follow-up closest to return to 
sport were extracted from the Project 
ACL database (TABLE 2).
All athletes completed a test battery 
of 2 strength tests (either isokinetic or 
isometric knee extension and knee flex-
ion, reflecting quadriceps and hamstring 
strength) and 3 single-leg hop tests. Be-
fore completing the test battery, athletes 
had to fulfill the following criteria: mini-
mal knee pain, minimal knee effusion, 
performed single-leg exercise without 
TABLE 1
Project-Specific Questionnaire 
Regarding Return to Sport
1. Have you, since your primary anterior cruciate ligament reconstruction, reached any of these levels of physical 
activity? (yes/no)
 If yes:
 1a. Please specify when you returned to at least level 6 (month/year)
Tegner Activity Scale Levels 6 to 10 and Corresponding Sports
Level 6: baseball, hurdling, orienteering, snowboarding
Level 7: badminton, high jump, tennis, downhill skiing, volleyball
Level 8: basketball, handball, floorball, long jump
Level 9: football, ice hockey, mogul skiing
Level 10: football: national or international level, American football, wrestling, figure skating
TABLE 2
Follow-ups and Number of Athletes Included 
in the Analysis, With Respect to Time to RTS
Abbreviation: RTS, return to sport.
Time to RTS, mo Month Data Were Extracted Included Athletes (n = 159), n (%)
7-11 8 101 (63.5)
12-17 12 40 (25.2)
18-23 18 13 (8.2)
24-35 24 4 (2.5)
≥36 36 1 (0.6)
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journal of orthopaedic & sports physical therapy | volume 50 | number 2 | february 2020 | 85
perceiving new or increased symptoms, 
and trained single-leg maximal hop tests 
with their responsible physical thera-
pist outside the testing environment for 
Project ACL data collection. At the time 
of follow-up, the test leader assessed the 
patient’s health status to ensure that he or 
she was well prepared to perform the tests.
The test procedure, including a warm-
up procedure, familiarization, and maxi-
mum repetitions in both strength and 
hop tests, has been described in detail in 
previous studies (TABLE 3).4,13 The results 
from the strength and hop tests were 
expressed as the limb symmetry index 
(LSI), defined as the ratio between the 
injured side and the uninjured side and 
expressed as a percentage. Symmetrical 
muscle function was defined as achieving 
an LSI of 90% or greater in all 5 tests of 
muscle function.
The LSI for the strength tests was 
calculated from isometric tests of quad-
riceps strength and hamstring strength 
using the F200 DMS-EVE (David Health 
Solutions Ltd, Helsinki, Finland) and 
from isokinetic concentric strength tests 
of the quadriceps and hamstrings using 
the Biodex System 4 (Biodex Medical 
Systems, Shirley, NY). In our study, the 
isometric tests contributed to 9% of the 
total muscle strength LSI data. Isomet-
ric and isokinetic strength tests are highly 
reliable (intraclass correlation coefficient 
= 0.91-0.99).1,7,21,23
After the strength testing, the partici-
pants performed 3 single-leg hop tests 
in the following order: vertical hop, hop 
for distance, and side hop.4,13 High test-
retest reliability for the 3 different tests 
in the battery of hop tests has been re-
ported (intraclass correlation coefficient 
= 0.93-0.97).11
Patient Characteristics
We extracted age at primary ACL recon-
struction, sex, anthropometric data, and 
preinjury Tegner Activity Scale score 
from the Project ACL database.
Outcome
The primary outcome was sustaining 
a subsequent ACL injury (yes/no). The 
injuries were confirmed by the treating 
physical therapist or orthopaedic surgeon. 
There were no specific criteria to verify the 
ACL injury. No maximum time of follow-
up was determined. Data regarding sub-
sequent ACL injury were extracted from 
the Project ACL database, comprising the 
number of ACL injuries, date of the subse-
quent ACL injury, and side of injury.
Statistical Analysis
Statistical analysis was performed using 
the SAS statistical analysis system (SAS/
STAT Version 14.2; SAS Institute Inc, 
Cary, NC). Descriptive statistics for pa-
tient demographics and outcomes were 
reported with count and proportion for 
categorical variables. Continuous vari-
ables were reported with mean, SD, me-
dian, and range.
For comparisons between athletes 
with complete data and those lost to 
follow-up, we used the Fisher exact test 
(lowest 1-sided P value multiplied by 
2) for dichotomous variables, the Man-
tel-Haenszel chi-square exact test for 
ordered categorical variables, and the 
Mann-Whitney U test for continuous 
variables.
We used a Cox proportional hazard 
regression model for the analyses of time 
to second ACL injury, with time to return 
to sport, symmetrical muscle function, 
symmetrical quadriceps strength, and 
demographics as independent variables. 
Time to return to sport was dichotomized 
into less than 9 months and 9 months or 
greater.10 Time 0 was defined as the first 
month of participation in sports equal to 
knee-strenuous sport (ie, a Tegner Ac-
tivity Scale score of 6 or greater). Sym-
metrical muscle function was defined as 
achieving an LSI of 90% or greater in all 
5 tests of muscle function. Symmetri-
cal quadriceps strength was defined as 
achieving an LSI of 90% or greater in 
quadriceps strength. Hazard ratios (HRs) 
were calculated for descriptive purposes.
Data were checked for nonpropor-
tionality using the supremum test for 
proportional hazards assumption, and 
by introducing a time-dependent co-
variate (the interaction between the 
TABLE 3 Tests of Muscle Functiona
Abbreviation: RM, repetition maximum.
aModified under a Creative Commons CC-BY-NC license (https://creativecommons.org/licenses/by-nc/ 
4.0/) with permission from Beischer S, Hamrin Senorski E, Thomeé C, Samuelsson K, Thomeé R. Knee 
strength, hop performance and self-efficacy at 4 months are associated with symmetrical knee muscle 
function in young athletes 1 year after an anterior cruciate ligament reconstruction. BMJ Open Sport 
Exerc Med. 2019;5:e000504. https://doi.org/10.1136/bmjsem-2018-000504
bMeasured with the F200 DMS-EVE (David Health Solutions Ltd, Helsinki, Finland).
cMeasured with the Biodex System 4 (Biodex Medical Systems, Shirley, NY) at 90°/s.
dMeasured with the F300 DMS-EVE (David Health Solutions Ltd).
eMeasured with MUSCLELAB (Ergotest Innovation AS, Porsgrunn, Norway).
fAs many hops as possible in 30 seconds over 2 lines 40 cm apart.
Knee Angle, 
deg
Practice Trials, n 
(% 1-RM)
Maximum 
Repetitions, n
Rest Between 
Repetitions, s
Knee extension 3-5 40
Isometricb 60 3 (70, 80, 90)Isokineticc 0-90 1-2 (90)
Knee flexion 3-5 40
Isometricd 30 3 (70, 80, 90)
Isokineticc 0-90 1-2 (90)
Single-leg vertical hope ... 2 3 20-30
Single-leg hop for distance ... 2 3 20-30
Single-leg side hopf ... 10 1 180
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https://creativecommons.org/licenses/by-nc/4.0/
https://creativecommons.org/licenses/by-nc/4.0/
https://doi.org/10.1136/bmjsem-2018-000504
86 | february 2020 | volume 50 | number 2 | journal of orthopaedic & sports physical therapy
[ research report ]
independent variable of time to return 
to sport and the time variable of time 
from return to sport). To compare mod-
els, generalized R2 was calculated for 
the univariable analysis. We planned a 
multiple survival analysis with stepwise 
Cox proportional hazard regression. 
However, a model based on fewer than 
20 events would have been overfitted 
with unreliable results5 and was not 
performed.
Sensitivity analyses were performed to 
check for influential outliers by excluding 
10% of the variables with the most influ-
ence on significant factors. In addition, 
we analyzed the association between time 
to return to sport and subsequent ACL 
injury for all eligible athletes, regardless 
of whether they had performed the mus-
cle function tests. Significance tests were 
conducted at the 5% level.
RESULTS
O
ne hundred fifty-nine (32%) 
athletes completed the muscle 
function tests. The main reason for 
exclusion from further analyses was that 
the athlete had not performed tests of 
muscle function close to the time of re-
turn to sport (n = 105) (FIGURE 1).
There were no differences in sex, age, 
preinjury level of physical activity, and 
anthropometrics between athletes with 
complete data (n = 159) and athletes with 
missing data from the muscle function 
tests or the study-specific questionnaire 
(n = 335). The athletes with complete 
data had a shorter time from injury to 
ACL reconstruction compared with the 
excluded individuals, by an average of 2 
months (P = .007).
The athletes (n = 159) had an average 
age of 21.5 ± 4.4 years at their primary 
ACL reconstruction, and 50% were fe-
male. The median time to return to sport 
for all included athletes was 11.0 months 
(range, 7.5-37.9 months). One hundred 
one athletes (64%) returned to knee-
strenuous sport between 7 and 11 months 
after ACL reconstruction (TABLE 2). The 
median follow-up time was 15.5 months 
(range, 0.4-46.5 months) after return to 
sport, and the time between return to 
sport and athletes answering the study-
specific questionnaire ranged from 2 days 
to 5 years, with an average of 1.3 years. 
Athletes performed the tests of muscle 
function 65 ± 47 days before return to 
sport. The average LSI for each of the 5 
muscle function tests varied between 89% 
and 99%. Twenty-four percent (n = 39) of 
the athletes achieved symmetrical muscle 
function across the battery of tests before 
returning to knee-strenuous sport.
Eighteen (11%) athletes sustained a 
new ACL injury that was registered in 
Project ACL: 10 graft ruptures and 8 
contralateral ACL ruptures (TABLE 4) oc-
curred between 9 and 36 months after 
ACL reconstruction (median, 19 months). 
Athletes who sustained a new ACL injury 
returned to knee-strenuous sport, on av-
erage, 10.1 ± 3.3 months (range, 7.6-19.4 
months) after ACL reconstruction, com-
pared with 12.7 ± 4.8 months (range, 7.5-
37.9 months) for athletes with no new 
ACL injury (TABLE 5). Ten of the 33 athletes 
who returned to knee-strenuous sport ear-
lier than 9 months after reconstruction 
sustained a new ACL injury. Twelve (67%) 
of the second ACL injuries occurred in 
athletes who returned to knee-strenuous 
sport between 8 and 9 months after ACL 
reconstruction.
Athletes who returned to knee-stren-
uous sport at 9 months or later after sur-
gery had a lower rate of new ACL injury 
compared with those who returned ear-
lier than 9 months after ACL reconstruc-
tion (HR = 0.15; 95% confidence interval 
[CI]: 0.06, 0.39; PACL injury in 
athletes who had returned to knee-stren-
uous sport earlier than 9 months after 
surgery. Even though some of the included 
athletes returned to sports that were less 
demanding of knee function than in other 
studies,6,10 our results mirror the findings 
of previous research.
Achieving Symmetrical Muscle Function
We did not find an association between 
achieving symmetrical muscle function 
and sustaining a second ACL injury. 
However, only 5 (28%) of the athletes 
who sustained a second ACL injury, and 
33 (23%) of the athletes who did not, 
regained symmetrical muscle function 
close to return to sport. The fact that few 
athletes had symmetrical muscle func-
tion, in combination with a relatively 
limited population (n = 159), may explain 
TABLE 4
Baseline Demographics, Stratified 
by Athletes With and Without 
Subsequent ACL Injurya
Abbreviations: ACL, anterior cruciate ligament; NA, not applicable; TAS, Tegner Activity Scale.
aValues are mean ± SD or mean ± SD and median (range) unless otherwise indicated. For comparison 
between groups, Fisher’s exact test (lowest 1-sided P value multiplied by 2) was used for dichotomous 
variables, the Mantel-Haenszel chi-square test was used for ordered categorical variables, and the 
Mann-Whitney U test was used for continuous variables.
Subsequent ACL Injury 
(n = 18)
No Subsequent ACL Injury 
(n = 141) P Value
Patient sex, n (%) .47
Female 11 (61) 59 (49)
Height, cm 171.2 ± 8.3 174.7 ± 9.5 .13
Weight, kg 67.2 ± 8.5 71.2 ± 12.5 .21
Preinjury TAS score, n (%) .029
6 0 (0.0) 6 (4.3)
7 2 (11.1) 18 (12.8)
8 3 (16.7) 43 (30.5)
9 5 (27.8) 51 (36.2)
10 8 (44.4) 23 (16.3)
Graft choice, n (%) .099
Hamstring 13 (72.2) 120 (87.0)
Patella 4 (22.2) 17 (12.3)
Quadriceps 1 (5.6) 0 (0)
Allograft 0 (0) 1 (0.7)
Age at index ACL reconstruction, y 20.3 ± 3.4 21.7 ± 4.5 .21
Time from ACL injury to 
reconstruction, mo
4.3 ± 4.8
2.8 (0.1-20.8)
6.4 ± 8.1
3.9 (0.2-58.7)
.041
Time of follow-up, mo 11.1 ± 10.0
7.6 (0.4-28.4)
19.4 ± 11.1
16.5 (2.5-46.5)
NA
TABLE 5
Postoperative Outcome in Patients With 
and Without a Subsequent ACL Injurya
Abbreviations: ACL, anterior cruciate ligament; LSI, limb symmetry index; RTS, return to sport.
aValues are mean ± SD and median (range) unless otherwise indicated.
bAll 5 tests of muscle function: LSI of 90% or greater.
Subsequent ACL Injury 
(n = 18)
No Subsequent ACL Injury 
(n = 141)
Time to RTS, mo 10.1 ± 3.3
8.6 (7.6-19.4)
12.7 ± 4.8
11.0 (7.5-37.9)
Symmetrical muscle functionb closest to RTS, n (%) 5 (27.8) 33 (23.4)
Quadriceps LSI, % 92.3 ± 12.1
93.2 (56.9-112.0)
95.7 ± 9.4
96.5 (74.6-121.3)
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88 | february 2020 | volume 50 | number 2 | journal of orthopaedic & sports physical therapy
[ research report ]
why there was no association between 
new ACL injury and muscle function.
Our results contradict previous re-
search that has supported a relationship 
between muscle function and new knee 
injury.10,19 The discrepancies in results 
might be explained by different athlete 
populations (we studied a mixed group 
of professional and nonprofessional ath-
letes; Kyritsis et al19 only included male 
professional athletes) and by all athletes 
in our study having achieved an average 
LSI of 90% or greater (athletes in the 
study by Grindem et al10 had an aver-
age LSI of between 75% and 84%). The 
higher LSI in our study might have been 
protective against a second ACL injury, 
and was partly explained by our criteria 
for patients to participate in completing 
the muscle function tests.
Approximately 1 in every 10 athletes 
in our study sustained a new ACL injury, 
which is lower than the proportion found 
in other reports.6,26,28 Our results might 
be explained by the fact that the athletes 
were repeatedly assessed with tests of 
muscle function and patient-reported 
outcomes. Structured and progressive 
preoperative and postoperative rehabili-
tation, combined with clear goal setting 
and detailed patient information, may 
improve rehabilitation outcomes.9
Patient Demographics
Higher preinjury physical activity level 
was associated with a higher rate of sub-
sequent ACL injury. Our results support 
previous research10 in which patients 
returning to level 1 sport (eg, soccer and 
team handball) had a 4-fold increase in 
the risk of a subsequent knee injury com-
pared with those who did not participate 
in level 1 sport (29.7% versus 6.9%). In 
the present study, the rate of second ACL 
injury was approximately 25% in athletes 
with a preinjury Tegner Activity Scale 
score of 10, which is in accordance with 
previous studies.2,8,16,22,26,28
Younger age has been reported as a 
risk factor for subsequent ACL injury.10,20 
We did not find an association between 
second ACL injury and patient demo-
graphics. This may be because we studied 
a young group of patients, and the rate of 
new ACL injuries was low.
Limitations
Only one third of the 494 eligible athletes 
responded to the study-specific question-
naire and had attended a follow-up of 
muscle function testing close to the time 
of return to sport. New ACL injuries were 
diagnosed clinically by the responsible 
physical therapist or orthopaedic surgeon. 
Because magnetic resonance imaging veri-
fication of injury was not mandatory, some 
ACL injuries might have been missed. The 
mean follow-up time of 15.5 months to re-
TABLE 6
HRs Associated With a Subsequent 
ACL Injury (n = 159)
Value Event Rate HR of Subsequent Injurya P Value Generalized R2
Patient sex 0.69 (0.27, 1.77) .44 0.004
Female 8.6
Male 6.0
Height (cm), HR per 10 units 0.96 (0.91, 1.01) .14 0.014
150-defined as a 
Tegner Activity Scale score of level 6 or 
above, and none of the eligible athletes 
sustained a second ACL injury prior to 
return to sport, which eliminates the risk 
of immortal time bias. Therefore, the use 
of the Tegner Activity Scale (level 6 or 
above) may be an appropriate proxy for 
the risk exposure for ACL injury.
A comparison analysis of demograph-
ics between athletes with complete data 
and those lost to follow-up revealed no 
significant differences, except for the 
time between ACL injury and ACL recon-
struction. There is no reason to believe 
that this influenced the results. However, 
we cannot rule out bias in the results due 
to unmeasured factors.
We used 2 different modes of strength 
testing (isometric and isokinetic). As 
previous studies have demonstrated a 
moderate to high correlation between 
isometric and isokinetic tests of knee 
strength,14,18 we suggest that using results 
from 2 different tests had no or only mi-
nor influence on the conclusions drawn. 
We did not account for other factors that 
might further explain the risk of second 
ACL injury, such as differences in reha-
bilitation protocols, surgical techniques 
of ACL reconstruction, the treatment of 
concomitant injuries, contextual and so-
cial factors, and psychological factors.
CONCLUSION
R
eturning to knee-strenuous 
sport before 9 months after ACL re-
construction was associated with a 
7-fold increased rate of sustaining a sec-
ond ACL injury. Achieving symmetrical 
muscle function or quadriceps strength 
was not associated with new ACL injury 
in young athletes. U
KEY POINTS
FINDINGS: The rate of a subsequent an-
terior cruciate ligament (ACL) injury 
was approximately 7 times higher in 
athletes who returned to knee-strenuous 
sport earlier than 9 months after ACL 
reconstruction compared with athletes 
who returned to sport at or later than 9 
months. There were no associations be-
tween sustaining a subsequent ACL in-
jury and achieving symmetrical muscle 
function or quadriceps strength.
IMPLICATIONS: Clinicians should inform 
young athletes who undergo ACL recon-
struction that delaying return to knee-
strenuous sport until at least 9 months 
after ACL reconstruction confers a re-
duction in subsequent ACL injury rate.
CAUTION: This study only included 18 ath-
letes who sustained a subsequent ACL 
injury, which limited the opportunities 
for in-depth analyses and assessment of 
multiple risk factors. The nonsignificant 
association between achieving symmet-
rical muscle function and a subsequent 
ACL injury may be attributed to low sta-
tistical power and to the fact that 68% 
of the athletes had missing data from 
the muscle function tests.
ACKNOWLEDGMENTS: The authors thank 
bio statisticians Bengt Bengtsson and Nils-
Gunnar Pehrsson from Statistiska Konsult-
gruppen for help with statistical analyses.
STUDY DETAILS
AUTHOR CONTRIBUTIONS: All authors 
contributed to project planning. Drs 
Beischer, Hamrin Senorski, and Thomeé 
and Ms Gustavsson and Mr Thomeé 
acquired the data. Drs Beischer, Hamrin 
Senorski, and Thomeé and Ms Gustavs-
son interpreted data. Dr Beischer and 
Ms Gustavsson drafted the manuscript. 
All authors critically revised the manu-
script and approved the final version.
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Time From RTS to Event/End of Study, mo
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journal of orthopaedic & sports physical therapy | volume 50 | number 2 | february 2020 | c1
[ research report ]
APPENDIX
HRS OF EACH OF THE INDEPENDENT VARIABLES 
FOR THE SENSITIVITY ANALYSES (N = 264)
Value Event Ratea n HR of Subsequent Injuryb P Value Generalized R2
Patient sex 0.61 (0.24, 1.53) .29 0.004
Female 5.6 140
Male 3.4 124
Height (cm), HR per 10 units 0.95 (0.91, 1.00) .043 0.014
150-Reconstruction: A Case Report. Cureus 10. . [Crossref]
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for Special Surgery 62. . [Crossref]
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Leaders in the Field: A Survey of the Herodicus Society. Orthopaedic Journal of Sports Medicine 12:⒑ . [Crossref]
⒐ Anastasia Vasilopoulou, Stavros Angelis, Theodore Balfousias, Christos Nikakis, Spyridon Maris, Antonis Trichonas,
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with bone-patellar-bone grafts: Autograft vs. allograft. Journal of Orthopaedics 55, 149-15⒍ [Crossref]
⒓ Olivia J. Bono, Albert Mousad, Michael Parman, Eric Manz, Jason Byrne, Katharine Ives, Matthew Salzler, Sarav S.
Shah. 202⒋ Return to Play at Preinjury Level After Anterior Cruciate Ligament Reconstruction in Divisions II and III
National Collegiate Athletic Association Student-Athletes. Orthopaedic Journal of Sports Medicine 12:⒐ . [Crossref]
⒔ Jay R. Ebert, Peter K. Edwards, Alistair I. W. Mayne, Peter S. E. Davies, Robert Evans, Randeep S. Aujla, Shahbaz
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reconstruction injured during pivoting sports demonstrate similar clinical, functional and return to sport outcomes by
2 years compared with those undergoing anterior cruciate ligament reconstruction. Knee Surgery, Sports Traumatology,
Arthroscopy . [Crossref]
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M. Bazett-Jones, Grant E. Norte. 202⒋ Test–Retest Reliability and Visual Perturbation Performance Costs During 2
Reactive Agility Tasks. Journal of Sport Rehabilitation 33:6, 444-451. [Crossref]
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Watarastaporn, Najeeb Khan. 202⒋ Medial Meniscectomy at the Time of ACL Reconstruction Is Associated With
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