Young Athletes Perceiving Greater Improvement After Return to Sport Bridge Program Sustained More Ipsilateral ACL Graft or Contralateral ACL Injuries During Their First Season Back: An Observational Study
Abstract
1. Introduction
2. Materials and Methods
Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
ACL | Anterior cruciate ligament |
cm | Centimeter |
IQR | Inter-quartile range |
kg | kilogram |
KOS-SAS | Knee outcome survey—sports activity scale |
NFL | National Football League |
PROM | Patient reported outcome measurement |
RTS | Return to sports |
SD | Standard deviation |
s | Seconds |
References
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No ACL Graft or Contralateral ACL Injury (n = 187) | ACL Graft or Contralateral ACL Injury (n = 17) | Gender p | Group p | Interaction p | |||
---|---|---|---|---|---|---|---|
Gender (#) | 97 male, 90 female | 11 male, 6 female | NA | 0.26 | NA | ||
Male | Female | Male | Female | ||||
Age (mean ± SD) years | 20.9 ± 6 | 18.8 ± 6 | 17.8 ± 2.1 | 17.0 ± 2 | 0.33 | 0.01 | 0.70 |
Height (mean ± SD) (cm) | 180.4 ± 8 | 169.5 ± 8 | 181.1 ± 5 | 163.4 ± 6 | <0.001 | 0.16 | 0.08 |
Weight (mean ± SD) (kg) | 85.6 ± 14 | 64.1 ± 8 | 84.4 ± 16 | 57.2 ± 8 | <0.001 | 0.19 | 0.35 |
Body Mass Index (mean ± SD) | 26.3 ± 4 | 22.3 ± 3 | 25.6 ± 4 | 21.3 ± 3 | <0.001 | 0.38 | 0.89 |
Post-Surgery RTS (mean ± SD) months | 8.1 ± 3 | 8.8 ± 2.5 | 8.0 ± 2 | 7.8 ± 1 | 0.52 | 0.64 | 0.08 |
Pre-Program KOS-SAS Score re-evaluation at program completion [median [IQR] | 59.2 [22.6] | 57.5 [31.5] | 60.1 [40.6] | 54.0 [52.4] | 0.50 | 0.82 | 0.71 |
Post-Program KOS-SAS Score [median [IQR] | 93 [8.9] | 90.3 [5.9] | 94.4 [5.1] | 95.3 [4.3] | 0.87 | 0.15 | 0.60 |
Post-Program KOS-SAS Score ≥ 25th percentile % (#) | 76.3% (74/97) | 77.9% (70/90) | 100% (11/11) | 83.3% (5/6) | 0.34 | 0.04 | NA |
Pre-Program Global Sport Activities Knee Function Score re-evaluation at program completion [median [IQR] | 55.8 [31.5] | 55.2 [30] | 50 [52.5] | 47.4 [51.6] | 0.80 | 0.29 | 0.88 |
Post-Program Global Sport Activities Knee Function Score [median [IQR] | 91.3 [8] | 91.0 [6.3] | 94.5 [10] | 94.6 [4] | 0.97 | 0.16 | 0.94 |
Post-Program Global Sport Activities Knee Function Score ≥ 25th percentile % (#) | 79.5% (77/97) | 76.1% (68/90) | 100% (11/11) | 83.3% (5/6) | 0.74 | 0.009 | NA |
Pre-Program Sports activities knee function rating (normal, nearly normal, abnormal, severely abnormal) % (#) | 70% (78/97) (abnormal) | 73.3% (66/90) (abnormal) | 72.7% (8/11) (abnormal) | 83.3 (5/6) (abnormal) | 0.64 | 0.75 | 0.38 |
Post-Program Sports activities knee function rating (normal, nearly normal, abnormal, severely abnormal) % (#) | 82.2% (80/97) (normal) | 79.4% (71/90) (normal) | 88.2% (9/11) (normal) | 83.3%(5/6) (normal) | 0.32 | 0.35 | 0.52 |
Two-level Sports activities knee function rating improvement from Pre- to Post-Program (normal, nearly normal, abnormal, severely abnormal) % (#) | 54.6% (53/97) (abnormal to normal or severely abnormal to nearly normal) | 44.9% (40/90) (abnormal to normal or severely abnormal to nearly normal) | 90.9%, (10/11) (abnormal to normal or severely abnormal to nearly normal) | 66.7% (4/6) abnormal to normal or severely abnormal to nearly normal) | 0.12 | 0.009 | NA |
Same or Better Perceived Sports Performance Level Rating (same or better, or worse) | 83/97 (85.9%) | 75/90 (83.7%) | 10/11 (90.9%) | 5/6 (83.3%) | 0.55 | 0.99 | NA |
No ACL Graft or Contralateral ACL Injury (n = 187) | ACL Graft or Contralateral ACL Injury (n = 17) | Gender p | Group p | Interaction p | |||
---|---|---|---|---|---|---|---|
97 male, 90 female | 11 male, 6 female | ||||||
Single Leg Triple Hop for Distance (Non-surgical) (mean ± SD) (cm) | 486.4 ± 121 | 379.2 ± 73 | 525.3 ± 103 | 422.9 ± 39 | 0.001 | 0.19 | 0.94 |
Single Leg Triple Hop for Distance (Surgical) (mean ± SD) (cm) | 471.3 ± 120 | 354.3 ± 67 | 507.7 ± 103 | 400.7 ± 33 | <0.001 | 0.18 | 0.87 |
Single Leg Triple Hop for Distance Symmetry Index (mean ± SD) (%) | 96.9 ± 5 | 93.7 ± 6 | 96.7 ± 5 | 94.8 ± 2 | 0.13 | 0.77 | 0.69 |
20 m Single Leg Timed Hop (Non-surgical) (mean ± SD) (s) | 4.6 ± 0.8 | 5.9 ± 1.1 | 4.6 ± 0.8 | 5.1 ± 0.6 | 0.007 | 0.27 | 0.18 |
20 m Single Leg Timed Hop (Surgical) (mean ± SD) (s) | 4.6 ± 0.8 | 6.2 ± 1.3 | 4.7 ± 0.9 | 5.1 ± 0.9 | 0.009 | 0.21 | 0.13 |
20 m Single Leg Timed Hop Symmetry Index (mean ± SD) (%) | 99 ± 6 | 96 ± 6 | 99 ± 5 | 99.8 ± 0.4 | 0.60 | 0.42 | 0.40 |
20 m Single Leg Timed Crossover Hop (Non-surgical) (mean ± SD) (s) | 5.6 ± 1.5 | 7.2 ± 1.7 | 5.3 ± 1.2 | 6.3 ± 1.2 | 0.015 | 0.28 | 0.63 |
20 m Single Leg Timed Crossover Hop (Surgical) (mean ± SD) (s) | 5.6 ± 1.4 | 7.2 ± 1.7 | 5.3 ± 1.1 | 6.1 ± 1.0 | 0.028 | 0.19 | 0.47 |
20 m Single Leg Timed Crossover Hop Symmetry Index (mean ± SD) (%) | 98.6 ± 7 | 99.6 ± 5 | 98.6 ± 5 | 103.6 ± 4 | 0.13 | 0.45 | 0.45 |
NFL “5-10-5” (Non-Surgical side first cut) (mean ± SD) (s) | 4.9 ± 0.6 | 5.6 ± 0.7 | 4.9 ± 0.4 | 5.3 ± 0.6 | 0.005 | 0.42 | 0.32 |
NFL “5-10-5” (Surgical side first cut) (mean ± SD) (s) | 4.8 ± 0.4 | 5.6 ± 0.7 | 4.9 ± 0.4 | 5.3 ± 0.6 | 0.001 | 0.46 | 0.23 |
NFL “5-10-5” Symmetry Index (%)(mean ± SD) (%) | 99.8 ± 6 | 99.5 ± 3 | 100 ± 3 | 100 ± 3 | 0.91 | 0.76 | 0.96 |
NFL 3 Cone Shuttle “L” Drill (Non-surgical side cut) (mean ± SD) (s) | 8.3 ± 0.9 | 9.3 ± 1.2 | 8.3 ± 0.6 | 9.2 ± 3 | <0.001 | 0.56 | 0.50 |
NFL 3 Cone Shuttle “L” Drill (Surgical side cut) (mean ± SD) (s) | 8.3 ± 0.8 | 9.3 ± 1.2 | 8.2 ± 0.5 | 9.3 ± 2 | <0.001 | 0.65 | 0.49 |
NFL 3 Cone Shuttle “L” Drill Symmetry Index (mean ± SD) (%) | 100 ± 3 | 100 ± 3 | 100 ± 2 | 100 ± 2 | 0.74 | 0.65 | 0.89 |
Early Adolescence (10–13 Years) | Middle Adolescence (14–17 Years) | Late Adolescence (≥18 Years) | |
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|
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Potential Sports Orthopedic Considerations | |||
1. | Family History of ACL Injury—If non- or in-direct contact, consider selection of a lower knee injury risk sport. | ||
2. | If positive knee Beighton sign [37,38,39,40]—Selection of a lower knee injury risk sport. | ||
3. | If positive abnormal tibial surface or femoral notch morphology [41,42,43,44]—Selection of a lower knee injury risk sport. | ||
4. | Confidence/Self-Efficacy [23,24,25]—Consider in relation to existing skill level and adolescence phase. | ||
5. | Fear/Kinesiophobia/Anxiety [24,25,26,27]—Consider in relation to existing skill level, injury history, and adolescence phase. | ||
6. | Athletic Identity [21,22,51,52]—Consider in relation to adolescence phase, desire for sport specialization or elite level training, and whether activity diversification is needed. | ||
7. | Primary Sport Selection(s)—Consider in relation to #1–3; if “+” consider selection of a lower knee injury risk sport. | ||
8. | Dedicated Sport Seasonality (in season, out of season (recovery) time periods)—Consider in relation to #1–3. | ||
9. | Injury/Re-Injury Cognitive Risk Appraisal [25,35]—Consider in relation to #1–3 and adolescence phase. | ||
10. | Social Support—Consider based on each adolescence phase and existing resources (parents/guardians, pediatrician, team physicians, coaches, and other stakeholders). |
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Nyland, J.; Pyle, B.; Carter, S.; Krupp, R.; Caborn, D.N.M. Young Athletes Perceiving Greater Improvement After Return to Sport Bridge Program Sustained More Ipsilateral ACL Graft or Contralateral ACL Injuries During Their First Season Back: An Observational Study. J. Funct. Morphol. Kinesiol. 2025, 10, 335. https://doi.org/10.3390/jfmk10030335
Nyland J, Pyle B, Carter S, Krupp R, Caborn DNM. Young Athletes Perceiving Greater Improvement After Return to Sport Bridge Program Sustained More Ipsilateral ACL Graft or Contralateral ACL Injuries During Their First Season Back: An Observational Study. Journal of Functional Morphology and Kinesiology. 2025; 10(3):335. https://doi.org/10.3390/jfmk10030335
Chicago/Turabian StyleNyland, John, Brandon Pyle, Samuel Carter, Ryan Krupp, and David N. M. Caborn. 2025. "Young Athletes Perceiving Greater Improvement After Return to Sport Bridge Program Sustained More Ipsilateral ACL Graft or Contralateral ACL Injuries During Their First Season Back: An Observational Study" Journal of Functional Morphology and Kinesiology 10, no. 3: 335. https://doi.org/10.3390/jfmk10030335
APA StyleNyland, J., Pyle, B., Carter, S., Krupp, R., & Caborn, D. N. M. (2025). Young Athletes Perceiving Greater Improvement After Return to Sport Bridge Program Sustained More Ipsilateral ACL Graft or Contralateral ACL Injuries During Their First Season Back: An Observational Study. Journal of Functional Morphology and Kinesiology, 10(3), 335. https://doi.org/10.3390/jfmk10030335