How Can We Optimize a Safe Return to Sport for Youth Athletes? Emerging Concepts and Perspectives – Multidisciplinary Approach

Dai Sugimoto,1,2 Mario Bizzini,3 Joan Putri Callista,4 Mary M Daley,5 Yuka Kimura,6 Tomas Maly,7,8 Genna S Patacchiola,1,2 Mark V Paterno9,10 1Division of Sports Medicine, Boston Children’s Hospital, Boston, MA, USA; 2The Micheli Center for Sports Injury Prevention, Waltham, MA, USA; 3Human Performance Lab, Schulthess Clinic, Zurich, Switzerland; 4Faculty of Sport Sciences, Waseda University, Tokyo, Japan; 5Sports Medicine and Performance Center, Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA; 6Department of Orthopaedic Surgery, Hirosaki University, Graduate School of Medicine, Hirosaki, Aomori, Japan; 7The AC Sparta Praha Football Club, Prague, Czech Republic; 8Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic; 9Division of Occupational Therapy and Physical Therapy; Division of Sports Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA; 10Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USACorrespondence: Dai Sugimoto, The Micheli Center for Sports Injury Prevention, 9 Hope Ave, Waltham, MA, 02453, USA, Tel +1 781-216-3715, Email [email protected]: Although exercises and physical activities are beneficial for overall health, it can unfortunately result in a musculoskeletal injury that requires a surgical intervention in physically active youth. One of the major injures young athletes sustain is anterior cruciate ligament (ACL) tear, which often requires a surgical intervention. Following the ACL reconstruction (ACLR) surgery, athletes need to participate in rehabilitation and often perform return-to-sport (RTS) testing. During this process, the RTS decision requires the contributions of multidisciplinary sports medicine healthcare providers.Purpose: To discuss how to optimize a safe RTS from the perspective of multidisciplinary sports medicine healthcare practitioners and synthesize them with research-based evidence using a clinical scenario involving a female athlete following ACL injury.Methods: A clinical scenario of a young female basketball player with an ACL tear is presented. In this particular case, the patient had a previous ACL tear history in her contralateral limb. Thigh circumference, knee range of motion, quadriceps and hamstrings strength, hop tests, and psychological readiness measures at 9 months post-operatively is also presented.Results: An orthopaedic surgeon, academic-physiotherapist, sports psychiatrist, clinical physical therapy, and performance and sport scientist provided their RTS perspectives based on the given scenario. Because of her previous history and low psychological readiness, several emerging concepts were discussed including neurocognitive-based rehabilitation, cognitive-behavioral therapy, and step-by-step RTS progression (return to participation, sport, and performance).Conclusion: The current article synthesized clinical insights from various sports medicine healthcare with practitioners and research evidence based on an ACL clinical scenario. The approaches discussed in this paper may be beneficial to facilitate safe RTS.Keywords: pediatrics, female athletes, rehabilitation, ACL, knee injury