Utilization of Modified NFL Combine Testing to Identify Functional Deficits in Athletes Following ACL Reconstruction
Myer GD, Schmitt LC, Brent JL, Ford KR, Barber Foss KD, Scherer BJ, Heidt RS, Divine JG, Hewett TE. J Orthop Sports Phys Ther. 2011 June; 41(6): 377-388.
Anterior cruciate ligament (ACL) tears affect a large group of young athletes. Functional deficits such as strength deficits and decreased functional scores have been reported up to 2 years after an ACL reconstruction. Unfortunately, there is a lack of objective clinical measures that can identify these deficits and can be used to influence return to play decisions. This highlights the need for a performance-based, on-field assessment tool capable of detecting lower extremity deficits in the later stages of rehabilitation. Therefore, Myer and colleagues, attempted to identify unilateral lower limb deficits using a modified version of the NFL Combine tests (modified double-limb tests) and single-limb tests. Eighteen ACL reconstructed patients that were cleared to return to play and 20 matched, healthy-control athletes performed functional tests that included broad jump, vertical jump, modified agility T-test, timed hop, triple hop, single hop, and crossover hop (full text and slides available online for detailed descriptions). The authors reported that single-limb tasks (e.g., single hop test, triple hop) detected significant functional deficits in individuals who had undergone ACL reconstruction, while the modified bilateral-limb tasks (e.g., modified agility T-test) were not sensitive enough to identify these deficits.
Overall, this study highlights the effectiveness of using single-limb tasks (e.g., single hop for distance, crossover hop for distance, triple hop for distance) to identify functional deficits in ACL reconstruction patients that had been previously cleared to play. Properly identifying these deficits may be critical in determining an athlete’s return to play status, minimizing the risk for reinjury, and identifying functional deficits that should be addressed in rehabilitation or a strength training program. The authors suggest that we need more research exploring other combinations of functional tasks and measures of movement quality (e.g., does the hip adduct during a hop landing). This study supports other research [see Eitzen 2010], which indicated that these single limb tests can detect functional deficits. Clinically, these tests are fairly easy to administer without the use of extraneous materials or equipment. Is this something you currently use in your return to play decisions? If not, what is it about these test that makes you apprehensive?
Written by: Kyle Harris
Reviewed by: Jeffrey Driban