Total Score of Athleticism: Profiling Strength and Power Characteristics in Professional Soccer Players After Anterior Cruciate Ligament Reconstruction to Assess Readiness to Return to Sport

Background: There is no consensus on the optimal testing procedure to determine return-to-sport (RTS) readiness after anterior cruciate ligament (ACL) reconstruction. Current approaches use limb symmetry across a range of tests, but this does not consider a patient's level of athleticism or benchmarks relative to his or her noninjured counterparts. Purpose: To examine the utility of the Total Score of Athleticism (TSA), a composite scale including strength, power, and reactive strength assessments, to aid RTS decision-making. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 95 professional soccer players (60 who underwent ACL reconstruction [mean age, 25.1 +/- 12.6 years] and 35 who were uninjured [mean age, 23.8 +/- 2.8 years]) completed a battery of tests including isokinetic knee extension and flexion torque, bilateral and unilateral countermovement jump height, relative peak power, and reactive strength index-modified. The TSA score (derived from Z scores) was calculated, and we (1) examined differences between the ACL-reconstructed and uninjured groups at the time of RTS, (2) assessed the predictive ability of the TSA to identify the player's status (ACL reconstruction vs uninjured control), and (3) included a case series to discuss the characteristics of players who sustained a subsequent injury within 4 months after RTS. Results: A large difference between the ACL-reconstructed and uninjured groups in the TSA score (d = 0.84; P < .0001) was evident. For every additional increase of 1 unit in the TSA score, the odds of belonging to the ACL-reconstructed group decreased by 74% (95% CI, 0.19-0.56). By visual inspection, the frequency of reinjured players was higher in the low (4/7) TSA tertile compared with the medium (2/7) and high (1/7) TSA tertiles. Conclusion: Preliminary evidence indicates that the TSA may be a useful RTS readiness tool, as the composite score derived from strength and power measures was different in soccer players at the time of RTS after ACL reconstruction compared with healthy matched controls. There was also a higher frequency of low TSA scores in players who sustained a second injury after RTS. Therefore, it is recommended to routinely administer RTS tests encompassing strength, power, and reactive strength qualities each season across the largest possible number of players (ideally teammates).