From Rehabilitation to Sport Performance: A Criterion-Based, Functional Return to Sport Testing Algorithm—Part II Late-Stage Criteria

The determination of return to sport (RTS) following knee injury and surgical interventions is a complex, multifactorial process that remains controversial in sports medicine. However, current research and clinical practice patterns endorse a compilation of subjective outcome measures, physical examination, as well as physical performance and function to determine an athlete’s readiness for RTS, the specific tests, and the respective criteria areas of ongoing debate. Given the inconsistency of RTS tests and criteria, the less than satisfactory return to prior levels of competition, and increased risks of reinjury rates, a comprehensive and objective testing sequence is needed. The purpose of this chapter is to propose a comprehensive, criterion-based return to sport testing sequence for mid- to late-stage rehabilitation that synthesizes the current literature with practice-based evidence of industry-leading experts. The chapter is part two of a two-part chapter series and details the elements of muscle performance, functional jump and hop testing, physical performance batteries, and sport-specific considerations. Moreover, specific criteria for return to competition and performance of a functional testing algorithm (FTA) provide “evidence-informed” recommendations and guidance to rehabilitation and sport medicine professionals. The rationale for considering each physical construct (i.e., muscle performance, functional testing, physical performance battery, sport-specific assessments, etc.) and the justifications for selecting each assessment are discussed. The criterion-based FTA will provide experienced clinicians with a theoretical and tangible framework for an effective and efficient research-based testing approach while providing more novice clinicians in this specialty area with a specific, comprehensive, and replicable test sequence to follow.