The wealth of information provided in this unique text will enable orthopedic surgeons, medical practitioners, physical therapists, and trainers to ensure that athletes who suffer anterior cruciate ligament (ACL) injuries, or who require major knee operations for other reasons, have the best possible chance of safely resuming sporting activity at their desired level without subsequent problems. Divided into seven thematic sections, the coverage is wide-ranging and encompasses common barriers to return to sport, return to sport decision-based models, and the complete spectrum of optimal treatment for ACL injuries, including preoperative and postoperative rehabilitation. Advanced training concepts are explained in detail, with description of sports-specific programs for soccer, basketball, and tennis. Readers will find detailed guidance on objective testing for muscle strength, neuromuscular function, neurocognitive function, and cardiovascular fitness, as well as validated assessments to identify and manage psychological issues. In addition, return to sport considerations after meniscus surgery, patellofemoral realignment, articular cartilage procedures, and knee arthroplasty are discussed.

Generously illustrated and heavily referenced, Return to Sport after ACL Reconstruction and Other Knee Operations is a comprehensive resource for all medical professionals and support staff working with athletes and active patients looking to get back in the game with confidence.

Frank R. Noyes, MD, works at the Cincinnati SportsMedicine and Orthopaedic Center/Mercy Health, which he founded and where he has served as CEO since 1981. He is also President and Medical Director of the Noyes Knee Institute in Cincinnati, Ohio. Prior to founding the Center, Dr. Noyes was Director of the Sports Medicine Institute in the Department of Orthopaedic Surgery at the University of Cincinnati. He is currently a Professor of Orthopaedic Surgery, Emeritus, University of Cincinnati College of Medicine from 2017. Dr. Noyes has received numerous awards and honors, including the Kappa Delta Research Award from the American Academy of Orthopaedic Surgeons, the Dr. Ernst Jokl Sports Medicine Award from the U.S. Sports Academy, and induction into the American Orthopaedic Society for Sports Medicine's Hall of Fame. He was the most frequently cited author in orthopaedic and sports medicine in 2012. In 2013 he served as President of the Herodicus Society, which is considered the premier group of American, Canadian, and European sports medicine physicians. Dr. Noyes has held numerous editorial board appointments for leading journals. He has published over 400 articles in peer-reviewed journals and medical textbooks, is the editor of Noyes' Knee Disorders: Surgery, Rehabilitation, Clinical Outcomes, 1st and 2nd editions, co-editor of ACL Injuries in the Female Athlete: Causes, Impacts, and Conditioning Programs, 1st and 2nd editions, and co-editor of 12 eBooks that discuss a variety of knee and lower limb conditions.

Sue D. Barber-Westin, BS, is Director of Clinical & Applied Research at the Cincinnati SportsMedicine Research and Education Foundation and the Noyes Knee Institute, a position she has held since 1985. She is also the founder of Westin Research Consulting, which provides research consultation services. Ms. Barber-Westin is an exceptionally experienced clinical research professional specialized in the development, implementation, and completion of outcome studies in orthopaedics and sports medicine. Along with Dr. Noyes, she has conducted over 70 clinical research projects involving 7000 patients and volunteer subjects, and published over 200 papers in peer-reviewed orthopaedic journals and medical textbooks. In 2004, Ms. Barber-Westin and Dr. Noyes received the OREF Clinical Research Award, presented jointly by the Orthopaedic Research and Education Foundation and the American Academy of Orthopaedic Surgeons. Ms. Barber-Westin is associate editor of Noyes' Knee Disorders: Surgery, Rehabilitation, Clinical Outcomes, 1st and 2nd editions, co-editor of ACL Injuries in the Female Athlete: Causes, Impacts, and Conditioning Programs, 1st and 2nd editions, and co-editor of 12 eBooks that discuss a variety of knee and lower limb conditions.

1;Preface;5 2;Contents;8 3;Contributors;11 4;Abbreviations;15 5;Part I: Problems and Barriers for Successful Return to Sport;19 5.1;1: Advantages and Potential Consequences of Return to Sport After ACL Reconstruction: Quality of Life, Reinjury Rates, and Knee Osteoarthritis;20 5.1.1;1.1 Introduction;20 5.1.2;1.2 Quality of Life and Patient Satisfaction: Correlation with Return to Sport;21 5.1.3;1.3 Reinjury Rates After ACL Reconstruction;22 5.1.4;1.4 Factors Involved in the Development of Knee Osteoarthritis After ACL Surgery;26 5.1.5;References;33 5.2;2: Common Symptom, Psychological, and Psychosocial Barriers to Return to Sport;41 5.2.1;2.1 Common Physical Barriers;41 5.2.2;2.2 Common Psychological and Psychosocial Barriers;45 5.2.2.1;2.2.1 Fear of Reinjury and Reinjury Anxiety;45 5.2.2.2;2.2.2 Self-Efficacy;48 5.2.2.3;2.2.3 Locus of Control;48 5.2.3;2.3 Conclusions;49 5.2.4;References;49 5.3;3: The Arthritis Barrier: Long-Term Effects of ACL Trauma on Knee Joint Health;52 5.3.1;3.1 Epidemiology of Post-Traumatic Osteoarthritis Following ACL Trauma;52 5.3.2;3.2 Effect of Sport on PTOA Following ACL Trauma;53 5.3.3;3.3 Effect of ACL Injury and Concomitant Articular Cartilage Injury on PTOA;54 5.3.4;3.4 Effect of ACL Injury and Post-Traumatic Bone Marrow Lesions on PTOA;55 5.3.5;3.5 Effect of ACL Disruption and Concomitant Meniscal Injury on PTOA;56 5.3.6;3.6 Effect of Surgical Versus Nonsurgical Treatment of ACL Injury on PTOA;57 5.3.7;3.7 Effect of Timing of ACL Reconstruction Surgery on PTOA;58 5.3.8;3.8 Effect of ACL Graft Material on PTOA;58 5.3.9;3.9 Effect of ACL Trauma on Patellofemoral and Tibiofemoral PTOA;59 5.3.10;3.10 Return to Sport Considerations for Athletes;59 5.3.11;3.11 Limitations of the Current Literature;60 5.3.12;References;61 6;Part II: Return to Sport: Whose Decision Is It?;66 6.1;4: Return to Sport Decision-Based Models;67 6.1.1;4.1 Introduction;67 6.1.2;4.2 Overall Athlete Care;68 6.1.3;4.3 StARRT Framework for RTS Decision-Making;70 6.1.3.1;4.3.1 Step 1: Tissue Health;71 6.1.3.2;4.3.2 Step 2: Tissue Stresses;71 6.1.3.3;4.3.3 Step 3: Risk Tolerance Modifiers;71 6.1.4;4.4 A Concrete Example in Applying the StARRT Framework;72 6.1.4.1;4.4.1 Multiple Outcomes;73 6.1.4.2;4.4.2 From StARRT to Decision-Tree Analysis;74 6.1.5;4.5 The Athlete's Best Interests?;74 6.1.6;4.6 Which Stakeholder Should Be the Decision-Maker?;75 6.1.6.1;4.6.1 Protecting the Athlete with a Multidisciplinary Approach?;77 6.1.7;4.7 Summary;78 6.1.8;References;78 6.2;5: Role of the Team Physician, Orthopedic Surgeon, and Rehabilitation Specialists;80 6.2.1;5.1 Introduction;80 6.2.2;5.2 Preoperative Phase;80 6.2.3;5.3 Early Postoperative Phase;83 6.2.4;5.4 Late Postoperative Phase;85 6.2.5;5.5 RTS Phase;86 6.2.6;5.6 Summary;90 6.2.7;References;90 6.3;6: Return to Sport After Primary ACL Reconstruction in Amateur, Children, and Elite Athletes: Feasibility and Reinjury Concerns;92 6.3.1;6.1 Introduction;92 6.3.2;6.2 Amateur Athletes;94 6.3.2.1;6.2.1 Return to Sport: Rates and Influential Factors;94 6.3.2.2;6.2.2 Reinjuries: Rates and Significant Factors;105 6.3.2.3;6.2.3 Published Criteria for Release to Unrestricted Activities;105 6.3.2.4;6.2.4 Conclusions and Recommendations;105 6.3.3;6.3 Children and Adolescent Athletes;108 6.3.3.1;6.3.1 Return to Sport: Rates and Influential Factors;108 6.3.3.2;6.3.2 Reinjuries: Rates and Significant Factors;111 6.3.3.3;6.3.3 Published Criteria for Release to Unrestricted Activities;115 6.3.3.4;6.3.4 Conclusions and Recommendations;115 6.3.4;6.4 Elite Collegiate and Professional Athletes;116 6.3.4.1;6.4.1 Return to Sport: Rates and Influential Factors;116 6.3.4.2;6.4.2 Reinjuries: Rates and Significant Factors;120 6.3.4.3;6.4.3 Published Criteria for Release to Unrestricted Activities;122 6.3.4.4;6.4.4 Conclusions and Recommendations;122 6.3.5;6.5 Future Concerns;123 6.3.6;References;124 7;Part III: Spectrum of Optimal Treatment of ACL Injuries;132 7.1;7: What Is the Scientific Basis for Knee Ligamen