Interdisziplinäre Beurteilungskriterien für die Rehabilitation nach Verletzungen an der unteren Extremität: Ein funktionsbasierter Return-to-Activity Algorithmus

Background: In the treatment of patients with lower extremity injuries, a paradigm shift is taking place: Time-dependent concepts are increasingly being replaced by function-based concepts. Methods: A function-based return-to-activity algorithm is presented which contains a level classification (I-IV). Qualitative and subsequent quantitative tests are assigned to every level. Within each level, first the respective qualitative test has to be passed before patients are allowed to perform the corresponding quantitative test. Criteria for success are qualitative and quantitative comparisons with the unaffected side. Before entering the next level, both tests have to be successfully passed. The levels are ordered according to increasing demands on the loco-motor system. These demands are adequate stability without impact interaction in sagittal plane for level I, followed by dynamic stability demands for level II. Impacts in frontal plane are added for level III and finally multidirectional impacts have to be compensated at level IV. The time expenditure per level is no more than 5 minutes. The case of a professional soccer player will serve to exemplify the return-to-activity algorithm. Following a knee injury, he underwent arthroscopy with ACL reconstruction (patellar tendon) and a partial meniscectomy (lateral and medial). Results: The athlete was able to successfully pass each level and finished his rehabilitation 203 days post injury. He returned to the team training 221 days post injury. 247 days post injury, the athlete completed his first game. Conclusion: The return-to-activity algorithm is able to support the evaluation of the functional status of the loco-motor system after injury or surgery and is furthermore capable of uncovering deficits or asymmetries, which are a proven risk for re-injury. This function-oriented individual approach is able to adequately dose the therapeutic efforts on an individual basis. With this approach, the right timing for a safe return to sports activities can be detected with high certainty.