Force and power testing during anterior cruciate ligament reconstruction rehabilitation: a world-wide survey of current practices

Background
During rehabilitation, the importance of restoring strength and power in a stage-based framework highlights the paramount role of testing and monitoring. Despite theoretical understanding of an optimal recovery pathway, it is unclear and inconsistent as to how practitioners implement force and power assessment following anterior cruciate ligament reconstruction (ACLR).

Objectives
We aimed to examine current worldwide practices with evaluating patients post-ACLR, identify the relative utilisation of different devices and methodologies across the rehabilitation process, and to explore the interactions between the implemented devices and respondents’ self-perceived testing quality (evaluated by participants via a Likert scale).

Methods
Data were collected via an international online survey composed of 100 items, organised across 12 sections, exploring the demographics of respondents and implemented testing devices to assess individuals after ACLR and their perceived testing quality.

Results
A total of 1154 practitioners from 78 different countries completed the survey. According to the pre-defined eight categories, 157 different combinations were recorded among practitioners. Respondents tended to use multiple devices (95.8%), with a mean of 3.6 ± 1.4. Patient assessments were most often repeated longitudinally throughout the recovery process post-ACLR (96.4%). Specific devices were used as part of “criteria-based” testing by 46.4% of respondents, “criteria- and time-based” testing by 30.8% and solely “time-based” testing by 21.9%. A significant but weak direct correlation was observed between the number of implemented devices and self-perceived testing quality (ρ = 0.32, p < 0.001), with force plates, an isokinetic dynamometer, Nordic hamstrings device and a hand-held dynamometer significantly associated with increased self-perceived testing quality (R2 = 0.21, p < 0.001).

Conclusions
A high degree of variability in test device implementation existed among practitioners. According to the eight pre-defined device categories, over 150 different device combinations were recorded among respondents. Device use was different throughout the stages of rehabilitation and testing was primarily performed as criteria to advance patients throughout the recovery process. While acknowledging that these findings may be influenced by self-serving bias, they suggest that practitioners involved in force and power testing post-ACLR may benefit from implementing a wide range of devices, including more quantitative and objective instruments such as force plates and the isokinetic dynamometer, as these appeared to be related to higher levels of self-perceived testing quality.

This version of the article has been accepted for publication, after peer review (when applicable) and is subject to Springer Nature’s AM terms of use (https://www.springernature.com/gp/open-research/policies/accepted-ma...), but is not the Version of Record and does not reflect post-acceptance improvements, or any corrections. The Version of Record is available online at: http://dx.doi.org/10.1007/s40279-025-02374-4