Functional Testing Literature

For Medical Students

What the Question Was

The question was how to decide when someone can return to sport after a knee injury, since the ligament examination does not answer it. 4.21.7 covers return to sport testing.

The first answers were time based, and the work that followed asked whether performance could do better than a date. 4.21.8 covers return to play decision making.

The question then became which performance tests, measured how, and against what threshold. 4.21.2 covers the single leg hop.

What It Showed

The work established that side to side performance can be measured reproducibly, which is what made criteria possible.

It established that confidence is a separate and substantial limit on return, which the physical tests do not capture. 4.22.6 covers the psychological measure.

It did not establish that passing a battery prevents reinjury, which is the question everyone wants answered. 4.21.8 covers return to play decision making.

MRCS Level

What Was Done

Noyes, Barber and Mangine developed the hop tests and the limb symmetry approach that the batteries are built on, which made a functional deficit a number. 4.21.2 covers the single leg hop.

Daniel and colleagues worked on instrumented laxity and on the relationship between measured laxity and function, which established how loose that relationship is. 4.2.2 covers instability.

Landing mechanics were characterised and then scored, which produced the observational scoring systems. 4.21.6 covers the landing error scoring system.

Webster and Feller developed the psychological readiness measure, which added the component the physical tests miss. 4.22.6 covers that measure.

Cohort studies followed athletes after reconstruction and related their test results and their return decisions to reinjury.

What It Showed

The cohort work established that reinjury rates after cruciate reconstruction in young athletes are higher than the clinical impression suggested, which is the finding that changed practice. 4.20.1 covers the reconstruction assessment.

It established that time since surgery and performance criteria both carry information, and that neither substitutes for the other. 4.21.8 covers return to play decision making.

It established that psychological readiness predicts actual return independently, which is why the measure is in the battery. 4.22.6 covers that measure.

It established that symmetry can be achieved by a bilaterally deconditioned athlete, which is the systematic weakness of every paired comparison. 4.3.9 covers muscle wasting.

No sensitivity, specificity or likelihood ratio appears on this page, under decision 023 and decision 022 together. The ranking is what is recalled reliably; a specific percentage written from memory would look exactly like a correct one.

FRCS Level

What It Showed

At decision level this literature produced criteria that structure a decision without resolving it.

A battery identifies the limiting component, which makes advice specific, and that is its demonstrated contribution. 4.21.7 covers return to sport testing.

Time remains an independent criterion, because graft maturation does not report through performance. 4.21.8 covers return to play decision making.

The relationship between criterion based clearance and reinjury is contested in the literature, which means a clinician cannot promise what clearance buys. 4.22.8 covers the use of these scores.

Age and activity level dominate reinjury risk in the cohorts, which puts the largest effects outside anything the examination measures. 4.23.2 covers the elite athlete.

What It Changed

It replaced a date with a set of criteria, which is the clearest practical change. 4.21.7 covers return to sport testing.

It raised the expected rehabilitation duration, because the criteria take longer to meet than the traditional intervals. 4.21.8 covers return to play decision making.

It added a psychological measure to an assessment that had been entirely physical. 4.22.6 covers that measure.

It made the decision explicitly shared, because the residual risk is real and belongs to the athlete. 4.22.8 covers the use of these scores.

Fellowship Level

What It Changed

At fellowship level this literature is the most honest in the section about its own limits, and reading it that way is the point.

Criteria describe a state at a moment and the cohorts describe risk over years, so a battery result is not a forecast however many components it has. 4.21.8 covers return to play decision making.

Thresholds are conventions drawn from specific cohorts, so applying them to a different athlete is an extrapolation whose size is unknown. 4.23.2 covers the elite athlete.

Symmetry measured against a changed limb is the methodological weakness that every test in the battery shares, and no amount of additional tests fixes it. 4.3.9 covers muscle wasting.

The planned, self initiated tasks in every battery differ from the unplanned loading that injures knees, which is the gap the field has not closed. 4.21.4 covers the crossover hop.

Psychological readiness predicts return and the intervention for a low score is less well established than the measurement, which is a familiar asymmetry. 4.22.6 covers that measure.

What to Read Now

The cohort literature on reinjury after reconstruction is the reading that changed practice, and it is the most important body of work behind chapter 4.21.

The limb symmetry literature is where this page's omitted thresholds belong, and a reviewer with access can add them into the individual test pages. 4.21.2 covers the single leg hop.

The psychological readiness literature is the reading for the component the physical tests miss. 4.22.6 covers that measure.

Chapter 3.17 carries the landing and cutting biomechanics that the scoring systems are built on. 4.21.6 covers the landing error scoring system.

No reference list appears on this page. No source was retrieved, and under decision 022 a named author with a described finding is the most this process can honestly supply, with no year, journal or citation attached.