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ACL injury prevention — DCH MCQ

Instant feedback + full explanation. One question, done properly.

ModeratePaediatric SportACL injury preventionDCH

A 15-year-old female footballer is 12 months after anterior cruciate ligament reconstruction and is completing a secondary injury-prevention programme. She has full knee movement, no pain or swelling, and quadriceps and hamstring strength greater than 90% of the contralateral side. Her other return-to-sport criteria are satisfactory, but during repeated sport-specific cutting and deceleration drills she consistently demonstrates dynamic knee valgus. What is the most appropriate return-to-play decision?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Delay unrestricted match play and retrain landing and cutting control

Explanation lettering: B = shown as A · A = shown as B · D = shown as C · C = shown as D

B is correct. Persistent dynamic valgus during repeated sport-specific tasks demonstrates inadequate movement quality and neuromuscular control despite satisfactory isolated strength. Paediatric return-to-sport decisions should use quantitative measures together with qualitative assessment of sport-specific movement. Unrestricted pivoting football should therefore be delayed while landing, deceleration and change-of-direction mechanics are retrained and reassessed, including under fatigue. A is incorrect because strength symmetry alone does not establish safe functional control. C is incorrect because bracing is not a standalone clearance test and does not correct faulty mechanics. D is incorrect because cutting must be progressively retrained rather than avoided, as it is intrinsic to football. E is incorrect because a single prevention warm-up neither corrects the deficit nor demonstrates sustained readiness.

Reference: Lorange JP et al. Return to Sport After Pediatric Anterior Cruciate Ligament Reconstruction: A Systematic Review of the Criteria. American Journal of Sports Medicine. 2024;52(6):1641-1651. https://www.cuh.nhs.uk/patient-information/anterior-cruciate-ligament-acl-reconstruction-rehabilitation/