What is the Melbourne Return to Sport Score (MRSS)?

Assessment, and measurable outcomes

The Melbourne Return to Sport Score (MRSS) in an assessment tool for return to sport following anterior cruciate ligament reconstruction. There are three components to the test:

a)    Clinical Examination (25 marks)

b)   IKDC Subjective Knee Evaluation (25 marks)

c)    Functional Testing (50 marks)

People receive a score out of 100, and pilot data suggests that a score of more than 95 indicates a greater chance of returning to pre-injury sports and in the short term, predicts a quicker return to form. An abstract on the pilot data can be found here: http://isakos.com/meetings/2013congress/onsite/AbstractView.aspx?EventID=6243

All tests in the MRSS other then the Lachman’s test, pivot shift test, IKDC, and the single leg squats to fatigue test have been described in previous posts on ACL Rehab Phases 1-3. The single leg squats to fatigue test is described in the relevant section below.

A summary of the MRSS is as follow

A successful return to sports following ACL reconstruction involves overcoming both physical and mental barriers. Despite relatively small numbers higher MRSS scores appear indicate a greater chance of returning to pre-injury sports and in the short term, predicts a quicker return to form. The score is a useful tool for the surgeon and may provide a mental aid for the patient assisting a successful return to play.

Part A: Stability, Swelling, & Range

Part B: IKDC Subjective Knee Evaluation Form

Part C: Functional Testing

Final Score

And the testing sheet for the Functional Testing is below:

Star Excursion Balance Test

Single Hop Test

Triple Cross Over Hop Test

Abridged LESS: Jump-Land-Rebound Score

Single Leg Squats to Fatigue (90° knee flexion)

The single leg squats to fatigue test: Subjects are seated on the edge of a treatment plinth with hips and knees at 90°. Arms are to be crossed over the chest. On one leg, subjects are asked to raise to a fully extended knee as many times as possible at a tempo of 2 seconds up, and 2 seconds down. The test is complete when subjects are unable to complete any further squats, or the tempo or form is incorrect. The maximum number of squats are recorded for each leg.

The criteria for each of the MRSS outcome measures is as follows:

Part A: Stability, Swelling, & Range

Presence of effusion test

• absent
• present

Lachmans test

• Nil: no difference to the uninvolved side
• Mild: 0 to 5 mm laxity (greater than the uninvolved side)
• Moderate: 6 to 10 mm laxity (greater than the uninvolved side)
• Severe: 11 to 15 mm laxity (greater than the uninvolved side)

Pivot shift test

• I  : Gentle twisting slide with tibia twisting internally maximally;
• II : Clunk with tibia neutral, negative when tibia externally rotated;
• III: Painless glide for examiner and patient;
• IV : Jamming and Plowing, impingement;

Part B: IKDC Subjective Knee Evaluation Form

A link to the IKDC form:

http://www.sportsmed.org/uploadedFiles/Content/Medical_Professionals/Research/Grants/IKDC_Forms/IKDC%202000%20-%20Revised%20Subjective%20Scoring.pdf

Part C: Functional Testing

Functional Assessment Scoring

The hop tests, single leg squats, and star excursion balance test will be calculated as a limb symmetry index by dividing the mean distance (cms), or repetitions of the involved limb by the mean of the non involved limb, and multiply by 100. Each criteria of the abridged Landing Error Scoring System (LESS) – jump/land/rebound task will be assessed on a 0/5 point scale;

For the tests that use the limb symmetry index, the following criteria will apply:

The Melbourne Return to Sports Score (MRSS) – An Assessment Tool for Return to Sports Following Anterior Cruciate Ligament Reconstruction