ACL REHABILITATION & return to sports testing
We are committed to preparing our patients for return to sporting activity using evidence based testing and rehabilitation. Sadly, only 5% of ACL patients receive evidence based rehab guidelines (Ebert 2017). You can trust that your rehabilitation after surgery will be with someone who has rehabilitated hundreds of ACLs over the last 18 years, has worked directly with numerous orthopedic surgeons, mentors PT’s across the globe and is actively involved in ACL research.
The re-injury rate after ACL reconstruction is 20-30%, most occurring in the first 12 months after surgery. To prevent a second ACL surgery, an assessment of your knee’s function will determine when you are ready to return to full activity. In the past, time from surgery (typically 6 months) was the only factor used to clear a person for sports. In fact, only 13% of research papers cited include any measurable objective criteria to clear an athlete back to sport (Barber-Westin 2011). Evolving research has helped us realize that we need to closely evaluate strength, performance measures, neuromuscular control and psychological readiness. If specific criteria are not met, there is a 4x greater risk of ACL rupture (Kyritsis 2016). Return to Sports Assessments should be conducted by a physical therapist who has experience conducting reliable and valid tests and most importantly, interpreting results.
RETURN TO SPORTS TESTING INCLUDES:
STRENGTH. Quad imbalance is a significant predictor of knee-re injury and patient satisfaction in ACL patients. Quad strength can be accurately tested with an isokinetic machine and should be at least 90% of the non-surgical side. For every 1% in quad symmetry, there is a 3% reduction in re-injury (Grindem 2016). Patients are also more likely to have reached “functional recovery” at 1 year from surgery if their quads were symmetric at Return to Sports testing (Ithurburn 2017).
FUNCTIONAL TESTS. Performance measures include specific tests that assess single limb hop distance and jump landing technique. We know that higher single leg hop performance at the time of assessment predicts better self-reported function at 1 year from surgery (Logerstedt 2012). Further, those with symmetric single leg hopping distance as well as high self-reported function are 4x more likely to have successful sports participation (Schmitt 2016). The ability to pass these tests is correlated closely with strength; however, these tests can also identify if and how an athlete is compensating for their injury.
Rehabilitation also includes sport specific training that addresses known risk factors for ACL injury. We have worked with most types of athletes, even rodeo. Integrating sport specific training into rehabilitation will improve psychological readiness and confidence which is as important as physical recovery. We will also work with your athletic trainer or strength coach, if applicable, to ensure you transition back to training seamlessly.
VISIT our webpage dedicated to ACL topics HERE
Barber-Westin S, Noyes F. Factors used to determine return to unrestricted sports activities following anterior cruciate ligament reconstruction. Arthroscopy. 2011;27(12):1697-1705.
Ebert JR, Edwards P, Yi L, Joss B, et al. Strength and functional symmetry is associated with post-operative rehabilitation in patients following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2017 Sep 5.
Grindem H, Snyder-Mackler L, Moknes H et al. Simple decision rules can reduce re-injury by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study. Br J Sports Med. 2016;50:804-808.
Ithurburn M, Altenburger A, Thomas S, Hewitt T. Young athletes after ACL reconstruction with quadriceps strength asymmetry at the time of Return To Sport demonstrate reduced knee function 1 year later. Knee Surg Sports Traumatol Arthrosc. 2017;Sept 26(1320–1325):1-8
Kyritsis P, Bahr R, Landreau P, et al. Liklihood of ACL graft rupture: not meeting six clinical discharge criterior before return to sports is associated with a four times greater risk of re rupture. Br J Sports Med. 2016;50(15):946-51.
Logerstedt D, Grindem H, Lynch A, et al.Single legged hop tests as predictors of self-reported knee function after ACL reconstruction.Am J Sports Med.2012;Oct;40(10):2348-56
Sinacore JA, Evans AM, Lynch BN et al. Diagnostic accuracy of handheld dynamometry and 1 rep max tests for identifying meaningful quadriceps strength asymmetries. J Orthop Sports Phys Ther. 2017 Feb;47(2):97-107.