ACL injuries continue to be a hot topic in the sport world. A big reason is that even though they are still not very common, percentage wise, they have a large impact on long term joint health, recovery, cost and ability to return. As reconstruction techniques continue to evolve, athletes are able to return to play, but how successfully?
After surgery, the treatment consists of rehabilitation to regain motion, function, proprioception, strength and control. Once athletes have completed about 6-9 months of rehab, they return to sport. Here’s the sobering news, of those who suffer an ACL reconstruction, only 65% return to their pre-injury level of sport, with only 55% returning to competitive play. Even more discouraging is the fact that of those that return to sport, up to 1 in 5 will suffer a tear to their reconstructed knee, or the ACL on the non-reconstructed side.
In order to determine what risk factors existed, and ways to modify them, researchers looked at elite soccer players who had their ACL reconstructed and then followed them. They looked at the type of surgery they had, their rehabilitation process and their return to sport. What they discovered was that athletes who did not meet certain bench marks in rehab were 4 times more likely to have another ACL injury. The following shows the exercises and the discharge criteria that was deemed successful:
Discharge tests and criteria used during the study period
6 part return to sport tests with Discharge permitted when criteria was met
In addition to the tests above, athletes that had lower hamstring to quadriceps strength ratio were also more likely to injure their ACL. Since strong hamstrings act as an assistant to the ACL, weakness there can mean more stress on the ligament.
This study highlights a couple of key points when rehabilitating ACL injuries:
Kyritsis, P. et. al. (2016). Likelihood of ACL graft rupture: not meeting six clinical discharge criteria before return to sport is associated with a four times greater risk of rupture. British Journal of Sports Medicine, 50. http://bjsm.bmj.com/content/early/2016/05/23/bjsports-2015-095908.abstract
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*This site is for educational purposes only, it is not meant to diagnose, treat or replace medical advice. Before starting an exercise program always make sure that you are healthy and able to do so safely.*