By: T. Sean Lynch MD, Brian J. Cole, MD, and Christopher S. Ahmad, MD
While anterior cruciate ligament (ACL)?reconstruction in injured athletes who?desire a return to cutting and pivoting?sports has become the standard of care,?consensus regarding criteria for return to?play is unfortunately lacking. The criteria?for return to play is heavily debated and?not as simple as following a timeline after?surgery. An athlete?s safe return requires?sophisticated assessment of strength,?endurance, and neuromuscular control.
Neuromuscular deficits are common?to those athletes who sustain an ACL?injury and undergo ACL reconstruction.?Data from the MOON ACL study group?suggests that ACL failure rates of the?contralateral and reconstructed knees are?both 3 percent at 2 years after surgery.?In a systematic review with a minimum?of 5-year follow-up after reconstruction,?this risk increases to 11.8 percent for the?contralateral knee and 5.8 percent for the?reconstructed knee.?As one would expect,?the outcomes after a second ACL injury?and subsequent ligament reconstruction?are far less favorable,?therefore, re-injury?prevention by minimizing neuromuscular?discrepancies should be the priority of the?rehabilitation course.
The pressures that an athlete might?experience from coaches, parents, and/or?teammates can further complicate the ideal?timing of return to sport. It is noteworthy?to physicians and therapists that research?indicates that only half of the athletes who?undergo reconstruction return to athletics?within the first year of surgery.?Sharing?this information and managing realistic?expectations with all stakeholders will?reduce ?return-to-play stress? and decrease?the chance of re-injury.
Criteria for return to sport is complex?and therefore no single test can determine?an athlete?s readiness to return. Our current?practice is to include a battery of clinical?measures that include: pain level, patient?s?confidence with their knee, range of?motion, core and lower extremity strength?and endurance, and patient-reported?outcome scores.
In addition to these measurements,?assessment of neuromuscular control?is essential to determine an athlete?s?preparedness to return to sport. This can?be evaluated with a specialized Functional?Sports Assessment that requires the athlete?to perform real game-like activities that?measure agility, endurance, strength,?and stability. Specific tests include: hop?tests, box jumps, as well as maneuvers?requiring lateral movement, acceleration,?and deceleration.
Midwest Orthopaedics at Rush (MOR) Rehabilitation Department now offers a new assessment tool to identify the functional sports level of an athlete who has undergone surgery and rehabilitation for an ACL injury. This test provides guidance for a safe return to sport and determines if further rehabilitation is needed.
This assessment is?videotaped and analyzed for ideal form?and deviations in lower extremity?alignment. Any deficiencies are then?corrected with guided rehabilitation?prior to return to play. When used in?conjunction with objective measures, we?feel that the Functional Sports Assessment?helps the physician and the therapist?determine the patient?s progress?and provides the athlete with?safest return to play?following ACL?reconstruction. Read more>>>
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