Reconstruction still remains to be the gold standard for ACL ruptures. However, the debate continues to whether this is necessary…
Felray S. 2019 states that the average long-term outcomes are similar following management of an ACL rupture with Rehabilitation alone or reconstruction with rehabilitation. Even with high quality rehabilitation and improved diagnostics, re-injury/graft rupture and new knee injuries remains high on return to sport (RTP) (Clare L. 2019; Mahapatra P. 2018; Onate J. 2019). Leaving us to question, are we providing the best rehabilitation for our patients?
The common key stages for rehab are:
- Restoring knee function
- Address psychological barriers
- Prevent re-injury/new injury and reduce risk of osteoarthritis
- Continue to optimise quality of life (Filbay S. 2019; Clare L. et al 2019). How an individual rates their quality of life will differ, from sedentary patients to elite athletes.
So… if quality of life differs between patients so should their rehabilitation. Individualising rehabilitation is important help them achieve their personal goals. For our elite athletes’ rehab should be as sport specific as possible and utilise visual-motor function, address multi-directional and multi-tasking drills (Onate J. 2019).
Over the years rehab has progressed from solely using a timeframe-based program to a criterion-based program (Filray S. 2019) Yes, we need to ensure enough time for biological healing, but promoting our patients to have the fastest RTP as possible. Recovery rates will vary from patient to patient, using a criterion-based programme allows both the clinician and patient to track their progress and ensure that they are ready to move onto the next phase.
Using a battery of RTP test can help provide a successful RTP. Including tests such as isokinetic quadricep and hamstring strength test, using LESS to assess landing biomechanics, four single leg hop tests, psychological readiness tests and on-pitch assessments (Onate J. 2019; Filray S. 2019).
Filray S. 2019 found if an athlete failed any of the return to play tests they were 38% more likely to sustain a new injury, compared to 6% of the athletes that passed, and 33% more likely to sustain and graft rupture, compared to 10% of those who passed.
What if surgery is the part of the treatment plan?
Surgery should never be a standalone modality. If surgery is part of the treatment plan there is a lot you can do. Before the surgery you should receive exercises-based physical therapy, building up the strength around the knee can lead to a big difference in recovery rate and post-surgery quality of life. Developing a good level of quadricep strength is a big contributor to a better recovery. Post-surgery, continuing with physical therapy with early mobilisation and muscle activation is imperative!
Take home notes:
- Reconstructive surgery can be subjective
- Rehabilitation should be specific to your patient
- Using a criteria-based program can utilise recovery
- Use a battery of RTP tests to ensure they’re ready
- Receive physical therapy pre- and post-surgery