Return to Sport after ACL Reconstruction: Maximizing Function and Preventing Re-injury
One of the most important topics in ACL rehabilitation among physicians and physical therapists is the question of when to safely return the athlete to sport. A study published in The Journal of Orthopaedic and Sports Physical Therapy found that young athletes who return to sport before 9 months after ACL reconstruction have a re-injury rate seven times that of athletes who delay return to sports. To increase the chance of successful return to sport without re-injury following ACL reconstruction surgery, it is crucial that the athlete meets certain multi-factorial criteria before stepping back onto the field or court.
At the forefront of return to sport testing after ACL reconstruction is limb symmetry. Essentially, there should not be major differences in strength, range of motion, balance, or power production between the surgical and non-surgical limb. This is especially important for the quadriceps and hamstrings muscles. There are various ways to test this, including manual strength tests and assessment of jumping mechanics. The athlete should be able to demonstrate the ability to jump both vertically and horizontally on the surgical limb in a way that is comparable to the non-surgical limb.
Motor control involves the ability of the brain to send messages to the muscles to control body movements. Besides strength of the surgical limb, the ability to control the limb in sports-specific movements such as jumping, landing, cutting, pivoting, and running is crucial to safe return to sport. Physical therapists can work with the athlete to help re-train the motor control system to optimize movement. ACL injuries often occur when the knee twists during a pivoting movement or hyperextends during a landing. Working on motor control helps the athlete properly execute jumping and landing mechanics and decrease risk of re-injury.
Aside from meeting physical milestones, it is important that the athlete is mentally ready to return to sport. After surgery, it is not uncommon for athletes to experience a fear of movement. Physical therapists can utilize questionnaires to gage an athlete’s confidence in returning to sport, but it is also important that the athlete and medical professionals maintain open communication about the patient’s readiness to play.
Safe return of the athlete to sport should involve a collaborative effort between the athlete, surgeon, physical therapist, coaches, and athletic trainers. It is recommended that the athlete undergoes a sports-specific functional movement assessment to ensure that the athlete demonstrates proper strength, body mechanics, and motor control before returning to sport.
About the author
By Danielle Morency, PT, DPT, CSCS
Physical Therapist, Certified Strength and Conditioning Specialist
Midwest Orthopaedics at Rush