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ACL Rehabilitation: A Review of Current Treatment Approaches: Summary
• Open kinetic chain exercises should begin in a limited range (90-45 degrees) and gradually progress to the full range as healing allows "ACL-friendly" position : This is approximately 20-30 degrees of knee flexion. This position minimizes stress on the ACL graft and can be used as a starting point for many exercises. Clinicians should address hip and core strength in ACL rehabilitation, as these muscle groups play a crucial role in lower extremity Neuromuscular training can be beneficial as part of the rehabilitation process and as a strategy for preventing future injuries. There is significant evidence supporting the use of neuromuscular training programs to reduce the risk of ACL injuries, particularly non-contact injuries. Key components of effective neuromuscular training programs include: 1. Plyometric exercises 2. Balance training 3. Strengthening exercises 4. Agility drills 5. Sport-specific movement patterns These programs should be performed at least 2-3 times per week and should be continued as a maintenance program, even after return to sport. Consistent implementation of such programs can reduce ACL injury risk by up to 50%. control and injury prevention. Neuromuscular Training and Injury Prevention Clinicians should be aware of the importance of proper landing mechanics. The tuck jump assessment can be used as a tool for evaluating neuromuscular control and identifying athletes who may be at higher risk for ACL injury. Return to Running Progression The course provides a detailed overview of a return to running progression, typically implemented around 3-4 months post-surgery. It outlines the following stages:
1. Straight-line running on a consistent surface (e.g., turf or track) 2. Curved running (e.g., around a track or field) 3. Acceleration/deceleration drills ("buildups") 4. Figure-8 running 5. Cutting drills 6. Sport-specific agility patterns It is crucial to monitor the athlete's response to each stage, including pain, swelling, and movement quality. It is not recommended to progress to the next stage until the athlete can complete the current stage without adverse effects. Endurance running (e.g., distance running) can typically be introduced around the figure-8 stage, assuming the athlete has progressed through the earlier stages without issues. LEARNING TIP! return to running program after ACL reconstruction may include lack of drive from hip flexors during early swing, weakness of hip abductors during stance, and tightness in hip adductors causing a scissoring pattern. Functional Testing for Return to Play A critical component of the course is the discussion of functional testing to assess readiness for return to play. There is no single test that is sufficient, and a battery of tests should be used to comprehensively evaluate the athlete. The course covers the following functional tests: 1. Isokinetic Strength Testing : ○ This is considered the gold standard for assessing quadriceps and hamstring strength Some common deviations that clinicians should look for during ○ Look for limb symmetry index (LSI) of at least 90% for quadriceps and hamstring strength
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