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ACL Rehabilitation: A Review of Current Treatment Approaches: Summary
CASE STUDY AND CLINICAL DECISION MAKING
A 16-year-old high school football player (junior in school) injured his knee while participating in a playoff game. The athlete injured the knee when he went to plant and made a cut, causing him to feel a pop in his knee with immediate pain. He was unable to continue to participate on the day of the injury. The subsequent office exam and imaging revealed a complete tear of the ACL along with a lateral meniscus tear. The athlete has undergone a surgical procedure consisting of ACL reconstruction with a patella tendon graft along with a lateral meniscus repair. The time frame of the surgery is in the middle of December, and the athlete also plays baseball.
Key considerations: • The patient's age and skeletal maturity • Graft choice (patellar tendon autograft in this case) • Concomitant lateral meniscus repair • Timing of surgery (mid-December) and its impact on return-to-sport timeline
• The fact that the athlete also plays baseball, requiring consideration of multiple sport demands A comprehensive approach to return-to-play decision making should be initiated and multiple factors should be considered, including: • Time from surgery (typically 9-12 months for full return to high-risk sports) • Achievement of functional test benchmarks • Sport-specific readiness • Psychological readiness Return-to-play decisions should be based on meeting functional criteria rather than solely on time from surgery. Key Learnings The course concludes by summarizing key take-home points: 1. Use a battery of tests for return-to-play assessment, including both objective and subjective measures 2. Include open tasks and reactive decision-making elements in return-to-play testing 3. Assess psychological readiness as a crucial component of return-to-sport decisions 4. Monitor workload throughout the return-to-sport transition 5. Implement and maintain neuromuscular training programs to reduce injury risk There is an ongoing need for clinicians to stay current with the evolving literature in ACL rehabilitation and to critically evaluate their practices. There is a need to encourage participants to implement evidence-based strategies to improve outcomes for their ACL reconstruction patients.
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