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ACL Rehabilitation: A Review of Current Treatment Approaches: Summary
Psychological Readiness and Subjective Measures One of the key themes throughout the course is the importance of psychological readiness in return-to-sport decision making. There is significant evidence that fear of re-injury is one of the primary reasons athletes do not return to their pre-injury level of sport participation. There are several subjective measures to assess psychological readiness and overall knee function: 1. International Knee Documentation Committee (IKDC) Subjective Knee Form : ○ Assesses symptoms, sports activities, and function ○ Provides a total score out of 100 2. ACL-Return to Sport after Injury (ACL-RSI) Scale : ○ 12-item questionnaire specifically designed to assess psychological readiness for return to sport after ACL reconstruction ○ Aim for a score of 90% or higher 3. Lysholm Knee Scoring Scale : ○ Assesses various aspects of knee function ○ Total score out of 100 4. Subjective Knee Score : ○ Adapted from Noyes, it covers pain, swelling, stability, and function ○ Total score out of 100, with 80-100 considered an excellent function Of these measures, the ACL-RSI scale is preferred due to its focus on psychological readiness and fear of re-injury. Even if an athlete performs well on objective functional tests, a low score on the ACL-RSI may indicate the need for additional time or interventions before Functional knee bracing after ACL reconstruction is a controversial topic. The current literature does not strongly support the use of functional bracing after isolated ACL reconstruction in terms of reducing re-injury risk . However, bracing may provide psychological benefits and may be considered in certain cases, particularly for the first year after surgery. A patient-specific approach to bracing is recommended, considering factors such as the type of sport, position played, and the athlete's comfort level. Post-operative Bracing : While it was once standard practice, many surgeons now opt for an early range of motion without a brace, depending on the specific procedure and any concomitant injuries. Blood flow restriction (BFR) training : BFR is an emerging technique in ACL rehabilitation. While promising, more research is needed to fully establish its role and optimal protocols. clearing them for a return to sport. Bracing and Other Considerations
LEARNING TIP! Some common deviations that clinicians should look for during 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 ○ Look for limb symmetry index (LSI) of at least 90% for quadriceps and hamstring strength ○ Consider the hamstring-to-quadriceps ratio, aiming for at least 60-70% 2. Functional Hop Tests : ○ Single hop for distance ○ Triple hop for distance ○ Cossover hop for distance ○ 6-meter timed hop ○ Aim for LSI of at least 90% on all hop tests 3. Y-Balance Test : ○ Assesses dynamic balance and neuromuscular control ○ Look for less than 4 cm difference in anterior reach between limbs ○ Aim for less than a 6 cm difference in posteromedial and posterolateral reach between limbs 4. Tuck Jump Assessment : ○ This evaluates neuromuscular control and landing mechanics ○ This is scored based on various technique flaws (knee and thigh, foot placement, and plyometric technique) observed during 10 seconds of continuous tuck jumps While these tests provide valuable objective data, they should be considered alongside other factors such as the quality of movement, sport-specific demands, and psychological readiness.
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