ACL Rehab: When Am I Ready?
ACL tear of the knee is one of the more common injuries we see in young athletes, in particular, young females. More often than not, patients elect to receive surgical intervention in order to return to their chosen sport, although there are in fact a very small percentage of athletes that can compete without an ACL. For those that do elect to receive surgery, fear of retear and reinjury tends to emerge as one of the biggest barriers that patients face when attempting to return to sports at their preinjury intensity level. This begs the question… When am I ready to compete?
Thankfully, through a combination of evidenced-based practice, objective measures, and clinical expertise, we can confidently and objectively tell you if and when you are ready to compete safely. There are highly specific criteria that we strive to meet regarding our patients’ capacity to perform. Through the arduous process of sport-specific physical therapy rehabilitation, constantly progressing, regressing, redirecting or modifying, we aim to meet an end-goal. This end-goal, or criteria, can help statistically determine if you are ready to return to high level sport participation, successfully and safely. And it is our job to get you there.
What is this highly specific criteria you ask? First we must look at residual symptoms. The patient must have no residual swelling post-op. The patient must also have no bouts of “buckling” or “giving out.” The patient must be vigilant in observing and reporting symptoms, as they are significant red flags for reinjury, incomplete rehab, or even unsuccessful surgery. Next, the patient must demonstrate at least 90% strength capacity in their quadriceps and hamstring strength in their surgical leg versus their non surgical leg. Utilizing our TindEquipmment Progressor tool, we can objectively and mathematically assess and monitor strength on post-op athletes. This is an excellent tool to take out the guesswork and give the athlete concrete evidence on the progress of their rehab.
Third, and arguably most important, the patient must pass a series of plyometric tests that assess his or her capacity for jumping, landing, stabilizing, absorbing shock, and cutting. These tests are backed by scientific research. Demonstrating an ability to successfully perform these tests will significantly lower your chance of re-injury. Finally, we utilize objective measures, or questionnaires if you will. Three important Objective measures available to us include the Global Rating Scale, IKD-2000, and KOS-ADLs. Reporting and interpreting certain scores can also help predict successful return-to-sport capacity.
Returning an athlete to successful competition is never as easy as assigning a series of exercises until they feel ready. It requires hard work and consistency on the patient’s behalf. On the physical therapist’s side, it requires a commitment to the latest scientific evidence, sound clinical reasoning, and excellent communication with the surgeon and coaches. These two factors combined optimize the patient’s chance of success, so they can feel confident knowing that they are ready to return to successful competition.
References:
Rudolph KS, Eastlack ME, Axe MJ, Snyder-Mackler L. 1998 Basmajian Student Award Paper. Movement patterns after anterior cruciate ligament injury: a comparison of patients who compensate well for the injury and those who require operative stabilization. J Electromyogr Kinesiol. 1998;8:349-362.
Manal TJ, Snyder-Mackler L. Practice guidelines for anterior cruciate ligament rehabilitation: a criterion based rehabilitation progression. Oper Tech Orthop. 1996;6:190-196.
Dr. Cody Benavides
Co-owner
PT, DPT, MFDc
